MH  - Students, Health Occupations/*//
            MH  - Community Health Services/*/Pennsylvania
            MH  - Pennsylvania
            KW  - 20C
            CN  - Philadelphia Student Health Project
            CN  - Student Health Organization in Philadelphia
            CN  - United States. Division of Regional Medical Programs
            Ti  Philadelphia Student Health Project, summer 1968./G
            IM    [Bethesda, Md.]/Health Services and Mental Health Administration/[19691
            CO - vi, 133 p.
            GN  - Sponsored by the Student Health Organization in Philadelphia.
            GN  - Project supported in full by Contract no. 43-68-1533 with the Division of
                  Regional Medical Health Programs, Health Services and    Mental Health
                  Administration.
            CP    02NLM,01SSY:WA 546:AP4.2:P4S9p::1969
            CA    WA 546 AP4.2 P4S9p 1969:02NLM,Ol SSY
            Yl    S/1 969/
            LP    Eng
            LA    Eng
            MT    CORPORATE NAME MAIN ENTRY
            RO    O:MED
            RO    C:MED
            RO    M:NMC
            DA    710322
            LR  -780426
            EL  - FULL LEVEL
            IT  - MONOGRAPH
            Ul  -1255573


               PHILADELPHIA STUDENT HEALTH PKOJI=t;l summer iuoo


                                U.S. Department of Health, Education, and Welfare
                                                  Public Health Service
                                 Health Services and Mental Health Administration
                                        Division of Regional Medical Programs
                                         This project was supported in full by
                                               (Contract No. 43-68-1533)

                     This report does not necessarily represent the vieivs of the Ptiblic Health Service

                                                   PHILADELPHIA
                                      STUDENT HEALTH PROJECT
                                                             1968


                                                         FOREWORD

                               The reports included in this volume describe the variety of  experiences
                          available to health professional students during  the  summer  of  1968.  Al-
                          though some accounts of  activities  are  more  complete  than  others,  some
                          far more sophisticated than others, and many are naive,  the  impact  of  all
                          these experiences on the reader is profound.
                               Young professionals, at the threshold  of  their  careers,  have  had  a
                          real opportunity to observe the complexities and  inequities  of  our  health
                          and welfare delivery systems, and     to record their  impressions  of  these
                          experiences.
                               The interest expressed by Regional Medical Programs  in  service  deliv-
                          ery systems has been served well in that the  participants  were  enabled  to
                          observe at first hand the current problems in the delivery  of  services.  It
                          can be predicted that none of these students will be content, in the  future,
                          blindly to accept the status quo.

                               These students  have  worked  conscientiously  and  maturely  in  accom-
                          plishing their goals. I consider it a privilege to have been associated  with
                          them and with the Student Health Project, Philadelphia, 1968.

                          ROBERT L. LEOPOLD, M.D.,
                             Associate Professor of Clinical Psychiatry
                             and Director of Division of Community
                             Psychiatry, Department of Psychiatry,
                             University of Pennsylvania

                             Director, West Philadelphia   Community
                             Mental Health Consortium

                             Director, Student Health Organization


                                    Preface and Acknowledgments

                       The  Philadelphia  Student  Health  Organization   Summer   Health   Proj-
                  ect  wag  funded  by  the  Division  of  Regional  Medical  Programs  (Contract
                  #PH-43-68-1533),  and  the  work-scope  of  the  contract  indicated  that  the
                  purpose of the project was to collect information  relevant  to  the  following
                  categories:
                       1. Descriptions of new kinds of cooperative arrangements.
                       2. Descriptions  of  features  of  community   organizations;   how   they
                          facilitate and/or block attainment of RMP objectives.
                       3. Description of the health status of poor populations.
                       4. Evaluation of the present adequacy of health care programs.
                       5. Estimation of health attitudes of poor populations.
                       6. Descriptions  of  new  and  creative  methods  for  obtaining  informa-
                          tion relevant to the above questions.
                       This report is, therefore, primarily a response to the contractual  agree-
                  ment  with  the  Regional  Medical  Programs.  The  papers   of   the   project
                  workers are collected  in  sections  II  and  III  together  with  comments  by
                  the  research  directors,  Miss  Karen  Lynch  and  Mr.  Jon  Snodgrass.  These
                  sections are the core of the  report  and  contain  the  material  relevant  to
                  the stated purpose of the project.
                       Section  I  provides  some  background  information  to  help  orient  the
                  reader to the papers that follow. Section IV  presents  an  evaluation  of  the
                  educational and attitudinal impact. of  the  project  on  student  participants
                  as well as some general comments on  the  significance  of  the  project  as  a
                  whole.  The  various  research  instruments  designed  and  used  by  the   re-
                  searchers in obtaining  their  information  are  contained  in  the  appendixes
                  of Section V. A list of  the  projects  and  project  participants  appears  in
                  Section V also.
                       In  addition  to  Drs.  Richard  F.  Manegold  and  Herbert  0.  Mathewson
                  of  the  Division  of  Regional  Medical  Programs,   other   individuals   and
                  groups  who  were  instrumental  in  making  the  project  possible   are   the
                  following:  George  Silver,  M.D.,  Joseph  English,  M.D.,  Mrs.  Edna  Rostow
                  and Mrs.  Carol  Simons,  who  helped  with  negotiations  in  Washington  dur-
                  ing the winter and spring of  1968;  Leo  Molinaro,  I.  Milton  Karabell,  and
                  members of the  Board  of  Directors  of  the  West  Philadelphia  Corporation,
                  who  approved  the  arrangement  whereby   the   corporation   acted   as   the
                  grantee and official  administrator  of  the  funds  of  the  project;  Gaylord
                  P.  Harnwell,  who  was  instrumental  in  providing  for  use  of   University
                  of  Pennsylvania  funds  by  the  project,  later  to  be  reimbursed  by   the
                  government on presentation  of  vouchers;  and,  finally,  Robert  L.  Leopold,
                  M.D.,  and  almost  the  entire  staff  of  the  West  Philadelphia   Community
                  Mental  Health  Consortium,  on  whom  the   project   depended   for   counsel
                  and support throughout,  its  course,  beginning  in  the  fall  of  1967  when


                       organizational work began.  These  people  and  many  others-students,
                       school administrators, secretaries-helped with the many  little  steps
                       which ultimately lead to the project becoming a reality.
                           Patrick Storey, M.D., acted as liaison between the Division of Regiona
                       Medical Programs and the Philadelphia SHO's during the crucial  period
                       in May when agreement was essentially reached.
                           This Report was edited by Jon Snodgrass,  Karen  Lynch,  and  Paul
                       Frame.

                        iv


                                                       Table

                                                         of

                                                    Contents

                   FOREWORD, Robert H. Leopold, M. D       .     .........................
                   PREFACE AND ACKNOWLEDGMENTS                   ............................
                   SECTION 1. BACKGROUND TO THE PROJECT, Ron Blum            ...    ........
                   SECTION II. PROBLEM PAPERS, Karen Lynch               ............I......        3
                        Studeiit Health Organization in the Community        ............           3
                               Gray's Ferry, Summer 1968     .........................              4
                               1400 Block, South Taylor Street       .....................          8
                                                                                                    10
                               The Pocket            ........................................
                         Health-A Priority Item              ................................       12
                               Complex  Problems   in   Ludlow        ........................      13
                               Eastwick Survey Report            ............................       13
                               Report on Community Work With The Paschall           .......         15
                                Betterment League             .......................
                               Welfare Rights Organization   .........................              17
                         Community-"Establishment" Relations              ...................       18
                               Community Pharmacies in North-Central Philadelphia                   19
                               Philosophical  Conflicts  of  the   Temple   Community               20
                                Mental Health Center's Day Program           ................       21
                               The Saga of Fidel Cruz          ..............................
                               Presbyterian-University   of   Pennsylvania    Medical.              22
                                Center (I)           ........................................
                               Presbyterian-U-niversity   of   Pennsylvania   Medical
                                                                                                    27
                                Center (II)            ......................................
                         Student  Health  Organization,  and   Health   Professionals ......        33
                               The Unexplored: SHO Working in Poor White
                                 Communities   ........................      .........   ....       34
                               The  Effect  of  Inappropriate  Reinforcement   System.
                                 on  Program  Establishment:  A   Case   Study    ............      35
                               Professionals'  Values  and   Their   Consequence   on ........  .   39
                                 Serving Clients         ............................
                                                                                                    40
                               Eagleville           .........................................
                               Mantua and Mantua Community Planners (1)             ...........     41
                               Mantua   and   Mantua    Community    Planners    (II) ........      43
                                                                                                    45
                          Various   Mental   Health   Problems       .........................      45
                               Organizing Mental Health Services          ...........
                               Proposal:  Summer   Training   Program   for   Medical
                                                                                                    46
                                 School Students           ..................................

                                                                                                    v


                                  The Recreation Project for One Psychiatric Service:
                                    Two Points of View (I)        ...........................    47
                                  The Recreation Project for One Psychiatric Service:
                                    Two Points of View (II)   ...........................        49
                                  Horizon House   .....................................          50
                            Planning and Developing Programs           ......................    51
                                  Changing  Direction  at  Southwest  Center  City  Community
                                    Council: From Survey to Proposal       ..................    51
                                  What is  Public  Health?  (Delaware  County)    ............   56
                                  The Wee-Care Babysitting Service       ....................    60
                                  The Photography Club  at  St.  Christopher's    ............   62
                            Some Other Interesting Experiences         ......................    63
                                  Hawthorne-Viewed by a Staff Member, a Student,
                                    and  a   Community   Worker      .........................   63
                                  Teaching Sex Education Classes at Hartranft
                                    Community Corporation        ............................    65
                                  Preparing  a  Community  Health  Booklet  at
                                    Houston Community Center         ........................    67
                                  Working With Pernet Family Health Service        ..........    67
                                  Holmesburg Prison Project   ..........................         68
                                  Drama as a Means of Changing Health Professionals'
                                    Attitudes         .......................................    69
                                  Misericordia Hospital      ................................    69
                        SECTION  III.  PROJECT  WORKER  PERSONAL  CONTACTS,   Jon   Snodgrass    77
                                  St. Christopher's Child and Youth
                                    Comprehensive Care Center        ........................    78
                                  Spring Garden Community Center         ....................    82
                        SECTION  IV.  SHO'S  SHOW:  AN   EVALUATION   OF   THE   PHILADELPHIA
                          STUDENT HEALTH ORGANIZATION SUMMER PROJECT,
                          Jon Snodgrass    ...........................................           85
                                  Background Characteristics of the Health Science
                                    Students         ........................................    87
                                  Student Education        ..................................    93
                                  Students' Ideology       ..................................    95
                                  Attitude   Change       ...................................    96
                                  Student Accomplishments and Student Perceptions
                                    of Philadelphia Student Health Organization      ........    102
                                  Penn Medical Student and PSHO Medical Student
                                    Comparison    ......................................         104
                        SECTION V. APPENDIXES     ........................   I.............      113
                                  Appendix   1. Pre-Test Background Questionnaire      ......    113
                                  Appendix   2. Post-Test Background Questionnaire     ......    114
                                  Appendix   3. Attitude Scales    ..........................    117
                                  Appendix   4. Guidelines for Problem and Community
                                    Papers   ........................................    I ...   127
                                  Appendix   5. Personal Contacts     .......................    130
                                  Appendix   6. Project List: Project Sites and
                                    Participants  .....................................          131

                         vi


                                                   Section I

                                   BACKGROUND TO THE PROJECT

                                                    Ron   Blum

          The genesis  of  the  Student  Health  Organiza-   grant proposalg-modeled  after  the  other  proj-
         tio-ns in Philadelphia can be traced to  the  at-   ects, but  with  important  major  revisions  and
         tendance  at  the  Second  National  Assembly  of   alterations based on  the  experience  and  ideas
         the Student  Health  Organizations  held  in  New   of those on  the  steering  committee,  which  bv
         York in February 1967,  of  about  half  a  dozen   early winter  was  steadily  expanding  in  size.
         interested  medical  students  from  Philadelphia   At the same time proposals  were  being  written,
         In  1966  the  first  summer  project  was   con-   many  community  groups,  agencies,   and   indi-
         ducted in California aXid  two  medical  students   viduals  were  approached,  both  as  prospective
         from Philadelphia  participated.  After  the  New   project sites, and  in  some  cases  as  possible
         York  assembly,  citywide  meetings   were   held   financial resources. Committees  worked  also  in
         in Philadelphia, at which plans for  a  Philadel-   seeking  support  of  faculty  members  and   the
         phia  Student  Health  Organization   were   dis-   deans of the medical schools.
         cussed and the prospects  for  a  summer  project     The individuals  involved  in  setting  up  the
         in 1967  were  considered.  Though  this  project   Philadelphia  Summer  Project  1968  attend   the
         did not materialize, local activities did  begin,   six area schools of medicine  (one  osteopathic),
         as  the  SHO  philosophy  became   dispersed   to   several nursing  schools,  and  various  graduate
         the student -bodies. The  interest  generated  at   schools, representing a coordinated effort  that,
         some of the schools  waned  as  the  school  year   in itself, was an experience  in  interscholastic
         ended, but  several  more  students  from  Phila-   cooperation. The  project  was  designed  to  ex-
         delphia schools participated in  the  California,   pose health science students to  the  patient  as
         New  York,  and  Chicago   summer   projects   in   a  social  being.  At  35  community  and  agency
         1967.                                               project sites, 74 students,  21  community  work-
           During  the  summer  of  1967,  some   students   ers, and 20  high  school  interns  worked  under
         who  remained  in  Philadelphia  made   important   selected  preceptorg.  The  sites  were  predomi-
         inquiries  toward  establishing  a  summer  proj-   nantly  in  lower  socioeconomic  level  communi-
         ect,  and  promoted  with  increasing  enthusiasm   ties that included Caucasian,  Puerto-Rican,  and
         the considerations of such a  program  in  Phila-   Negro  slums.  Placements  were   selected   that
         delphia. In September 1967,  at  a  meeting  held   had potential to provide a  good  learning  expe-
         to  report  on  SHO  experiences,  an   unantici-   rience while offering students  opportunities  to
         pated surge  of  interest  forced  standing  room   develop  judgment  and  initiative  in  construt-
         only. Full efforts were  thereafter  directed  to   tive community  action.  The  freedom  to  direct
         establishing SHO  chapters  at  the  Philadelphia   their activities was left with the  project  fel-
         schools and directing full  strength  toward  or-   lows and the  preceptors.  Summer  project  staff
         ga,nizing  a  summer  project.  A  Student  Health  were oriented to support, not direct.
         Steering  Committee   evolved   that   made   the     The  philosophy   of   managing   the   student
         necessary  contacts   and   wrote   and   rewrote   health project might  best  be  refle@d  in  part
                                                                                                             1


             by a brief  consideration  of  the  roles  and  strue-   The  five  area  coordinators  were  each   responsi-
                                                                      ble  for  a  given  number  of  project  sites.  They
             tures involved:
                a.  The  project  fellow  was  a   health   science   met  the  workers  regularly  and  served   as   com-
             student in the  fields  of  medicine,  -nursing,  den-   munication channels to the  project  office  for  all
             tistry,  law,  social  work,  pharmacy,  or   psychol-   personnel.
             ogy. He worked for a 10-week period.                        Multiple  means  were  provided   by   the   proi-
                b.   Community   workers   were   individuals   who   !et  staff  for  workers  to  become   involved   and
             resided   in   the   immediate   community   of    the   Informed.   Weekly    meetings    were    held    for
             project  site  where  they   were   hired   to   work.   groups  of  12  to  14  people,  led  by   individual
             They  were  adults  working   shoulder   to   shoulder   'taff  members,  to  consider   problems   and   sub-
                                                                      jects of interest or  concern  to  the  group.  These
             with  students.  They  served  as  liaisons  with  the
                                                                      pr              portunity for worker
             community   and   now   remain   as   vital   contacts      ovided an op                         s at  diff6r-
             for continued community programs.                        ent  sites  to   share   experiences   and   exchange
                c.  Youth  interns  were   high   school   students   ideas.    Another    major     educational     aspect
             who   fit   similar   criteria   as   the    community   planned  by  the  staff  and  committees  of  project
             workers.   These   students   worked   closely    with   people   were   the   orientation,   the   midsummer,
             their  health   science   student   counterparts   and   and  the  final  conferences.   Also,   one   evening
             in  the  proIcess developed,  it  is  hoped,  an  inter- each  week  for  most  of  the  summer,   a   special
             est in health science careers.                           program  was  held  for  the   project   participants
                d.  The  project   site   was   the   organization,   and  friends,  bringing  in  speakers  and  films  on
             agency,  or  office  where  the  project  participants   pertinent local and    .general    issues.    Through-
             worked.   Health   science   students   were   allowed   out  the   summer   various   work   groups   evolved
             to indicate  preference  of  job  site,  and  disposi-   that  allowed  people  with  similar   interests   to
             tions  were  made  on  the  basis  of  request   when-   consider  action  in  such  areas  as  Summer   Proj-
             ever possible.                                           ect 1969,  admissions  of  blacks  into  health  sci-
                                                                      ence  professions,  the  SHO  Fourth   National   As-
                e.  The  preceptors   were   individuals,   usually   sembly, and other issues.
             professionals,   who   were   responsible   for    the      Biweekly  meetings  were  held  with  staff,   in-
             activities  of  the  project  workers  (a,  b,  c)  at   terested   project   workers,   and   the    advisory
             that  site.  They  met  with  the  workers   regularly   council, the  latter  consisting  of  four  Philadel-
             to  provide  guidance  and   assistance   if   needed.   phia  professionals:  two  physicians,  one  in  city
                f.  The  summer  project   staff   included   three   government,  and  one   in   medical   education,   a
             student  directors,  five   area   coordinators,   two   full-time   community   organizer   and    a    group
             research directors, two office  staff,  and  a  physi-   trainer.   Policy   decisions   were   reviewed   and
             cian project director.                                   made  at  these  meetings.  The  staff   met   weekly
                The  part-time  project  director   is   affiliated   also  with  training  consultants  who  assisted   in
             with   the   West   Philadelphia   Community    Mental   developing  leadership  skills  and  an   understand-
             Health  Consortium,  a  subsidiary  of  the   grantee,   ing of group processes.
             the   West   Philadelphia   Corporation.   The   proj-      The  goal  of  the   extensive   programming   for
             ect  director  is  also  on  the  faculty  of  one  of   and  by  the  staff  and  project   workers   was   a
             the  medical   schools.   He   advised   the   student   total   involvement   experience.   Individuals   had
             directors  in  overseeing  the  entire  project.   The   the  opportunity  to  pursue  any  area  of  interest
             student  director   was   responsible   for   adminis-   as it related  to  community  health  and  their  own
             trative  duties  and  organizational   liaisons.   The   education.  The  results  of  their  involvement   in
             two   associate    directors    coordinated    project   the student health project are  reflected,  in  part,
             sites and the  educational  aspects  of  the  project.   in the following pages.

             2


                                               Section 11

                                          PROBLEM PAPERS

                                                 Karen Lynch

                                                Introduction

         Since the Student Health Organization's  pat-   other topics. They  should  be  read  as  cases
       tern of sponsoring  summer  projects  and  pub-   which  present  problems   and   possible   ap-
       lishing reports of the projects seemed  on  the   proaches to solving them.
       verge of becoming an inviolable  tradition  de-
       spite SHO's resistance to adopting  routinized,    STUDENT HEALTH ORGANIZATION IN
       institutionalized  activities,   the   attempt   was           THE COMMUNITY
       made  to  orient  the  reports  of  the  sites  away
       from a  narrative  "this-is-my-summer"  account   What  Happens  When  SHO   Workers   Step   In?
       toward  a  more  critical  isgue-oriented   examina- At  25  of  37  sites,  approximately  80  project
       tion of the health care delivery system.          workers   were   cooperating   with   local   commu-
         Thus, early in  the  summer  a  brief  outline  of nity  groups,  some  digrags-rootst'  organizations,
       plans  and  expectations  about   the   summer   was some  settlement  houses,  and  some   other   types
       collected  from  all  the  project  workers.   These of organizations.
       reports were then  used  to  distribute  three  dif- With  all   of   these   organizations   the   SHO
       ferent  guidelines  for  problem  papers   and   one workers   were   planning   with    the    community
       guideline   for   describing   local    communities. to do  a  variety  of  things.  With  Pernet  Family
       These  forms  are  included  in  appendix  4.   Each Health    Service,    Spring    Garden     Community
       site was different and I  ran  the  risk  of  asking Services   Center,   and   Young   Great    Society,
       irrelevant questions of a site's activities.      SHO  workers  were   ,   directly   meeting   health
         Yet the  resulting  articles  present  a  critical needs.  At  other  sites,  for  example,  Hawthorne,
       point of view  on  a  number  of  issues  which  the Ludlow,   and   Hartr'.anft,   SHO   workers    were
       .project  workers   experienced   first   hand.   In serving  their  communities  directly  by   sponsor-
       future  projects  this  approach  may  be  used   in ing recreational  activities  and  leading  classes.
       a  more'directed  way,  asking  specific   questions Others,     among     them     Fairmount,     "The
       about   specific   problems.   This   summer,   how- Pocket"  and  Taylor  Street  projects  of   Univer-
       ever, such  an  approach  would  have  been  totally sity  Settlements,  and  Gray's  Ferry,  were  help-
       at odds with  the  philosophy  of  the  Philadelphia ing   communities   attack   environmental    health
       project.                                          problems or community needs.
         The  articles   which   follow   concern   experi- Others  were  identifying  problems  in   such   a
       ences  with  community  groups,  health   and   non- way  that  other  organizations,  political  bodies,
       health   agencies,   attempt   to   solve    various public   agencies,   and   planning   boards   would
       health and   environmental   problems   and    many become  aware  of  them.  SHO   workers   at   Dela-

                                                                                                       3


                ware  County's   Citizens   for   Better   Public   yet  even  high  motivation  cannot  be  sustained
                Health,    Eastwick    Community    Organization,   without   cooperation   where   communities   need
                Welfare  Rights  Organization,  North  City  Con-   the assistance of, for  instance,  the  Sanitation
                gress,  and  Southwest  Center   City   Community   Department,  the  Housing  Authority,   or   other
                Council were working on these problems.             agencies. Bill  Robinson  saw  this  in  his  work
                Still others were  setting  up  or  planning  for   with  Taylor  Street   residents.   The   environ-
                programs.   SHO   workers   at   Mantua    Commu-   mental problems there  could  not  be  effectively
                nity Planners,  Citizens  Concerned  for  Welfare   solved without the help  of  the  City  Sanitation
                Rights,   CEPA    (Consumers'    Education    and   Department.
                Protective   Association),   Houston    Community   Perhaps  Art  Pressman  found  one  of   the   so-
                Center,  and  Spruce  Hill   Community   Associa-   lutions to inaction: as an outsider  he  aimed  at
                tion  were  involved  in  designing  and  getting   personal vested interests of  residents  in  order
                programs started.                                   to build interest  in  Clean-Up  Day  at  the  Tot
                In  short,  SHO   was   working   with   a   wide   Lot and interest in  preparing  a  house  for  the
                variety of community  groups  this  summer  in  a   nursery school.
                vast range of activities.                           All  three  of  these  projects  were   confronted
                Out  of  these  experiences  a  number  of   dif-   with  the  problem  of  working  with  their  com-
                ferent  issued  were  raised.  Similar  questions   munities  rather  than  working  for   them.   The
                were asked  in  different  situations.  The  most   project workers built on  issues  which  the  com-
                prevalent were these: How can SHO    Iwork     ef-  munities  wanted  to  work  on   and   on   issues
                fectively with  local  communities'?  Why  aren't   which personally affected the residents. It  calls
                health problems priority  issues  in  these  com-   for a great deal  of  sensitive  probing  and  for
                munities? What  can  be  done  to  improve  rela-   identification  by  workers  with  the  community.
                tionships between local  communities  and  health   Looking at these three  accounts  of  attempts  to
                institutions and health professionals?              work  with  communities  with  an  eye   for   the
                The three papers in  this  section  describe  at-   approach to  problems  at  each  site  will  point
                tempts  to  work  with  local  communities.   The   out the successes  related  to  working  with  the
                four papers in  the  next  section  describe  at-   communities and  the  failures  related  to  work-
                tempts to identify health issues in  communities,   ing without them.
                the  problems  involved   and   the   explanation
                for the apparent  unimportance  of  health  prob-          Gray 's Ferry, Summer 1968
                lems.
                The project workers in Gray's Ferry,           on      Richard Bonano and Rhoda Halperin
                Taylor  Street  and  in  "the  Pocket"  were  all
                confronted  with  similar  problems.  There  were     To those who do not  live  there,  Gray's  Ferry
                obvious  improvements   which   the   communities   is a community  located  1.5  miles  southwest  of
                wanted,  but  action  depended  on  the  approach   City Hall. It is clearly defined and cut off  from
                the project workers and  others  made.  As  Rich-   the  rest  of  Philadelphia  by   the   Schuylkill
                ard Bonano and Rhoda Halperin      observed    as   River on  the  north,  west,  and  southwest,  the
                they  worked  in  Gray's  Ferry,  an  independent   railroad highline on 25th Street to the cast,  and
                survey team failed in  their  community  to  make   Morris Street,  to  the  south.  The  presence  of
                use of informal ways of gaining  access  to  com-   these  natural  boundaries  provides  one  with  a
                munity residents. They  also  noticed  that  com-   sense of physical enclosure  and  thus  unity.  In
                munity fears  and  distrust  keep  some  families   reality,  Gray's  Ferry  exists  as  many  social,
                from cooperating  with  other  families  even  on   economic,  racial,  religious,  and  ethnic  frag-
                the same block.                                     ments.  Each  group  has  @  own   way   of   per-
                 Action  also  depended  on  the  spirit  of  the   ceiving  things,  and  its  own   way   of   doing
                community  to  move.  The  contrast  they   found   things. In this  sense,  Gray'g  Ferry  is  not  a
                between  the  white  community  of  Gray's  Ferry   single community.
                and the  black  community  of  Gray's  Ferry  are     While geographical  factors  act  to  unify  the
                clear examples of  the  consequences  of  motiva-   community  on  the  one   hand,   geography   con-
                tion'and lack of motivation.                        tributes  to  the  fragmentation  of  the   Gray's

                '4


         Ferry  area.  Wharton  Street,  which  runs   east-    An  additional  element  in   the   Gray's   Ferry
         west,  is  viewed  by  many  members  of  the  com-   situation  is  University  Settlements.  The   Com-
         munity  as  a  barrier  which  cannot  be   crossed   munity   Council   originally    contracted    with
         from  the  south  side   by   whites,   and   which   University  Settlements  for  social  -workers   to
         should not, although it is,  be  crossed  from  the   explain  the  renewal  plan  to  the  people  north
         north side  by  the  blacks.  The  black  community   of  Wharton  Street.  The  hope  of   the   council
         is referred to  as  that  area  "north  of  Wharton   was that this  would  serve  to  gain  the  support
         Street."                                              of the  black  community  for  the  plan.  Instead,
          The  people  in   the   white   community   "south   the   black   community   has   begun   to   become
         of Wharton  Street,"  are  primarily  of  Irish  or   aware of the reality that  their  homes  have  been
         Italian descent. Some of  the  older  citizens  can   scheduled for  renewal.  This  means,  in  essence,
         barely speak  English;  some  families  have  lived   black removal. As a result of  the  realization  of
         in  Gray's  Ferry  for  six  or  seven  generations   the  plan's  inequalities  for  the  black   commu-
         and would  never  consider  living  anywhere  else.   nity,  the  people  north  of  Wharton  Street  are
         Some  members  of  the  younger  generation,  older   beginning  to  mobilize  themselves   against   it.
         teenagers primarily, cannot  wait  to  get  out  of   The  black  leadership  has  taken   the   position
         Gray's Ferry. Practically  all  the  residents  are   that if the  redevelopment  plan  does  not  change
         Catholics; most belong  to  St.  Gabriel's  Parish.   to  accommodate  their  wishes,   the   plan   must
         The Church is a highly  influential  force  in  the   be thrown  out.  This  has  created  a  great  deal
         community.  Most  of   the   working   people   are   of  friction  in  the  community  and  the   Commu-
         employed in  the  surrounding  factories  as  weld-   nity Council has for the  first  time  been  forced
         ers, placeworkers,  etc.  There  are  a  few  small   to  take  the  demands  of  a  semiorganized  black
         businesses owned by  the  residents  of  the  area.   community into account.
         Their proprietors are often looked  to  for  advice     The  problem  of  redevelopment,  and  the   gen@
         or funds  for  the  few  community  projects.  Some   eral situation in Gray's  Ferry  has  been  exacer-
         families own three and  four  houses  on  a  block-   bated by the  requirement  for  a  diagnostic  gur-
         These  people  consider   themselves   better   off   vey  of   the   community's   needs.   Transeentury
         than  the  majority  of  people  in  Gray'g  Ferry.   Corporation  has  been  contracted  with   by   the
         One lady  told  us  that  the  reason  people  kept   Community  Council  first,  to  conduct   a   diag-
         this  property   was   "to   keep   the   community   nostic social survey  in  Gray's  Ferry,  and  sec-
         nice." What she really  meant  was  that  the  peo-   ond,  to  relate  to  the   community's   immediate
         ple wanted  to  keep  the  blacks  and  other  "un-   needs. Because of the  position  it  has  taken  as
         desirables out." "Right  behind  this  block,"  she   an  establishment  organization,  and  because   of
         said,  "is  a  family  who  live  like  pigs."  The   a  series  of  blunders,  Transeentury   has   been
         white community itself, is by  no  means  a  single   unable to gain  the  support  of  the  black  corn-
         social, economic, or cultural milieu.                 munity.  That   is,   the   black   community   has
          The  Gray's  Ferry  Community   Council   is   the   barred  the  surveyors  from  their  homes.  Trans-
         official  representative  structure  of   community   century  has  relied  upon  the  formal  structure,
         organization.   The   total   membership   on   the   the  Community   Council,   without   taking   into
         council includes  some  400  citizens.  The  Execu-   account   many   informal   structures.   For   ex-
         tive  Committee,  however,  is  the   main   policy   ample,  Transcentury  hag   set   up   a   referral
         making  body.  It  is  composed   of   businessmen,   service  without  taking  into  account  the   fact
         most of the  religious  leaders  in  the  community   that  such  a  service  exists  in  the  community.
         and residents, a few of whom are black.               Transcentury's major fault has  been  that  it  has
           The  Community   Council   has   primarily   been   tried  to  impose   itself   upon   the   community
         concerned with the urban renewal and          rede-   rather  than  to  work   with   community   people.
         velopment  which  has  been  planned   for   Gray's   Transcentury has set  up  a  series  of  topics  to
         Ferry.  A  full-time   Community   Relations   Rep-   be surveyed. Some  of  these  are  health,  employ-
         resentative   of   the   Redevelopment    Authority   ment, and recreation'     Education,   specifically
         works  with  the  Community  Council.   The   Coun-   the issue of  the  building  of  a  new  school  in
         Cil claims to represent  the  entire  Gray's  Ferry   what  the  community  considers  to  be  a  danger-
         community on the redevelopment issue.                 ous industrial  area,  is  of  primary  concern  to

                                                                                                                 5


                the people in Gray's  Ferry.  Yet,  the  survey  has   children walking through the Italian section.
                no  section  to  deal  with  educational   problems.   That   people   are   primarily    concerned    about
                Since  Transcentury  has   been   unable   to   gain   what immediately  and  directly  affects  or  threat-
                the  support  of  the  black  community  in   carry-   ens them is particularly  evident  in  the  field  of
                ing  out  the  survey,  additional  tension  between   health.  Most   people   in   the   white   community
                the   Redevelopment   Authority   and   the    black   have  their  own  private  physicians.   When   asked
                community  has  grown  up.  Action  to  the  benefit   about  health  problems  in   the   community,   they
                of  the  community  has  been  f   urther   delayed.   usually  told  us  about  a  relative  who  had  been
                In  progress  now  are  negotiations   between   the   sick recently. Similarly, the  doctors  in  the  com-
                various parties involved.  The  issues  have  by  no   munity  were  only  concerned  with   their   private
                means been settled.                                    patients.   When   asked   about   community   health
                It  is  in  the  context  of  this  tense  situation   problems, responses were: "Well, I can    tell    you
                that  some  of  the  problems   of   community   or-   right now mumps are goin    , around,"    Or,    "The
                ganization   and   community    action    must    be   problems are not here.  They  are  in  the  clinics."
                viewed.                                                 Our  job  now   was   to   find   an   issue   which
                Our   decision   had   been   to   concentrate   our   would  have  a  direct,   immediate,   and   positive
                efforts  primarily  in  the  white  community.  How-   impact  upon  at  least  a  f  ew  people  in  Gray's
                ever, we soon  discovered  that  this  presented  us   Ferry.  We  learned  that  the  residents   of   Earp
                with   many   unanticipated   problems.   The   most   Street,  a  small  street  between  27th   and   28th
                striking of these  is  the  prevailing  attitude  in   Streets, had participated  in  a  series  of  organi-
                the  white  community   towards   change   and   im-   zational  meetings  to  discuss  plans  for  building
                provement.   For   example,   a   pharmacist    told   a play  area  on  a  vacant  lot  on  the  block.  At
                us that  it  would  be  impossible  to   organize   a  one time,  we  were  told,  the  residents  had  been
                group of  people  on  a  given  block  to  do  some-   quite   enthusiastic   about   this   project.   Now,
                thing about  a  particular  issue  because  "no  one   for  a  number  of  reasons,   interest   had   waned
                cared."   He   agreed   that    conditions    needed   and  the  various  authorities  involved  were  under
                changing,  but  was  certain  that,  in  fact,.there   the  impression  that  the  people  were  no   longer
                was   little   or   no   chance   of    implementing   interested  in  obtaining  a   Tot   Lot   from   the
                change.  He  was  not  pleased   with   the   status   city.
                quo; he merely  accepted  it  and  the  problems  it     It  seemed  only  logical  to  us,  however,   that
                presented to him  on  a  day  to  day  basis.  "Peo-   parents  would  rather  have  their   children   play
                ple  here  are  lazy,"  he  said.  He  gave  ug  the   on grass than in the dirty  streets.  Since  interest
                impression  that  a  definite  inertia  existed   in   in  the  project  had  been  quite   substantial   at
                Gray's  Ferry.  People  are   prone   to   complain,   one  time,  why  would  it   not   be   possible   to
                but  do  not  move  to  act.  In  this  sense,  they   revitalize  the  initial  enthusiasm?  We  were  soon
                seem to accept.their fate as it is.                    to see  why  there  would  be  no  Tot  Lot  on  Earp
                 An  Italian   woman   expressed   concern   to   us   Street.
                about  the  plans  for  a  new  elementary   school.     It soon became  evident  that  there,  too,  people
                Her  concern,  however,  was  based  on   the   fear   were willing to  act  in  their  own  self  interest,
                that her house might  be  taken  in  order  for  the   and only  in  their  own  self  interest.  One  woman
                school  to  be  constructed.  The  white  people  in   said,  "Why  should  I  give  my   time   and   money
                the southeast section  of  Gray's  Ferry,  in  fact,   when  Mrs.  X  across  the  street  will   not.   Her
                have  formed  a  separate  community  council.   The   children will play on the  lot  the  same  as  mine."
                purpose  of  this  organization  is  to  oppose  the   Another  great  concern  was   connected   with   how
                building  of  the  school  in  their   neighborhood.   the  residents  of  Earp  Street  would  be  able  to
                This  woman  wants  the  school  to   remain   where   prevent  the  children  from  "over   there,"   mean-
                it  is.  "That  school  has  been  there  for  years   ing the  black  children  from  across  28th  Street,
                and years," she  said.  The  school  she  is  refer-   from  using  their  play  lot.  There  seemed  to  be
                ring  to  is  the  Benson  Elementary  School  which   no understanding  or  acceptance  of  the  idea  that
                was  built  in  1888.  Now   it   serves   primarily   action  which  would  be  in  the  interest  of   the
                black children. The  presence  of  a  public  school   entire  community  would  also  benefit   one's   own
                in  this  neighborhood   would   necessitate   black   self interest.

                6


           In  fact,  to  the  people  on  Earp  Street,  the   Recreation,  by  avoiding  it  completely.  A  group
        use of the lot  by  "outsiders"  posed  a  threat  to   of black youths  rented  a  garage  to  house  their
        them,  What  would  they  do  if  a  fight   occurred   own  recreation  center.  They  are  very  concerned
        on the lot?  Who  would  be  responsible  for  break-   about doing constructive things for  "the  f  ellas"
        ing  it  up?  Who  would  be  responsible  for  keep-   who  have  nothing  to  do  in  the  evenings.  They
        ing it clean? The  fact  that  the  city  would  pro-   are  not  afraid  to  attack   monumental   problems
        vide the  facilities  if  the  residents  would  take   with  imaginative  solutions.   A   group   of   the
        on some responsibilities  for  taking  care  of  them   teenagers  set  up  a  film   program   which   they
        was  incidental.  The  people  wanted  the   authori-   run  themselves.  In  addition   to   securing   the
        ties to  take  care  of  everything,  or  nothing  at   films, this project involved  printing  leaflets  to
        all.                                                    advertise  the  program,  obtaining  chairs  from  a
           The Tot  Lot  was  voted  down  by  the  residents   church,  and  selling  refreshments   to   replenish
        of  Earp  Street.  Given  the  racial  situation  and   f und5. People in  the  black  community  have  also
        the  attitudes  of   the   people   towards   change,   realized that the  so-called  establishment  can  be
        positive action was virtually impossible.               used  to  their  own  advantages.  In  direct   con-
           At the  Vare  Recreation  Center,  located  in  an   trast  to  the  inaction  of  the  people  on   Earp
        Italian  neighborhood,  we  were   to   see   an   n-   Street,  a  group  of  black  residents,  after  one
        stance  in  which  people  will  move  to   eliminate   meeting  with  the  people   from   the   Department
        that  which  is  negative  or  detrimental  to  them,   of  Licenses  and  Inspection,  began   to   collect
        but  will  not  tax  their  energies  to  create  the   money  for  their  play  lot.  Children   from   the
        positive.  Programs   at   Vare   are   designed   to   area   were   consulted   with   regard   to    what
        keep kids  off  the  streets,  not  to  provide  new,   equipment would be put on the lot.
        er 'eative activities. The  staff  hired  by  the  De-    On  a  somewhat   larger   scale,   the   communi-
        partment  of   Recreation   run   everything.   Those   ty's  desire  to  move  on  its  own  is  manifested
        in charge find sufficient gratification  in  contain-   in  the  formation  of  the  King's  Village   Asso-
        ing the youths within the  confines  of  the  recrea-   ciation  in  a  section  north  of  Wharton  Street.
        tion center. It  is  great  for  rough  teenage  boys   This  group  has  helped  to  stir  people  out   of
        to sit and  play  cards  all  day.  This  keeps  them   their   apathy   towards   accomplishing    meaning-
        out of trouble.                                         ful social change.
           We  have  sensed  a  different  attitude   towards     These  attitudes  toward   change   have   largely
        change  among   many   of   the   black   people   we   determined  the  course  of  our  action  in  Gray's
        have   met.   Although   they   are   not   militant,   Ferry.  We  had   originally   been   contacted   by
        many  clearly  have  decided  that   certain   things   the   Community   Council    to    strengthen    the
        will  not  be   accomplished   in   their   community   Health  and  Welfare  Committee,   with   the   hope
        unless  they  do  it  themselves.   They   will   not   of  eventually  getting  up  a  heaJth   center   in
        accept   the   premise   that   "the   establishment"   Gray's  Ferry.  We  soon  learned,   however,   that
        will do it  for  them.  In  f  act,  they  have  come   to  strengthen  the   Health   and   Welfare   Corn-
        to distrust establishment organizations.                mittee was  impossible  on  several  counts.  First,
           A  segment  of  the   black   community   success-   this committee did  not  exist  as  a  f  unctioning
        fully organized  and  carried  out  a  clean-up  cam-   body. It  hardly  even  existed  on  paper.  Second,
        paign in  the  area  north  of  Wharton  Street.  The   the  community   had   other   priorities.   Because
        designated   purpose   of   this   effort   was   not   the  people  were  concerned   about   their   homes
        simply  to  clean  the  street,  but  to  develop   a   being   demolished   by   the   Redevelopment    Au-
        sense  of  unity  among  the  people   and   to   get   thority, there was little interest  in  establishing
        people  together  for  the  purpose  of   confronting   such a committee.
        the,egtablishment.  The  press  was  there  to   wit-     We  then   discovered   that,   although   recrea-
        ness and  report  that  these  citizens  had  cleaned   tion  was  not  such  an  urgent  concern  as  urban
        the streets  and  were  in  the  process  of  sending   renewal, it did represent  a  concern  of  the  com-
        the  city  the  bill  for  the  job  the   Sanitation   munity  which  held  higher  priority  than  health.
        Department was supposed to have done.                   Our  task  was  to  find  someone  or  some  organi-
           The  youth  of  the  community  dealt   with   the   zation  in  the  community  with  which   to   work.
        establishment,  in  this  case,  the  Department   of   Fortunately  we  have  been  able  to  work  with  a
                                                                                                                   7


              black  woman  who  is  probably  the  person   most        1400 Block, South Taylor Street
              concerned  about  the  activities   of   the   com-
              munity's  youth.  Her  activities  reach  far   be-                   Bill Robinson
              yond  her  responsibilities  as  director  of   the
              Summer  Urban  Day   Camp.   One   of   her   chief      The 1400 block  of  South  Taylor  Street  is  A
              concerns  has  been  lack  of  indoor  space  which   single  block  in  South  Philadelphia.  The  resi-
              is essential for  carrying  out  a  winter  program   dents are  all  black  and  generally  of  low  in-
              of any sort.                                          come.  Most  houses   are   rented.   Approximately
                We became aware of the urgency of th           is   five  to  seven  are  owned  by   residents.   Five
              need, and realized that  the  city  agencies  could   houses in the  block  are  vacant.  The  street  is
              not be relied upon to f urnish this  space  in  any   very  narrow.  The  residents  have  a  large  num-
              reasonable  amount   of   time.   With   the   com-   ber of teenage and pre-teenage children.
              munity  people  we  began  to   investigate   other   Sei-t7ices to the Sti-eet
              ways to obtain space and facilities.
                We  were  fortunate  enough  to  be   given   the      There  is  no  public   transportation   through
                                                                    Tavlor Street or on adjacent  streets,  but  it  is
              name of  a  socially  minded  architect  who  Would
                                                                    iairiv accessible to residents.
              work  with  the  community  people.  He   willingly
              offered his services in  drawing  up  plans  for  a      Shopping  and  schools  are  also  not   immedi-
              cost estimate on a new  center  for  Gray's  Ferry-   ately available, but they  are  accessible  without
              Our idea is to take his  plans  to  private  indus-   major inconvenience.
              try with the hope of  finding  a  sponsor  for  the      Rubbish and  trash  are  collected  once  weekly
              project.                                              on   Monday   (usually   in   the   morning).   The
                                                                    major problem  for  residents  is  the  failure  of
                In  the  meantime,  we  have  obtained  a  vacant   city  workers  to  clean  alleys   of   trash   and
              building  on  the  corner  of  30th   and   Wharton   garbage.
              Streets  to  house  the  Gray's   Ferry   Workshop,
              as it will be called, on a  temporary  basis.  Evi-      Police protection is adequate,  at  best.  Resi-
              dence  of  community  support  for   this   project   dents generally do not  hold  police  in  high  re-
              has  taken   many   forms.   One   businessman   in   gard. Police are  slow  to  respond  to  residents'
              the community  has  donated  a  kiln  for  ceramics   calls.
              and paid  for  the  first  month'g  rent.  A  group      Recreation  is   another   major   problem   for
              of youth  have  planned  a  paint  party  and  gen-   concern  of  residents.  A  public  square  is  ap-
              eral  fix-up  weekend.   Attendance   at   planning   proximately  one  block  away  but   parents   feel
              meetings has been extremely good.                     the area is not safe for  their  children.  Parents
                Our  aim  with  this  project,  from  the  begin-   have tried  unsuccessfully  to  get  a  vacant  lot
              ning has been to  help  the  community  set  things   .  the block converted  to  a  Tot  Lot.  No  other
              up in such a way that  they  would  in  no  way  be   facilities are  available.  Children  play  in  the
              dependent  upon  us  for  the  project's   continu-   street.
              ance. We  have  tried  to  act  as  a  stimulus  to      Residents have little  concern  for  the  health
              the  people  so  that  they  would  respond  in  an   care  system.  They  prefer   to   concentrate   on
              active  way  to  their  own  needs.  Now  they  are   realities  of:  (1)  No  play  area  for  children;
              beginning  to  become  aware   of   and   use   re-   (2) danger   .of traffic to  children  playing  in'
              sources outside of Gray's Ferry.                      street; (3) fire hazard  from  -  children  playing
                We believe that any project  of  this  sort  must   in open vacant  houses;  (4)  rats  in  homes;  and
              be initiated, planned, and carried  out  by  people   (5) trash accumulating in alleys.
              from  the  community.  Outsiders,  like  ourselves,      The  major  community  health  problems  is  the
              can be  most  effective  as  advisors  and  as  re-   social well-being  of  the  block.residents.  Prob-
              source people.  To  go  to  a  community  with  the   lems  associated  with   their   environment   have
              idea of doing  things  for  and  to  the  community   been  under  primary   consideration.   In   'light
              rather  than  with  the   community   would   prob-   of this, the Taylor  Street  Residents  Association
              ably prove to  be  highly  detrimental  and  possi-   has  been  working  on  all  of  the  problems  de-
              bly disastrous.                                       scribed above.

              8


            When  the  people  of  the  block  have  decided   to   day,  it  has  a   high   degree   of   car   and   truck
            act on  a  problem,  they:  (1)  Decide  on  a  chan-   traffic.  This  presents  an  obvious   danger   to   the
            nel for action; (2) contact city  official  or  other   large   number   of   children   who    play    in    the
            power  and  register  complaint   by   phone   and/or   street.   They   attempted   'to   get   signs    reading
            letter;  (3)  repeat  action  if  needed;  (4)   con-   "No   Through   Trucks"   and    "Slow,    Watch    Chil-
            tact  Congressman   William   Barrett   for   assist-   dren."
            ance for  the  city  related  problem;  (5)  consider    The   presence   of   five   vacant   houses   in    the
            other actions if needed.                                block   has   caused   more   concern   for   the   resi-
            Environmental Problems                                  dents.   They   had   become   depositories   for   trash
                                                                    and   garbage   'for   people   from   other    neighbor-
            The central movement      of   the   Taylor    Street   hoods,   and   thus   havens   for   rats.    But    more
            Residents  Association  was   a   multi-faceted   at-   important   to   the   residents,    they    were    open
            tack  on   problems   associated   with   their   en-   invitations   for   children   playing   with    matches.
            vironment.  From   the   health   standpoint,   their   Many   fires   had   resulted    in    previous    months
            aim  wag  to  improve  their  own  social  well-being   and years.
            by  acting  on  their   own   community.   This   was     This   problem   was   presented    by    letter    and
            the  position  presented  to  me  by  the   residents   phone  calls  to  Mr.  S.  at   the   Complaint   Depart-
            themselves.  They  wanted  to  take  action  in   the   ment  at  Licensing  and  Inspections   at   City   Hall.
            specific  areas  described  below,  and   wanted   me   After  many  months,  only  one  of   the   five   houses
            to help them.                                           has   been   properly   cleaned   and    sealed.    Again
            One  major  area  of  concern   for   the   residents   the   residents   have   talked   with    feeling    that
            was to try to convert  a  vacant  lot  on  the  block   this  attitude   prevails   because   they   are   black.
            into  a  Tot  Lot,  on  which  their  children  could
            play.   Contacts   were   made   with   the   Depart-     The  final  major   problem   voiced   by   the   resi-
            ment  of  Recreation,   Land   Utilization,   Univer-   dents  concerned  the   presence   of   rats   in   their
            sity Settlements,     Congressman             William   homes   and   backyards   and   the    accumulation    of
            Barrett's office, et.  al.,  to  attempt  to  achieve   trash  and  garbage  in  their  alleys.  The  rat   prob-
            this.                                                   lem  seemed  to  be   caused   or   at   least   enhanced
                                                                    by  the   trash   problem,   so   emphasis   wag   placed
            The    stumbling    block    was    presented    when   on   removing   trash   and   garbage.   A    representa-
            one  of  the  property  owners,  Mrs.  X,  said  that   tive   from   the   City's   extermination    unit    was
            she  could  grant  permission  for   the   group   to   contacted,  but  he  felt  that  it   would   be   futile
            use  her  property  if  she  were   insured   against   to  place  poisoned  bait  where   rats   had   so   much
            any  liability  charges  from  parents  whose   chil-   other debris and food to eat.
            dren  might  be  hurt  playing  on   the   Tot   Lot.     At   least   ten   complaints   and    probably    more
            Attempts  to  seek   this   insurance   through   the   were   registered   with   the   Mayor's    Office    for
            City   of   Philadelphia,   University    Settlements   Complaints   because   the   City'g   sanitation    work-
            and  others  were  rebuffed  and   the   action   has
                                                                    ers  would  not  clean  the  alleys.  The   alleys   were
            been stymied.                                                                  oximately   the    first    Monday
                                                                    last cleaned on appr
            At   present   the   property   is   tax   delinquent   in  June.   Since   then   they   have   become   deplor-
            according to Mr.  M.  of  the  city's  Land  Utiliza-   able.  It  is  a,fact  that  the  people  of  the   block
            tion Office. In this case, the land  will  be  placed   could  clean  the  alleys  themselves,   but   again   it
            available  for  sheriff's  sale  in  approximately  8   is  a  point,that  their  taxes   help   pay   for   this
            months. At  this  time  the  city  can  purchase  the   service   and   if   they   were   more   affluent,.   or
            property  and  effect  the  conversion   to   a   Tot   white,  they  would  not  have   to   be   subjected   to
            Lot.  A  major  consequence  of  the  delay   through   this treatment by the City.
            "red  tape"  and   negotiations   has   been   waning      The  concern  of  the  residents  of   Taylor   Street
            interest and skepticism on  the  part  of  the  resi-   for   their   own    improvement,    through    uplifting
            dents  that  anything  will   improve   their   situ-   their    environment,    has.been     suppressed.     The
            ation.                                                  City  has  shown  in   various   areas   to   be   imper-
            Another situation     which     the     residents.saw   sonal   and   unresponsive   to   their    needs.    They
            as  a  problem  was  the  fact  that   although   the   have   gone   "through   proper   channels"   to   affect
            street is  very  narrow,  at  various  times  of  the   changes,  but   the   results   have   been   negligible.
                                                                                                                            9


             Their interest in  helping  themselves  is  waning,   thony's Parish has  a  school;  there  also  is  a
             as  their  confidence  in  those  who  make  change   public elementary school,  but  pupils  there  are
             is reaching a new low.                                mostly black;  most  Pocket  children  go  to  St.
             . I identify very closely  with  the  residents  in   Anthony's.  Police  protection  is   good   during
             general, and have not, and will  not  try  to  con-   the day, but there are  complaints  of  its  being
             sole  them  or  attempt  to  reconcile  them   with   almost nonexistent at night.
             the  systems  of  the  "establishment."  If   some-     Since  most  Pocket  women  are  Catholic,   one
             one  with  a   more   militant   approach   revives   would not imagine  many  to  be  practicing  birth
             their interest in  helping  themselves,  they  will   control, but  most  are.  Three  blocks  from  the
             be  much  more  receptive   to   an   attitude   of   Hospital  of  the   University   of   Pennsylvania
             "damn  the  establishment!,  we'll  change   things   and  Philadelphia  General  Hospital,  the  people
             our own way!"                                         use the clinics quite often.  St.  Agnes  Hospital
                                                                   is  also  frequented.  No  complaints  were  heard
                               The Pocket                          of these  institutions  other  than  waiting  time
                                                                   and the  Filipino  doctors  who  don't  understand
                              Art Pressman                         what is wrong with the people.
                                                                     There  has  been  almost  no  community  action.
                "The  Pocket"   is   the   area   within   Taney   "The  Pocket"   expects   the   community   organ-
             Street,  Webster  Street,  Catherine  Street,   and   izer to do everything.  They  sit  and  talk,  but
             South 26th Street.                                    are  mysteriously  absent  when  the  time   comes
                This  is  an  all  white  community.  One  black   for the work to  be  done.  This  sounds  presump-
             family was  driven  out  about  a  year  ago.  Once   tuous but I  just  spent  today  trying  to  round
             mostly Irish, now some  Italian,  but  still  over-   uP 45  men  to  work  for  two  hours  this  week-
             whelmingly  Irish,  most  men  work  at   Philadel-   end  in  the  nursery  and  got  a  most  negative
             phia Electric,  half  a  block  away.  There  is  a   response. At this stage,  the  next  thing  to  do
             large  incidence  of  interrelation   among   fami-   is incense the men individually about  their  col-
             lies.  Many  residents  have  lived  their   entire   lective  weakness.  Maybe  some  will   come   out
             lives in "The  Pocket."  A  few  are  really  large   that  way.  The  women  are  fairly   industrious-
             families  with  eight  or  14  children  but   most   some are notorious laggards,  others  are  bundles
             f amilies  have  about  three  to  four  kids.  One   of energy.
             very  rarely  sees  any  teenagers,  therefore  the     Before  anything  can  be  accomplished   in   a
             impression exists  that  only  young  children  are   community,  the  community  must  desire  the  end
             around,  butteenagers   mysteriously   surface   in   result. For an outsider to  enter  a  neighborhood
                           Most   people   marry   from   within   and  identify  and  remedy   certain   problematic
             the evening.
             "The Pocket." It  is  rare  for  someone  to  bring   conditions is  a  condescending  gesture.  Certain
             a  stranger  in  (stranger:  more  than  10  blocks   circumstances  cannot  equal  a   problem   unless
             away).  "The  Pocket"  is   completely   surrounded   the community  sees  a  problem  from  their  per-
             by  black  communities..   There   are   no   other   spective.  No  doubt  many  conditions  exist   in
             whites  for  blocks.  There  has   been   hostility   the  pocket  that  warrant  immediate   attention,
             for years with the power  shifting  to  the  blacks   but I feel that it is not  my  place  to  identify
             more   and   more   every   year'.   Eight   vacant   them. This is not to say that I blissfully  ignore
             houses stay vacant;  no  one  wants  to  move  into   them.  Questioning  of  a  random  nature   during
             "The  Pocket."  Their  most  difficult  problem  is   a  friendly.conversation  generally  produces  one
             realizing that they live in a  poor  white  ghetto.   of two possible  results.  "How  long  have  those
                "The Pocket"  is  convenient  to  public  trans-   three  abandoned  cars   been   on   the   block?"
             portation; garbage  collection  is  regular;  South   "Two years" or "Two  years  .  .  .  I  sure  wish
             Street "business" district  is  very  close;  there   we could get rid  of  them."  If  the  people  af-
             is a swimming pool  at  26th  and  South  (in  ter-   fected by  the  problem  recognize  iti  then  the
             rible  shape,  and  the  community  is  disgruntled   community  organizer  and  the   community   reach
             about  the  Marian   Anderson   Center   being   so   the  first  plateau-a  problem   exists.   Without
             nice)  ;  University  Settlement  House   has   day   this  recognition,  the  community  organizer   is
             camps, day schools,  a  gymnasium,  etc.;  St.  An-   nothing  more  than  an  officious   intermeddler.

             10


        Once  there  comes  this  recognition  and,  there-   in that self-appointed  kings  are  constantly  be-
        fore,  identification  of  the  problem  as   their   ing  deposed.  Even  if  a  leader  is  "democrati-
        own,  the  mobilization  of  the   community   into   cally"  elected  by  the  community,   the   commu-
        some  form  of  functioning  political  entity  can   nity refuses to look upon him  as  a  leader.  Dis-
        be  attempted.   (N.B.,   atte@pted   rather   than   trust,  envy,  and  backseat  driving   immediately
        accomplished.)                                        set in. A feeling of community is the only alter
          The  organization  process  is  the   most   dif-   native to the  leader  problem.  This  can  be  ac-
        ficult.  The  two  major  issues  of   the   summer   complished  through  total   involvement   of   the
                                                              entire group in an  issue  with  pointed  relevance
        helped facilitate this process  in  that  both  is-
        sues  affected  a  major  part  of  the  community.   to all. The Tot Lot was one  of  these.  By  making
        A digression  into  the  background  of  these  is-   the Tot  Lot's  condition  each  person'g  problem,
        sues is necessary at this  juncture.  In  conjitnc-   rather   than   the   vague   general   community's
        tion  with  Unive?,sity  House  and   the   commit-   problem  (and  therefore  no  one's  problem),   we
        nity, the Land Utilization  Depa?-tment  of  Phila-   were  able  to  wage  a  successf  ul  campaign  to
        delphia consti-2tcted a Tot Lot last  fall.  Reread   clean  up  the  Tot  Lot.  "When's  the  last  time
        this sentence  because  here  is  where  the  basic   your  child  cut  his  foot  in   the   Tot   Lot?"
        problem  lies.   The   community   did   not   con-   "When's  the  last   time   your   neighbor's   kid
                                                              came  into  your  home  and  bled  all  over   your
        struct,  but  Land  Utilization  constructed.  Cer-     ug, because  no  one  was  home  at  his  place?"
        tainly  men  and  women  of   "The   Pocket"   con-
        tributed valuable  man  hours  of  labor  and  cer-   is effective rather than "Let's  clean  it  up  be-
        tain materials, but the end  result  was  not  "The   cause it's  a  mess."  One  must  touch  each  per-
        Pocket's"  project.  The  fact  that  the  Tot  Lot   son's vested interest, whether  it  is  his  child,
        resembles  a  first  year  architecture   student's   his rug, his hatred for  the  sight  of  blood,  to
        nightmare,  which  indeed  it  turned  out  to  be,   mobilize  a  group  of  individuals  into  a  func-
        does not  matter.  Merely,  this  project,  because   tioning  body.  There  was   excellent   attendance
        of  the  great  stake  the  City  of   Philadelphia   on  C-lean-Up-Day  and   heretofore   disinterested
                                                              persons took an active role.  The  beauty  of  this
        had in it, was not  allowed  to  fail.  By  this  I   project  was  that  it  was  a  one  time   affair-
        do not  mean  to  imply  that  it  was  a  success-   the lot has  remained  in  excellent  shape  for  6
        not  at  least  to  the  people  in  "The  Pocket."   weeks -now. One lady  hoses  it  down  every  other
        They use it, play in it,  and  gather  in  it,  but   day or so and takes care of  the  hose  that  oper-
        it is almost as  if  they  have  borrowed  it  from   ates the sprinkler for the kids. Because  of  their
        someone  else.  For  Land  Utilization  it  was   a   involvement in  the  initial  clean-up,  the  moth-
        success,  but,  alas,  only  a  hollow  one   ("The   ers,  when  present,  impress  upon  the   children
        Pocket"  strikes  back!)  Within   the   space   of
        six  unattended  months,  the  Tot  Lot  became   a   ttie need to keep it  clean.  Play-Street,  a  Uni-
        mass  of  broken  glass  and  litter.   No   commu-   versity   House   afternoon   recreation   project,
                                                              a .  instills this attitude. For a period of  about
        nity responsibility existed for its  condition  and     !so
                                                         .1   ttiree  weeks  after  clean-up  day,  the   mothers
        indeed, none  should  have  for  the  Tot  Lot  dia   took  turns   supervi.sing the lot, keeping  out  the
        not belong to "The Pocket."                           bottle  breaking  older  kids,  and  watching   out
          Once   "The   Pocket"   recognized   the   hazard   for the saf ety  of  the  younger  ones.  While  it
        the  Tot  Lot  presented,  we  were  back  at   the   lasted,  this  scheduling  of  mothers   wag   very
        organization  process.  No  strong  leadership  ex-   effective, but its  breakdown  is  directly  linked
        ists in this neighborhood, as I  am  sure  it  does   with issue No. 2-the nursery school.
        not  exist  in  many  other  ghetto   areas.   Many
        reasons   for   this   exist-general   complacence,      The  University  House  and  "The  Pocket"   had
        the  individual's  desire  to  drink  his  beer  in   long  considered  opening   a   nursery   in   "The
        peace,  and  lack  of  confidence  to  lead,   much   Pocket"    for   the   Pre-schoolers.    University
        less influence, the  opinions  of  others.  If  one   House  negotiated  for  a  vacant  house  and   had
        is  able  to  overcome  these  obstacles,   another   an  option  to  buy  the  building.  The  Board  of
        more  serious  barrier  presents  itself-the  corn-   Education  had  promised  to  furnish   a   teacher
        munity's  reluctance  to  accept  anyone  as  their   and  some  equipment,  if  the  school  met   their
        leader.  "The  Pocket"  resembles  a  petty   duchy   standards.  Through  a  raffle,  "The  Pocket"  was


             able to raise about $100 that  acted  as  consid-   the  nursery.  Discrimination  by  geography   was
             eration for the option contract. Paint  was  pur-   one  thing-only  people  from  within  the   boun-
             chased and the community  began  to  fix  up  the   daries were  eligible-but  we  would  not  support
             building, which was in a state of  terrible  dis-   any  other  type.  After  about  three  weeks  the
             repair.  Scrubbing  on  hands  and   knees   came   mothers  decided-with   the   empty   half-painted
             first and the women eagerly pitched  in  and  the   school on  their  block  serving  to  remind  them
             place began to take shape.  It  was  looking  too   of   their   foolishness-that   something   really
             good to be  true  and  was.  The  Board  of  Edu-   ought to be done  one  way  or  the  other,  so  a
             cation  required  a  minimum  of  18-20  children   meeting   took   place.   Somehow   they   miracu-
             enrolled for them to sponsor a  school  and  pro-   lously came up  with  three  other  children  from
             vide a teacher. Since  "The  Pocket"  is  teeming   within  the  boundaries;  independent  action   on
             with children, no one  had  ever  considered  the   their part  because  they  finally  realized  that
             possibility that maybe  "The  Pocket"  could  not   they really  wanted  the  nursery.  Or  did  theyl
             come  up  with  enough   children.   After   long   Whatever  the  answer,   work   begins   anew   on
             arduous searching,  we  only  came  up  with  16.   Monday and hopefully  the  school  will  be  ready
             The big question was  where  Nvould  others  come   to go by the middle of September.
             from. If two more children could  not  be  found,     These  two  projects,  the  Tot  Lot   and   the
             the nursery would fail.  Because  of  its  unique   nursery, were the  major  issues  of  the  summer;
             position in  relation  to  the  surrounding  com-   but in order to  substain  overall  interest,  nu-
             munity,  "The  Pocket"  was  in  the  hole.  "The   merous  secondary,  easily  remedied  issues  were
             Pocket's"  unbelievable  antagonism   for   their   worked on. Boarding  up  a  vacant  house,  fixing
             black  neighbors  surfaced  when  we  asked  them   the fireplug that  had  eroded  half  the  street,
             to consider the possibility of getting the  other   and  having  one  vacant  house   condemned   pro-
             two  children  from   the   adjoining   neighbor-   vided  a  type  of  day-to-day  incentive   system
             hoods-all  of  them  black.  Spoken  to  individ-   that kept  the  community's  interest  intact  for
             ually,  a  scant  few  of  the  mothers  who  had   the major issues.
             already enrolled their children  in  the  nursery
             indicated  that  they  would  have  no  objection          HEALTH-A PRIORITY ITEM?
             to an  integrated  school.  Even  though  we  de-
             scribed the nursery in terms affecting their  in-     At a  few of  the  sites  this  summer,  project
             terests, i.e., getting rid of the  children  five   worke?-s tvere  a-sked  by  their  sites'  organi@
             mornings  a  week  as  well  as  improved  educa-   tion-s to conduct surveys or  investigations  into
             tional backgrounds  and  easier  adaptability  to   the  health  needs  of  their   communities.   The
             the first grade, the community acted  in  accord-   startling result of these investigations  is  that
             ance  with  their  emotional  needs.  At  a  com-   health  is  not  a  priority  item.  Although  the
             munity  meeting  with  100  percent   attendance,   SHO  workers  began   by   asking   about   health
             the unanimous decision  was  .  .  .  no  nursery   needs,  environmental  problems   and   recreation
             of black  children.  To  circumvent  the,problem,   were more visible  and  more  urgent  issues  than
             rather than drop the entire  plan  for  the  nur-   health problems.
             sery,  the  community  developed  their  own  op-     In this section the process of  setting  up  the
             tions: get the Board of Education  to  lower  the   studies, the results of the studies and  the  con-
             limit of children to be involved; rent  a  build-   -.equent action at four'sites is presented.
             ing from  University  House  and  staff  it  with     The  first  article  about  attempts  in  Ludlow
             mothers;  have  University   House   extend   the   to set  up  a  community  blood  bank,  teach  sex
             geographical   boundaries   that   the    nursery   education classes, and  show  a  cancer  detection
             would service in order  to  take  in  areas  with   film points out  the  fact  that  health  problems
             some white children.  No  one  really  worked  on   are obvious, but  they  have  to  be  met  in  the
             these  options  and  work  on  the   half-painted   order of  their  priority  to  the  community.  If
             school stopped. Tot Lot supervision  also  ceased   you  are  faced  with  rats,  shabby  housing  and
             as a  sort  of  protest.  "Lethargic  limbo"  was   unpaid  food  bills,  as  Jerry  Braverman  points
             where "The  Pocket"  found  itself.  We  made  it   out, you haven't got  time  to  worry  about  can-
             clear that in no way would we help to segregate;    cer, give blood, or learn about sex.

             12


          Both   Eastwick   and   Paschall    community    or-   which  does  not  directly  attack   these   problems
        ganizations  requested  a  survey  of   their   neigh-   is  destined  to  meet  with  limited  success.   Our
        borhoods  in  order  to  gather  evidence   to   bring   basic  programs,  sex  education  and   blood   bank,
        to  bear  on  government  authorities  and   also   to   are    prime    examples.    Although     worthwhile,
        identify  for   themselves   where   the   needs   and   these  were   indirect   efforts   to   remedy   some
        priorities  of  their  community  were.   Unlike   the   comparatively   minor   community    problems,    and
        report  from  Ludlow,  the  results  of   surveys   in   consequently,  did  not   stimulate   any   community
        Eastwick  and  Paschall  indicate  that   their   real   support.
        health  needs  are  not  as  fundamental   and   basic      A  more  illustrative  example  was  our   attempt
        as  the  needs  found   in   Ludlow.   Attention   was   to  show  to  the  women  of  Ludlow  a  short   film
        placed  on  recreation  facilities  in  Paschall   and   concerning  breast  and   uterine   cancer.   Despite
        on   a   variety   of   environmental   prolalems   in   leaflets,  posters,  sidewalk  solicitation  and  an-
        Eastwick. These  findings  suggest  that  it  is  very   nouncements  in  the  local  churches,   only   three
        difficult  to  deal   with   the   underlying   health   or four women showed up.
        problems  in  ten  weeks   and   that   attention   is      They  do  not  have  cancer  now   and   are   not
        likely  to  be  diverted  to  easier   projects   like   worried about it; they have never needed bloo
        recreation   programs,   blood   banks   and   visible   in  the  past  so  why  give   now;   academic   mat-
        environmental  health   problems.   The   basic,   un-   ters  about  sex  do  not  interest  them.  NOW   are
        derlying  problems  are  obvious  to   residents   and   rats,   shabby,   overcrowded   housing,   and   food
        those   concerned   with   meeting    health    needs,   bills.
        and they  are  vast.  Concern  for  the  less  visible      Further,  I  do  not  feel  that  a   SHO   person
        problems  of  cancer  and   other   chronic   diseases   should  initiate  an  attack  against   these   prob-
        can  only  be  stimulated  and   can   only   interest   lems.  They  are  the  problems  of  the  people  who
        residents   of   these    communities    when    other   live  here,   and   when   these   people   come   to
        more pressing needs have been met.                       recognize  these  themselves   as   community   prob-
          The final  report  in  this  section  describes  the   lems   (without   having   been   told)   and   begin
        experience  of  SHO   workers   who   provided   tech-   their  own  action,  then  would  be  the   time   to
        Dical  competence  to  the  Welfare   Rights   Organi-   enter  with  funds  and  personnel  to  provide   im-
        zation  in  designing  a  survey  at  WRO's   request,   petus to their movement.
        training  WRO  members  to   do   the   surveys,   and      Our  problem  is  a  complex  one  and  I  do  not
        then examining survey results.                           have an answer.
          These  experiences   suggest   that   health   needs
        are  obvious  and   pressing.   Communities'   priori-               Eastwick Survey Report
        ties  are  also  obvious,  even  though  it  may  take
        unsuccessful  programs  to  show  it.   Health   serv-      Paul Frame, Bill Woods, Andrea Benn,
        ice   producers   must   be   aware    of    community           Renee Edwards, and Eileen Fair
        demands  and   meet   these   in   order   for   their
        programs to be effective.                                   The  Eastwick   Community   Organization   is    a
                                                                 fairly  new   organization.   The    Eastwick    area
                Complex Problems in Ludlow                       has  been   an   urban   redevelopment   area   since
                                                                 1958.  A  large  number  of   families   have   moved
                        Jerry Braverman                          from  the  area  and  public  services  have   dimin-
                                                                 ished  since  then.  The   Eastwick   Community   Or-
          The     Ludlow      community      extends      from   ganization  felt  that  a  survey  could  better  de-
        Girard    Avenue    to    Montgomery    Avenue     be-   termine  the  needs  of  the  community   and   could
        tween  Fifth  Street  and   Ninth   Streets.   It   is   be used as  a  working  paper  to  get  better  serv-
        approximately   50   percent   Negro,    40    percent   ice into the area.
        Puerto  Rican,  and   10   percent   White;   it   has      The  survey  is  to  be  used  by  the   Community
        been  described  as  one  of  the  ten  worst   slums.   Organization  to  put  pressure  on   various   agen-
        in Philadelphia.                                         cies  and  institutions,  especially   City   Govern-
          The  health  problems  are  obvious,  most  of   all   ment   and   the   Redevelopment    Authority.    The
        to   those   who   live   there,   and   any   program   survey   was   commissioned    by    the    Community

                                                                                                                    13


               Organization  and  the  survey  committee  of  the  twice in  the  evening  before  writing  it  off  as
               organization is in charge of carrying  it  out.  A  "No Answer."
               community  worker  with  the   Methodist   Service  Stti-vey Findings
               Center who works in  the  Eastwick  area  is  also     We are  presently  in  th.e  process  of   evaluat-
               interested in the  survey  and  has  been  working
               with us  on  some  of  the  individual  followups.  ing  the  survey  findings.   Some   of   the   main
               The  Community  Organization  received   a   grant  problems which have developed are:
               from  the  Philadelphia  Council   for   Community     1. Problems caused by redevelopment.
               Advancement  which  allowed   them   to   hire   a       A. Lack of stores in the area.
               community resident, Mrs.  T.,  to  work  with  the       B.  Weeds  which   have   not   been   cut   in
               SHO  students  and   survey   committee   on   the     many fields. This  poses  a  traffic  and  rodent
               survey. This grant also paid  for  the  incidental     hazard.
               expenses of the survey.                                  C. Poor public transportation.
                The  actual  survey  was  drawn  up  by   several     II. Problems the city should deal with.
               people,    including    Community     Organization       A. Lack of mosquito control.
               members,   SHO   workers,   an    urban    planner       B.  Lack  of   an   adequate   sewage   system.
               working  with   the   West   Philadelphia   Mental       C.  Lack  of  street  repair  and  cleaning  of
               Health  Consortium,   and   a   community   worker     gutters.
               with   the   Consortium.   A   rough   draft   was     III.   Problems   peculiar   to   the   Larchwood
               formed from a  list  of  problem  areas  the  com-   Gardens Apartments.
               mittee  thought  important  to  work  on.   Subse-       A. Bad relations with the landlord.
               quently  there  was  much  of  the  cutting,   re-       B.  Noisy  kids  in   the   nearby   schoolyard
               writing,  and  changing  which  goes   with   pre-     at night.
               paring  any  finished  paper.  The  final  version     It will  be  noticed  that  health  problems  are
               contained  questions  on   demography,   mobility,   not included. This is partly due to the  fact  that
               health needs, employment,  and  social  and  phys-   other problems  are  more  pressing  and  also  be-
               ical environmental conditions. The  final  version   cause  the  health  problems  which  do  exist  are
               had to  be  cut  down  f  rom  a  45-minute  ques-   individual  problems  and  were  handled  on   that
               tioning  time  to  a  more  workable  time  of  25   basis.
               minutes.  We  tried  to  make  all  our  questions     The  survey  was  useful   in   determining   the
               ones which  could  conceivably  lead  to  meaning-   overall  and  specific  needs  of   Eastwick.   The
               ful  followup  and  eliminate  those  which   were   subsequent   follow-up   has   taken   two    basic
               of purely sociological interest.                     directions:  helping   individual   members   where
                 Our aim  was  to  survey  as  many  of  the  500   help  was  needed,  and  attempting  to  strengthen
               homes  in  the  area  as  possible.  One  week  in   the  Community  Organization  and  help   it   deal
               advance  we  distributed  flyers  to   each   home   with   the   Redevelopment   Authority   and   City
               describing the  organization  and  explaining  why   Governmen .
               we  were  doing  a  survey.  This   advance   pub-     The  first  of  these  directions  has   probably
               licity proved to be very important as  it  alerted   involved the  most  successful  part  of  the  sum-
               people to our  presence  and  we  were  not  total   mer. Needs  of  specific  persons  were  identified
               strangers  when  we  knocked  on  their  door   to   as  the  survey  progressed  and  handled   on   an
               interview them. In  general,  people  reacted  co-   individual  basis.  For  example,  several  recipi-
               operatively or apathetically to  us.  A  few  were   ents  of  public  assistance  were  informed  of  a
               suspicious, thinking we  were  from  the  city  or   program   whereby   they    could    obtain    much
               the  Redevelopment  Authority,   and   of   course   needed  dentures  free  of   charge   through   the
               there were a  few  refusals  and  hostile  people.   University  of  Pennsylvania  Dental  School,   and
               Our  refusal  rate,  however,  was  less  than  10   two have actually  begun  to  be  fitted  for  den-
               percent.  One  problem  which  is  common  to  any   tures. Several persons in need  of  financial  help
               survey attempting  to  reach  a  total  population   were  found  eligible  for  Pennsycare   and   Food
               is that some  people  are  not  home  when  called   Stamp  Programs.   Other   persons   seeking   jobs
               on  and  cannot  be  reached.  We  usually   tried   were   directed   to   various   training   centers
               to visit a given house twice in  the  daytime  and   throughout  the  city.  One  man   who   lived   on

               14


        the  f  ringe  of  the  community  was   even   helped   munity   get-together.    The    SHO    workers    will
        in his effort to  obtain  a  telephone.  It  was  sur-   also  work  with  the  Or@anization  to   obtain   bet-
        prising  to  discover   how   many   people   in   the   ter mosquito  control,  set  up  a  possible  sex  edu-
        lower  income  brackets  had  no  knowledge   of   the   cation   course,   and   assist   where   we   can   in
        many  programs  available  for  all   types   of   as-   f  urther   dealings   with   the   Redevelopment   Au-
        sista-nce, and  we  gladly  supplied  the  needed  in-   thority.
        formation.    We    are    presently    preparing    a     Other   than   the   problems    already    discussed
        "Where  to  turn"  type  booklet  for   general   dis-   above,  no  major  health  deficiencies   were   found.
        tribution  in  Eastwick  as  a  continuation  of  this   The   most   pressing   problem   would   probably   be
        eff ort.                                                 the   general   lack   of   periodic   checkups.   Most
          The  second  part  of  our  effort,  that   of   at-   people  are  either  quite   healthy   or   have   ade-
        tempting  to   form   a   more   effective   Community   quate  health  care.  One  area  in  the  health  field
        Organization,  is  presently  the   concern   of   the   was  improved,  however.   It   was   discovered   that
        community.  It   is   an   important   issue   because   a  receiving  ward  type   of   clinic   was   recently
        the  community  is  in  need  of  an  effective  force   established  by  St.  Luke's   Hospital   at   Interna-
        to   handle   its    many    problems-mainly    public   tional  Airport  only  8  minutes   from   the   center
        transportation,  more   stores,   effective   mosquito   of   Eastwick.   The   community,,however,    is    un-
        control,  street  repairs   and   dealing   with   the   aware  that  this  facility  exists.  Plans  are  being
        Redevelopment     Authority.     The     Redevelopment   made  with  St.  Luke's   to   publicize   the   clinic
        Authority   began   its   operations    in    Eastwick   and  there  is  also  a  possibility  that  it  can  be
        over  10  years  ago  and  has  planned  the   project   used  as  the  site  for  a   Public   Health   Service
        so that it  is  the  largest  urban  renewal  site  in   Clinic in the future.
        the  country.  However,  due  to   ineffective   plan-
        ni-ng    Eastwick    today    has    many    overgrown      Report on Community Work With the
        fields  where  homes   have   been   torn   down   but
        nothing  has  been  built  to  replace   them.   Also,            Paschal Betterment League
        Redevelopment   has   not   always   dealt   straight-
        forwardly  or  fairly  with  the  residents   of   the       Renell Burden, Larry Budner, Dudley
        area.                                                                Goetz, and Chris White
          The   problem   of   forming   a   strong,    repre-
        sentative   Community   Organization   is    a    pri-     Our   major   concern   at   the   Paschall   Project
        mary  problem  since  it   is   the   community,   and   site  was  a  comprehensive  survey   of   the   neigh-
        not  outside  SHO  workers,  who   should   be   deal-   borhood,  made  at  the   request   of   the   Paschall
        ing  with   the   City   and   Redevelopment   Author-   Betterment      League.       Problems       concerning
        ity. It is  also  a  difficult  problem.  The  present   health  care   and   municipal   services   were   cov-
        organization  has  a  nucleus  of   dedicated   people   ered  in   the   study.   With   demographic   material
        but  does  not  have  the   widespread   participation   and   attitudes    toward    the    neighborhood    in-
        it needs.  Many  people  are  quite  bitter  over  the   cluded,   the   survey   was   undertaken   to    deter
        events of  the  last  10  years.  They  stood  up  and   mine  whether  the  residents  had  any   interest   in
        were   "bulldozed   over"   by   redevelopment    once   their   community   and   what    specific    community
        and  don't  feel  like  standing  up  and  being   run   problems exists.
        over    again.    In    Larchwood    Gardens    Apart'      As  a  result  of  the   survey!s   findings,   many
        ments,  the  people  are  more  transient   and   many   problems      concerning      environmental      health
        don't  feel  they  have  enough  of  a  stake  in  the   were   made   evident.   These   included   lack    of:
        community to get involved.                               street lights, traffic lights,  fireplugs,  recreation,
           The survey was itself  a  first  step  in  the  at-   a  day  care  center,   adequate   police   protection,
        tempt   to   strengthen   the   Community    Organiza-   and   adequate   shopping   facilities.   In   addition
        tion.  The  confidence  of  many  people  was   gained   to   the   above,   abandoned   houses,    inadequately
        in  the  process  of   door-to-door   canvassing   and   functioning   sewers   and   unfit    housing    condi-
        a  fair  number  of  people   showed   a   willingness   tions  were  reported  to  the  respective  city  agen-
        to  work  with  the  organization.   The   next   step   cies.   No   significant   personal   health   problems
        includes  the  planning  of  a   cook-out   and   com-   were brought to light, however.
                                                                                                                      15


                                                         ounded    ice, such as a car accident victim dying  in  the
               The Paschall community is roughly b                 hospital because of  too  long  a  wait  f  or  a
               on the East by  63d  Street,  on  the  South  by
               Grays Avenue  and  on  the  North  and  West  by    needed  operation.  There  is  no  community  in-
               Cobbs   Creek   Parkway.   This   community   is    volvement  on  the  planning  or   administrative
               quiet, lower  class  (and  some  middle  class),    boards of any health facility in the  area,  that
               and integrated, although mainly black.              we are aware of.
               Generally,  community  services,  except   those    In   order   to   obtain   immediate    community
               pertaining to shopping and recreation, are  con-    services from  the  city,  we:  confer  with  the
               sidered  adequate  by  the  residents.   Trolley    Paschall  Betterment  League  President,  as   to
               route   11,   running   from    Darby    through    whom in the  City  Bureaucracy  to  notify  about
               Paschall to Center  City,  is  the  only  direct    the problem;  call  up  other  voluntary  groups,
               transportation into the city. There  were  rela-    such   as   North   City   Congress;   and   work
               tively few complaints about the No.  11  in  our    through the  City's  published  reference  guides
               survey, but frequently of  service  is  signifi-    to municipal  departments.  After  a  phone  call
               cantly lower than other nearby lines.  Municipal    to the appropriate city office, most of  our  re-
               response to  residents'  complaints  about  city    quests are followed up by a letter  to  the  same
               services appears  to  be  prompt  and  at  times    office and  a  copy  to  Mayor  Tate.  Complaints
               efficient. There are two hospitals in the  area,    by  the  neighborhood  residents  were  also  ob-
               Mercy  Douglas  at  50th   and   Woodland,   and    tained in the PBL's storefront  office.  The  two
               Misericordia  at  53d  and  Spruce.  These  hos-    project fellows and two students  aides  assigned
               pitals appear to be used by the  residents  only    to   the   Paschall   Betterment   League,   7039
               in  case  of  emergency.   For   non-emergencies    Woodland  Avenue,  undertook  a  survey  of   the
               and/or for sustained  treatment,  the  residents    Paschall  neighborhood  at  the  request  of  the
               go to the Hospital of the  University  of  Penn-    PBL president.  The  survey  site  had  been  se-
               sylvania or the Philadelphia Ge'neral  Hospital.    lected on the basis of PBL's  conception  of  its
               Although  the  neighborhood  borders  the   city    "neighborhood."  Of   approximately   500   fami-
               limits, very few residents travel into Darby,  a    lies, 195 families were selected and  interviewed
               nearby suburb (literally across the street)  for    during various  times  of  the  day.  Supervision
               hospital or clinic care. A large number  of  re-    and "overall responsibility" for the  survey  re-
               spondents in our survey said  that  they  go  to    mained with SHO students.
               their private doctor or dentist  for  treatment.     The PBL president considered the survey
               This response cut across economic,  racial,  and    necessity in order to provide  estimates  of  the
               age lines. The use of public transportation  for    neighborhood population  density;  child  popula-
               obtaining medical care  is  time  consuming  but    tion; knowledge  of  PBL  and  any  other  neigh-
               reliable (except when snow falls, then  the  No.    borhood  organization;  "pressing".  neighborhood
               ll  doesn't  run  regularly).   One   respondent    problems;   complaints   about   city   services;
               complained about the necessity of  taking  three    racial composition;  age  composition;  mobility;
               buses to travel to a public  clinic.  There  are    number  and  types   of   dwellings;   employment
               almost no taxicabs  cruising  in  the  neighbor-    histories; and  neighborhood  development  possi-
               hood. Over half of  the  respondents  said  they    bilities.  The  large  number  of  questions   on
               did not own a car.                                  health care and services were  of  less  interest
                The  major  community  health  need   that   we    to the PBL.
               encountered is the lack of recreation facilities      The  survey  design  was  not   drawn   up   by
               in the area. Both a large number of small  chil-    either  the  SHO  staff  or  PBL  but  came  from
               dren in the area  and  the  adults  suffer  from    an  outside  source.  The  PBL  president   added
               i 4nothing  to  do."  This  deficiency  includes  a a page of questions to  the  schedule.  Each  SHO
               lack of: swimming pools,  athletic  fields,  and    staff  member  tabulated  his  own   survey   re-
               equipment and recreational centers.                 sponses in  conformity  with  a  master  schedule
                 Both Mercy Douglas and Misericord     ia  Hos-    devised  by  the  entire  staff.  Many  questions
               pitals have very poor reputations in  the  area.    were discarded as being either  too  inconclusive
               Several residents  have  accused  the  hospitals    ("How  much  money  did  you  spend  -on   cloth-
               of various forms of malpractice and  poor  serv-    ing in the last 6 months?") or  of  little  value

               16


       ("What   does   the   word   neighborhood   mean   to   not  provide  adequate  money  for  the  basic  needs
       you?") Some of  the  statistics  are  being  used  in   of life.  Provisions  in  welfare  regulations,  such
       a day care  center  proposal  being  written  by  the   as  that  which  states  the   recipient   must   pay
       SHO staff.                                              back all  of  the  money  "loaned"  to  him  by  wel-
        The  large  majority   of   the   respondents   were   fare when he finally gets off assist ance,    stifles
       quite responsive  to  the  survey  takers.  The  sur-   motivation   to   become   independent.   But    even
       vey  demanded  at  least  20  minutes  of   the   re-   more central to this  issue  is  the  fact  that  the
       spondents'  time.  The   noncooperators   tended   to   people   who   administer   and    deliver    welfare
       be  older,  white,  long-term   residents   who   ap-   services cheat,  insult,  degrade,  or  simply  don't
       peared  to  distrust  any  individual  or   organiza-   care about the people receiving the services.
       tion  connected   with   their   changing   neighbor-    These  and   other   indignities   were   identified
       hood.  The  area  residents  tend  to  be  poor   and   by  the  consumers  themselves.  The  central   issue
       black,  although  poor  whites   continue   to   move   is  how   these   consumers   have   been   effecting
       into the area.                                          changes  in  the   services   they   are   receiving.
         By  far  the  main  finding  was   the   residents'   They  have  done  this  by  banding  together  in   a
       desire for  recreation  facilities  for  their  chil-   self-controlled  and  directed   group,   independent
       dren. At this time,  the  few  recreation  sites  are   of   the   influence   of   nonconsumers.   Utilizing
       quite   overcrowded,   inadequate   and   beset    by   publicity and political  and  legal  sanctions,  they
       racial tensions.                                        have  attacked   the   structure   which   holds   up
         Other  problems,  but  which  were  not   as   uni-   the welfare system.
       versally  cited  as  recreation,  included  lack   of     The   Philadelphia   Welfare    Rights    Organiza-
       shopping  facilities.  and  transportation  and   the   tion  (PWRO)  is   a   truly   grassroots   organiza-
       need  for  a  Child   Day   Care   Center.   Although   tion  of  welfare   recipients.   The   SHO's   rela-
       over  half  of  the   respondents   were   aware   of   tionship  to  the  organization  was  to   help   WRO
       PBI!s  existence,  very  few   were   members.   Only   in their  fight  against  the  Department  of  Public
       15  percent  of  the  respondents  wanted   to   live   Assistance.  We  were  well   accepted   as   helpers
       "in the same area."                                     and extra staff people.
         After  the  survey   was   completed,   SHO   staff     Our first  activity  of  the  summer  was  to  con-
       members began to      attempt   to   obtain    needed   duct  a  cost  of  living  survey.  The  PWRO   asked
       city services  for  the  area.  Attention  was  drawn   the  Student  Health  Organization   to   help   them
       to  these  needs  by  the  survey   respondents   and   construct,  administer,  and  evaluate  a   cost   of
       noted  by  the  surveyors,  although   emphasis   was   living  survey.   The   survey's   purpose   was   to
       not  put  on  the  reception  of  complaints  by  re-   determine the actual  cost  of  food,  clothing,  and
       spondents.   On   the   whole,   municipal   reaction   shelter as  compared  to  the  allotments  recipients
       to  SHO  requests,  made  in   the   name   of   PBL,   receive  from  the  Department  of   Public   Assist-
       was  quite  good.@  However,  with  the  SHO  staff's   ance.  In  addition  to  the  food,   clothing,   and
       assistance,   the   Paschall    Betterment    League,   shelter  items  the  survey   included   items   such
       has  begun  action  on  the   need   for   recreation   as  furniture,  home  upkeep,  personal  care,   edu-
       sites.                                                  cational  and  recreational  expenses.  The   results
                                                               of  the  survey  will  be  presented  in   Harrisburg
                Welfore Rights Organization                    to the  Governor  and  members  of  his  cabinet.  It
                                                               is  hoped  that  the   Public   Assistance   payments
       Marpha  Crafton,   Shirley   Fischer,   Gene   Schat@   will  be  raised  from  their  present  level  of  71
              Jon Bonano, and Jean Wilkerson                   percent of the  1957  standard.  to  100  percent  of
                                                               1968 standards.
          The  central  issue  with  which  we   have   been      The questions  to  be  used  in  the  survey  were
       concerned  this  summer  is   the   power   of   con-   determined  in  the  following  way.  The  SHO   stu-
       sumers to affect the  services  they  are  receiving.   dents  prepared  a   preliminary   .   questionnaire.
       This  is,  a  central  issue  because   the   welfare   This   preliminary   questionnaire   was    presented
       system, as  it  presently  functions,  is  inadequate   to the 18 local  chapters  of  PWRO  for  their  cor-
       and insensitive  to  the  needs  of,  the  consumers,   rections  and   revisions.   These   revisions   were
       the  recipients.  The  present  welfare   grants   do   incorporated  into  the  final  survey.  On   Monday,
                                                                                                                   17-


               July 16, and Tuesday,  July  17,  a  training  ses-    tiorial  disputes.  Much  experience   was   gained
               Sion  was  held  for  the  18   community   workers    from  the  consumer  viewpoint.  This,  Nve  think,
               who  would  administer  the   survey.   The   first    by  the  students  in  battling  the  establishment
               training  session  consisted   of   reviewing   the 'has been  a  valuable  experience  for  future  deal-
               questions to iron out  any  last  minute  problems.    ings  with  the  medical   establishment   in   the
               The second training session consisted  of  a  trial    role of patient advocate.
               interview.   The   18   community   workers    were
               split into teams  of  two  -  one  interviewer  and       COMMUNITY-"ESTABLISHMENT"
               one interviewee. In the afternoon  the  roles  were                     RELATIONS
               reversed.  In  this  way  a  thorough   familiarity
               with the survey was obtained.                                           Karen Lynch
                 Each  community  worker   was   responsible   for     Where there    is  concern  and  action  by  local
               interviewing  11  people.  These  people  were   to    communities to  improve   neighborhoods   and    by
               be  taken  from   the   following   categories   of    individuals to  make  use   of   available   health
               Public Assistance, seven  Aid  to  Dependent  Chil-    services,   the   "establishment"   must    respond
               dren, two  Old  Age,  one  General,  and  one  Dis-    with similar  concern  and  action.  Effective  re-
               ability.  This  distribution  corresponds  approxi-    sponse by hospitals,  city  agencies,  and  clinics
               mately to the  percentages  given  by  the  Depart-    today,   means   changing   from   present   proce-
               ment of Public Assistance.  A  total  of  216  sur-    dures  and  adopting  new  philosophies   an   pro-
               ve ys  were  distributed.  As  of  now  (August  14)   grams and even  new  goals  in  light  of  changing
               about  half  have  been  returned.  About  20  per-    needs  and  priorities  of  individuals  and   com-
               cent  of  those  surveys   returned   were   incom-    munities.
               plete, i.e.,  one  or  more  vital  questions  were     The six articles in this section  present  experi-
               not filled out completely or correctly.                ences,  problems,  insights  and  potential   solu-
                 The  only  difficulty  expressed  by   the   com-    tions    to    community-establishment    relation-
               munity  workers  was  the  problem   of   obtaining    ships.
               people for interviews  in  either  the  disability,     The   project   workers    at    Fairmount    were
               old age,  or  general  assistance  categories.  The    confronted  with  much  "red   tape"   in   working
               interviewers   have   reported   very   cooperative    on problems  of  abandoned  houses  and  in  trying
               responses from the people  that  they  have  inter-    to set up discussions  of  family  planning.  Their
               viewed.                                                experience points out  the  problems  and  the  in-
                 At the present time  -no  analysis  of  the  data    ability of  communities  themselves  to  straighten
               has been undertaken.                                   out  communication  paths  from   neighborhood   to
                 After  the   survey   was   launched   our   main    City Hall,  to  the  Bureau  of  Licenses  and  In-
               function  was  to  assist  the  organization   with    spections,  and  with  the  Board   of   Education.
               some  of  their  other  activities.  The  main  one    Solutions to these  problems  must  come  from  the
               was  helping  the  women  staff   WRO   booths   in    agencies themselves.
               the district Public  Assistance  Offices.  The  re-      Solutions  are  being   suggested   for   another
               cipients have a right to  be  represented  by  any-    problem of the resident of the inner  city.  Steven
               one they want when  they  go  down  to  the  Public    Marder's   investigation   of   the   adequacy   of
               Assistance Offices. The -women assumed         I the   pharmacies  to  meet  the  needs  of  poor   people
               role of  client  advocates.  The  reaction  of  the    pointed out  the  pressing  need  for  young  phar-
               establishment  was  both   hostile   and   abusive.    macists and  the  possible  ways  of  meeting  this
               Their  main  objections  were   that   while   they    need. The  article  printed  here  is  an  abstract
               were  being  checked  by  the  women   they   could    of  a  much  longer,  more  detailed  report  which
               -not  function  properly.  A  great  part  of   the    he prepared during the summer.
               summer  was  also  spent  sitting  around  the  WRO      The  remaining  articles  in  this  section  deal
               office,  learning  the  problems  of  a  grassroots    with the difficulties of providing  service  within
               organization.  These  were  problems  of   building    large  organizational  structures.  Differences  in
               and  arousing   a   membership,   keeping   outside    philosophy  between  the  Day   Care   Program   of
               institutions  and  groups  from   influencing   the    the   Temple   Community   Mental   Health   Center
               organization,  and   just   simply   intraorganiza-    and  the  Department  of   Psychiatry   at   Temple

               18


       Medical  School  led  to  strain  in  running   that    opinion.   Conversations   with   the    Human    Re-
       program.   "The   Saga   of   Fidel   Cruz"    shows    sources  Standing  Committee   indicated   that   in-
       vividly  how  one  man  "battled"   with   an   ear,    formation   which   I   could   compile   would    be
       nose, and throat clinic and  will  never  return.  A    useful  in  the  action  programs  they   are   pres-
       few  incidents  like  this  one  may  result  in  an    eiitly  planning.   The   Health   Department   based
       entire community losing trust  in  the  clinic.  The    Model  Cities  Staff  provided  the   expertise   and
       proposed  position  of  patient  advocate  at  Pres-    influence that would  guarantee  that  I  could  find
       byterian   Hospital,   reported   by   Frank   Greer    maximal   involvement   in    the    medical-pharmacy
       and  Jerry  Lozner,  is  another  possible  solution    establishment.
       to this problem.                                         Especially   useful    in    evaluating    community
        The  two   extensive   articles   by   Lozner   and    opinion  was  a  report  by   the   Human   Resources
       Greer  about   their   work   at   Presbyterian-Uni-    Standing    Committee    entitled,    "Barriers    to
       versity    of    Pennsylvania     Medical     Center    Good  Health,"  and   meetings   with   the   Commit-
       (PUPMC)   are   models   of   the   changes    which    tee.  The  report  indicated   that   the   community
       can be planned for  a  hospital  in  order  to  make    viewed  deficiencies  in   pharmacist   services   as
       it  more  responsive   to   its   community.   These    being closely allied to deficiencies in the  services
       articles present, in detail and  occasional  d'upli-    of  other  health  professionals.  The   report   as-
       cation,  the  results  of  an  imaginative  coopera-    serts  that  there  is,  'ta  lack  of  quantity  and
       tive  effort   of   students,   community   workers,    quality of  doctors,  dentists,  druggists,  visiting
       and  hospital  staff  to  improve  the  relationship    nurses,  and  other  health  specialists."  The  com-
       of    PUPMC    with    its    neighborhood.    These    munity  indicated  that  pharmacies  are  often   not
       papers should be read very closely.                     open  when  the  people  need  them  and  that   they
        The  problems  discussed  in  these  articles   are    are  often  inconveniently  located.  It   was   also
       not new. These articles  are  significant,  however,    recommended  that  a  system  should   be   developed
       since  they  report  real   experiences   and   real    which  would  provide  necessary   health   services,
       attempts  to  meet  problems  and   they   are   not    including  drugs  at  prices  that  people   in   the
       editorials.  They  should  be   read   for   insight    community could afford.
       into  the  complexity  of  the  problems   and   for      When   interviewed,   the   pharmacists   disclosed
       the potential of the solutions.                         an  image  of  a  profession  which   was   more   or
                                                               less falling apart. Of  a  total  of  102  pharmacies
        Community     Pharmacies      in      North-Central    located  in  the  Model   Cities   Target   Area   in
                         Philadelphia                          1960,  only  57  remain  open  for  business   today.
                                                               Indications are  that  this  decline  will  continue.
                        Steve Marder                           At  least  10  of  the  43  pharmacists   interviewed
                                                               already  had  definite  plans  for  closing.  -  This
         The  encounter  between  a  black   ghetto   resi-    marked  decrease  is  not   unique   to   the   black
       dent and a  white  professional  takes  place  in  a    ghetto.  There  is  an  overall  tendency  in   Phil-
       number of  different  institutions.  This  summer  I    adelphia  for  the   total   number   of   pharmacies
       studied the  encounter  at  its  primary  source  in    to  decrease  at  a  rate  which  is  not  too   dif-
       the   community-namely,    the    community    phar-    ferent  from  that  in  the   Model   Cities   Target
       macy.  The  purpose  of  the  study  was  to  evalu-    Area.  The  difference  lies  in  the  fact  that  in
       ate  how  well  existing  pharmacies  were   meeting    most  areas  of  the  city,  small  "one-man"   phar-
       the  expressed  needs  of  the  poor   people   whom    macies have been replaced        by   larger,    more
       they  serve.  To  do  this,  the  opinions  of   the    modern stores. This has not      been  the  case   in
       black  community  were  evaluated   and   integrated    North-Central Philadelphia.
       into  a  questionnaire  for  pharmacists.  In   this      The survey indicated that      the   problem   lies
       manner,  the  health  professional  would,  by   ne-    as  much  with  the  pharmacist,   himself,   as   it
       cessity, be  responding  to  the  -opinions  of  the    does  with   the   economics   of   the   area.   The
       community.                                              pharmacist  in   the   Model   Cities   Target   Area
         For the  purposes  of  this  study,  the  areawide    is  rarely  a  young  man.  He   is   almost   always
       Citizen's Council  of  Philadelphia's  Model  Cities    older  than  his  middle  fifties  and  is  often  in
       Program  was  used  as   a   source   of   community    his sixties  and  seventies.  He  has  usually  owned
                                                                                                                  19


                                          30  years  and   he   con-   filled.  Discussions  with   the   community   have
                 his store for more than                the     only   already  brought  up  several  possibilities  which
                 tinues to run his store with himself as                           estigated.   These   include   coopera-
                 pharmacist.    The    North-Central    Philadelphia   are being inv
                 pharmacist   has   probably   not   remodeled   his   tive  drug  stores   replacing   pharmacies   which
                 store  in  any  rhanner  in  the  past  few  years.   have closed, pharmacies  in  District  Health  Cen-
                 Instead, he has allowed  it  to  deteriorate  until   ters,  and   Neighborhood   Health   Centers,   and
                 today it is  often  small,  depressing,  and  di:ty   programs   to   keep   hospital   pharmacies   open
                 with a rather scanty  inventory  available  on  the   during the evening.
                 shelves.
                 The   most   important   factor   preventing    the     Philosophical Conflicts of the Temple
                 North-Central    Philadelphia    pharmacist    from
                 providing  the  kinds  of  services  the  community      uommunity Mental Health Center's
                 wants lies in the  attitudes  he  has  towards  his
                 business.  He  very  rarely  has  any  ambition  to                   Day Program
                 improve  and  expand  his  pharmacy.   Rather,   he
                 is quite  content  to  manage  whatever  profit  he                   Bess Aronian
                 can from his business until he retires.  In  or  er
                 to detect what flexibility there might  be  in  the
                 system,  I  spoke  to  several  of   the   pharmacy    The  day  program   of   the.   Temple   Community
                 leaders  in  Philadelphia,  including   representa-   Mental Health  Center  is  an  experiment  in  com-
                 tives of  pharmacists  and  the  pharmacy  schools.   munity   psychiatry.   The   philosophy   of    the
                 From these men I  obtained  several  ideas  of  how   program  was  defined  largely  by  its   director,
                 pharmacists in the area  might  alter  their  busi-   Dr.  Frederick  B.  Glazier,  who  used   Day   Top
                 nesses  to  better  serve  the  community  and  in-   Village of  New  York  as  his  model.  Because  of
                 crease their  profits.  The  idea  included  stores   the  highly  innovative  nature  of  the   program,
                 merging  to  form  larger,  more   modern   pharma-   Dr.  Glazier  has  had  many   problems   to   face
                 cies  and  prepaid  drug  programs  which  are  im-   since its inception last September.  I  will  first
                 proved  over  today's  Public   Assistance   plans.   discuss one of  these  problems  and  then  briefly
                 It is interesting  that  when  questioned,  pharma-   explain  the  philosophy  of   the   day   program.
                 cists showed little enthusiasm  for  any  of  these     One of the  major  problems  faced  by  the  pro-
                 proposals. .                                          gram  is  its  validation  as   therapy   technique
                  All  of  these  results  were  taken  to  indicate   and thus its potential as a model  for  the  estab-
                 that  if  we  use  the  consumer's  needs  as   our   lishment of  future  day  programs.  This  involves
                 basis for evaluating the  services  being  rendered   bringing  about  its  acceptance   by   the   main-
                 by pharmacists, the  present  personnel  are  like-   stream of psychiatry.  At  the  present  time,  the
                 ly  to  continue  to  fail.  The  character  of  th   Temple  University's   Department   of   Psychiatry
                                                                       has  not  considered  the  day  program  especially
                 business and  the  age  of  the  pharmacists  would   suitable  training  ground  for  its  medical  Stu-
                 seem to serve as a good  basis  for  inflexibility.   dents and residents. It helps  to  understand  this
                 The problem in this case  lies  not  so  much  with   when we realize that  the  frame  of  reference  of
                 the fact  that  pharmacists  are  unable  to  solve   the  day  program  and  that  of  traditional  psy-
                 their problem, but more with the f  act  that  most   chiatry  are  so  different  that  comparison   be-
                 did  not  have  any  great  hope  or  ambition  for   comes  very  difficult.  Psychoanalysis  and  other
                 their businesses.                                     Freudian  based  therapy   techniques   face   many
                   Probably   the    most    important    conclusion   barriers  when  considered  as  treatment   methods
                 which  comes  f  rom  the  survey   is   that   new   in  community  psychiatry,  especially   when   the
                 sources of  pharmacists  must  be  found  to  serve   community is the  black  ghetto.  First,  there  is
                 North-Central  Philadelphia.  The   obvious   solu-   the  problem  of   sheer   numbers.   Temple   Com-
                 tion  which  comes  to  mind  is  increasing   dra-   munity Me   ntal Health Center  is  the  only  psy-
                 matically  the  number  of  black   pharmacy   stu-   chiatric  facility  servicing  an  area  of   North
                 dents. There is also  a  necessity  that  the  gaps   Philadelphia  with   a   population   of   approxi-
                 left by pharmacies  which  are  closing  should  be   mately  215,000.  The  verbal   facility   normally

                 20


       required  for  successf  ul  psychiatric  treatment             The Saga of Fidel Cruz
       would  be  a  barrier  with  this  population,   as
       would   the   medical   terminology   usually   em-                     Tom Fiss
       ployed. Also, the crisis orientation of this  popu-
       lation  makes  it  unlike  the  middle  class  from
       which  psychiatry  has  traditionally   drawn   its    The following is  an  attempt  to  illustrate  the
       clien tele. As  a  rule,  people  in  the  ghetto  are problems  of  the  clinic  system  as   encountered
       approaching  or  are  at  the  breaking  point  be-   in a midcity hospital  in  this  area.  The  system
       fore  they  seek  help-many  do   not   voluntarily   is  a  mire,  bogging  down,  and  hindering  those
       seek help, but are brought to  the  center  by  the   who  administer  it,  those  whom  it   claims   to
       police or their families. Generally,  middle  class   serve, and those who  attempt  to  reform  it.  The
       people seek help  before  a  crisis  is  incipient.   administrator  too  often  becomes  frustrated  and
       It is significant that the  stress  psychoses  pro-   overwhelmed  by  the  system.   The   patient   be-
       duced  by  ghetto  living  have  been  likened   to   comes  a  unit  of  the  system  frequently   proc-
       those observed in combat veterans.                    essed but  seldom  treated.  The  reformer  becomes
                                                             quickly  disillusioned.  He's  told   that   change
        These are some of the problems       which     Dr.   must  be  slow  but   too   often   slow   movement
       Glazier has had  to  consider  while  evolving  his   becomes complete halt.
       program;  into  a  working  treatment  center.   He
       incorporated   many   ideas   into   his   program,     Tuesday  morning,  July  16,  Fidel   Cruz,   72,
       probably the  most  significant  of  which  is  his   walked  into  the  community   center   complaining
       conception  of  the  behaviorally  oriented  thera-   of  dizziness  and  marked  auditory   dysfunction.
       peutic  community.  The  device  used   to   imple-   It  was  discovered  that  the  patient  could  not
       ment  the  formation  of  this  community  is  that   hear with his right ear  because  it  was  impacted
       of  multiple,  interlocking  group  therapy.  There   with  wax.  The   Rene-Weber   test   showed   that
       is virtually  no  one-to-one  therapy  between  the   the ossicles  were  functional.  The  physician-in-
       patients,  or  members  as  they  are  called,  and   charge called the  ear,  nose,  and  throat  clinic
       the staff.  Basically,  the  therapeutic  community   (ENT)  at  the  hospital  for  an  appointment   so
       depends  upon  the  responsible  behavior  of  each   that Mr. Cruz should  be  there  at  11  a.m.  When
       member  towards   himself   andevery   other   mem-   Mr. Cruz was  told  of  his  appointment,  he  pro-
       ber.  Responsible,  mature  behavior   is   encour-   tested  vehemently.  He  wanted  no  part  of   the
       aged by the  staff  and  "sick"  behavior  is  dis-   hospital-he'd   been   there   before   too    many
       couraged.  The  community   is   a   democracy   in   times.  They  had  X-rayed   him,   palpated   him,
       which the traditional  authoritarian  role  of  the   hooked  him  up  to  wires  but  nothing  had  ever
       staff  members  is  relinquished.  Dr.  Glazier  is   been  done  for  him.  But  Mr.   Cruz   was   per-
       known  as  Fred,  and  his  opinion,  which  counts   suaded that  things  would  go  better  this  time.
       equally with each  of  the  members  as  one  vote,   Mr. Cruz walked the three  fourths  of  a  mile  to
       can  be   overruled.   The   members,   themselves,   the hospital, was on time  for  the  supposed  jap-
       are the therapeutic  agents  for  each  other,  and   pointment,  but  was  told  the  doctor  would  not
                                                             be  present  until  1  p.m.  Mr.  Cruz  went   home
       the  openness  of  the   community   accounts   for   and returned, by foot,  at  1  p.m.  At  3:30  p.m.
       the  fact  that  a  person  like  myself,  who   is   Mr.  Cruz  was  told  that  the  doctor  would  not
       neither  member  nor  staff,  can   function   with   be in that day.
       the group.                                              Wednesday,  July  17:  In  the   case   followup,
         Although  the  National   Institute   of   Mental   staff   member,   Santo   Smith,   encountered    a
       Health evaluation  report  recently  issued  states   rather  aggravated  Fidel  Cruz.  He  vowed   never
       in reference to this program, "It  is  our  opinion   to return to the clinic.
       that  this  day  program  constitutes   the   model     Thursday,  July  18:  To  prevent  a  repeat   of
       of  what  a  therapeutic  type   of   day   program   Tuesday's fiasco the  day's  activity  was  planned
       should  be,"   Temple's   Department   of   Psyphi-   carefully  and  precisely.  The  ENT   clinic   was
       atry  remains  doubtful,  and  maintains  at   best   called and it  was  discovered:  1.  that  although
       a  tenuous  relationship  with  the  Day   Program.   the doctor does not  arrive  at  the  clinic  until
                                                                                                               2


               1 p.m. the patients are told to report at  11  a.m.    Presbyterian-University of Pennsylva    nia
               so that they would  be  on  hand  at  the  doctor's               Medical Center (1)
               arrival; 2. the  doctor  would  be  present  today.
               Santo Smith  would  act  as  patient  advocate  and                   Frank Greer
               translator  (Mr.  Cruz  spoke  only   Spanish)   to
               insure  a  successful  outcome.  With  some  diffi-    "Proposed  projects  include   a   Child   Health
               culty  Santo  convinced  Mr.  Cruz  that   it   was    Project  and  developing  roles   for   community
               best for his  health  if  he  went  to  the  clinic    aids  to  reach  people  not  now  covered.  Home
               today. Santo guaranteed  Mr.  Cruz  that  the  out-    visits, group sessions at the hospital and place-
               come would be  diff  erent  this  time.  Santo  and    meiit in the Family Planning Clinic,  birth  con-
               Fidel  arrived  at  the  clinic  at  1  p.m.-"ahead    trol education, or in the receiving ward."
               of the  doctor."  At  2:30  p.m.  Mr.  Cruz  wanted    It was  about  10  weeks  ago  that  I  read  the
               to  leave  because  the  doctor  is  not   coming."    above words  in  a  massive  publication  by  SHO
               Santo  inquired  and  was  told  that  the   doctor    describing  the  various  summer  work  sites  in
               would be  delayed  until  3:30  p.m.  Santo  calmly    Philadelphia.  I   suppose   the   words   "Child
               informed  Mr.  Cruz  that   the   wait   would   be    Health  Project"  attracted  my  attention,   and
               worth  his  while.  At  4:30  they  were   informed    I  made  the  work  site   at   Presbyterian-Uni-
               that: 1. the doctor was  detained  in  surgery  and    versity   of    Pennsylvania    Medical    Center
               would not be in that  day;  2.  clinic  hours  were    (PUPMC) my first choice as a work site.
               over  for  the  week.  Santo  reported   that   Mr.    Arriving  here  in  Philadelphia,  I   hesitantly
               Cruz was extremely agitated.                           decided to live with a black  family  in  Mantua.
                 Friday,  July  19:  Needless  to  say,  by   this    Though  I  went  through   some   traumatic   ex-
               time Fidel Cruz had become      a  legend  in   his    periences,  it  was  an  invaluable  part  of  my
               own  time.  Interest  was  taken  in  his  case  by    summer.  When  the  people   of   the   community
               the  physician  at   the   community   center   who    learned  I   worked   at   PUPMC   they   immedi-
               called the hospital for Fidel's file. In  the  past    ately  wanted  to  "fill  me  in"  on  what  they
               few  months  Mr.  Cruz  had  had  an  X-ray,   EKG,    knew about the hospital.  I  got  many  reactions
               PPD,  and  various  other  tests  to   satisfy   an    from  community  people   about   the   hospital,
               intern's academic curiosity.  There  was  only  one    most of  them  negative.  For  example,  consider
               remark  concerning  Fidel's  hearing  "right   ear-    that case  of  Mrs.  B.,  who  lived  across  the
               drum not visible."                                     street from  me  this  summer.  On  Sunday,  June
                 Monday,  July  22:  The   hospital   ENT   Clinic    23,  she  had   stomach   pains   and   Went   to
               was  called.  The  clinic  may  have  hours  Thurs-    PUPMC.  After  a  long  wait,  which  she  didn't
               day.                                                   seem to mind, she  saw  the  doctor  in  the  re-
                                                                      ceiving  ward  (RW).  He  gave  her  some   pills
                 Wednesday,  July  24:  ENT  Clinic  still  uncer-    and told her  to  call  the  hospital  on  Monday
               tain about hours. Call 12:00 tomorrow.                 for  an   appointment   for   Tuesday's   Medical
                                                                      Follow-Up Clinic. So, at 9 a.m.  on  Monday,  she
                 Thursday, July 25: The  doctor  -will  be  in  at    called  and  was  told  by  the  admission  clerk
               12:30 p.m. but will leave at 1 p.m. if  not  enough    that clinic was in session and  to  "Please  call
                                                                                    pi
               people are  present.  Mr.  Cruz  was  not  able  to    back at I p.m. At 1  p.m.  she  called  back  and
               be contacted. No  clinic  hours  until  next  week.    was told  "The  book  (appointment  book)  hadn't
                                                                      come  back  yet-please  call  back  at  3   p.m."
                  Tuesday, July 30:  Mr.  Cruz  visited  the  cen-    Calling back at 3 p.m.  she  was  told  that  she
               ter today. He felt much better.  He  still  had  no    couldn't get a clinic appointment  bef  ore  July
               hearing  in  his  right  ear  but  his  morale  was    9. She tried  to  explain  that  the  doctor  had
               good.  Mr.  Cruz   had   not   unreasonable   doubt    told her to come  on  June  29.  Ultimately,  she
               concerning the  value  of  his  clinic  visits  and    received a clinic appointment for  July  9.  Mrs.
                                                                      B. was the victim of a great deal of  run-around.
               expressed  a  desire  that  they   be   terminated.    As she did not have a telephone,  this  cost  her
               The physician in  charge  complied  with  his  very    30  cents.  When  asked  why  she  had  gone   to
               reasonable wishes and dismissed him.                   PTJPMC in the first place, she gave as  a  reason

               22


       the  fact  that  her  brother  had   been   treated     2.  Many  of  the  community  people  could   re-
       ,,just swell there." In general,  however,  despite    member, or were  told,  about  the  former  segre-
       her  treatment,  she  described  things  at   PUPMC    gationist policy of the hospital.  They  felt  un-
       ,is "pretty nice."                                     welcome  at  PUPMC  as  people   from   a   black,
         As  another  example,  take   the   case   of   a    economically  deprived  community.   Indeed,   one
       neighbor,  Mrs.  S,  She  related  how   a   nephew    woman  boasted  about  the  fact  that  her  teen-
       had  been  treated  at   PUPMC   two   years   ago.    age son was the first black  baby  born  at  Pres-
       Having  received  third  degree   burns,   he   re-    byterian.
       ported  to  PUPMC  on  Monday,  only  to  be   told     3.  Community   people   were   afraid   of   the
       to  come  back  on  Wednesday.  Instead,  he   went    research"  going  on  in  the  hospital,  particu-
       to  the  Veterans  Hospital  that  very  same   day    larly after its affiliation  with  the  University
       and  was  admitted   immediately.   Mrs.   S.   ex-    of  Pennsylvania.  Many  older  people   expressed
       pressed  disgust  with  PUPMC,   not   being   able    the fear of being used  as  guinea  pigs.  If  one
       to  understand  why  her  nephew   had   not   been    died  at  PUPMC,  then  his  kidneys,  eyes,  etc.
       admitted.                                              were  removed  for  transplants,  and   even   the
         Mrs.  W.,  also  from  the  community   and   who    corpse was given to the medical school.
       was   employed   by   PAAC,   expressed   the   be-     Thus,  as  a  result  of  our  first  two   weeks
       lief  that   PUPMC   was   just   too   "high   and    experience, both  in  and  out  of  the  hospital,
       mighty."  She  recalled  the  time  when  no  black    our point of focus became  directed  at  hospital-
       patients  were  accepted  at   PUPMC-and   a   spe-    community  relations.  This  problem  can  be  at-
       cific  case  where  a  black  nurse  had  sued  the    tacked on two different levels as  is  exemplified
       hospital for the.right  to  work  there.  A  friend    by programs at  several  area  hospitals.  On  the
       of hers had  told  her  that  the  Bookkeeping  De-    one  hand,  one  can  work  towards  the  improve-
       partment   was   "bad"   at   PUPMC.   The   friend    ment of  community  relations  with  the  idea  of
       had  been  billed  repeatedly  for  a  service  for    improving  health  services  to   community   peo-
       which she had paid  before  leaving  the  hospital.    ple already making use of the  hospital's  facili-
       Surprisingly  enough,  Mrs.  W.  thought  that  the    ties.  Such  programs  are  being   conducted   at
       hospital   turned   away   Department   of   Public    Temple  and  Jefferson  Hospitals.  On  the  other
       Assistance patients.                                   hand,  one  can   work   towards   improving   the
         Taking  another  case,  Mrs.  E.  said  that  she    hospital's image  with  the  community  at  large.
       and her family used  the  hospital  regularly.  Her    This  approach  could  not  include  the  specific
       son  was  employed  there.  But  she  did   mention    in-hospital tasks required  of  the  first  level.
       the fact that she had a great  deal  of  difficulty    Rather, it would  involve  close  contact  between
       in  making  clinic  appointments.  When  she  tele-    hospital and community so  as  to  keep  the  hos-
       phoned, the  extension  was  always  busy  and  she    pital informed  of  the  community  health  needs.
       was asked to'  "hold"  or  to  "call  back  later."    The hospital would also be  kept  in  close  touch
       Having  no  phone,  she  found  it  less  expensive    with  other  community  institutions  and  cooper-
       to  spend  50  cents  carfare  and  to   make   the    ate with them when asked  to  do  so.  This  would
       appointment in person at the hospital.                 probably involve the  hospital  in  community  ac-
         Finally, take the case  of  an  old  white  woman    tivities not often considered a part  of  "health"
       living  in  Mantua.  She  reported  that   "Presby-    except  under  the  broadest  definition  of   the
       terian was a good hospital, but  I  wouldn't  touch    word.  Such  a  program  is   currently   underway
       it with a 10-foot pole."                               at Misericordia Hospital.
         After   having   heard   such   comments    about     Our  approach  to  the   problem   of   hospital-
       the hospital, I and my colleagues felt  that  there    community  relations  has  been  on  both   levels
       was a  serious  schism  between  the  hospital  and    this  summer,  though  our  daily   emphasis   has
       community.  We  attributed  this  to  three   basic    been on the first level,  the  theory  being  that
       factors:                                               by  improving  hospital  services,  patients  will
         1.  Patients  Were  generally  dissatisfied  with    act as catalysts to  improve  relations  with  the
       long  waits  in  the  Receiving   Ward   and   felt    community at large.
       that  there  was  discriminating  behavior  on  the     Invited into the hospital initially by Dr     F.,
       part of the RW personnel.                              we began first to investigate his  Pediatrics  and
                                                                                                              23


              Well-Baby  Clinics.  He  had   expressed   concern    it is to be  expected  that  such  patients  would
              that his Pediatrics  Clinic  had  not  been  grow-    not make any  extra  efforts  to  receive  immuni-
              ing appreciably in  the  past  years  and  that  a    zations. The  hospital  would  be  doing  a  favor
              very  high  percentage  of   clinic   appointments    for  themselves  as  well  as  the  community   by
              were  broken.  We  noted  one  fault   immediately    supplying these indigent patients  with  the  nec-
              in  the  appointment  system  for  the   Pediatric    essary   immunizations.   Jerry   Lozner   and   I
              Clinic-patients  were  admitted  only  after  they    made  the  trips  for  these  immunizations   this
              had first  been  seen  in  Receiving  Ward.  Thus,    summer  and  have  worked  out  a  plan  with  the
              a mother  with  a  sick  child  could  not  simply    Volunteer   Department   for   their   continuance
              call up and make an  appointment  for  the  child,    this fall.
              being required first to bring her child  into  RW,      Other  suggestions  for  the  Pediatrics  Clinic
              which  automatically  meant  a  long  and   incon-    included  providing  some  sort  of  entertainment
              venient  wait.  Now  appointments  for  the  Pedi-    for the children. As patients  are  instructed  by
              atrics Clinic can be made directly  by  telephone.    the clinic  admissions  desk  to  register  at  12
              Turning  to  the  problem   of   broken   appoint-    noon for a 2 o'clock clinic, it is not unf air  to
              ments, I began to call  on  all  of  the  patients    ask the hospital  to  provide  the  children  with
              signed  up  for  Pediatrics  Clinic,  on  a  given
              day, on the  morning  of  the  afternoon  appoint-    some  sort   of   amusement.   To   make   matters
                                                                    worse, many patients feel that  if  they  register
              ment.  About  one-third  of  those  patients  whom    before 12 noon, they  will  be  seen  earlier.  Of
              1. was able to  contact,  admitted  they  had  in-    course the  obvious  solution  would  call  for  a
              deed  forgotten  the  afternoon  appointment.   Of    supply of toys  for  the  Pediatrics  Clinic,  but
              those  who  said  they  would  not  keep  the  ap-    then several objections were raised to  this  pro-
              pointment,  about  two-thirds  stated   that   the    posal. It was pointed out  that  such  toys  would
              child  had  improved  significantly  and  that  it    quickly  become  dirty  and  serve  as  germ  car-
              was  felt  that  the  appointment  was  no  longer    riers. However, it is also -noted  that  toys  can
              necessary. The  other  one-third  said  that  cir-    be  purchased  which  can  easily  be  cleaned  by
              cumstances  had  arisen   making   it   impossible    the   Housekeeping   Department,   and    besides,
              to keep the afternoon appointment.  It  is  inter-    many of  the  children's  personal  habits  spread
              esting to note that I met with  very  little  hos-    so  many  germs  around  the  clinic  that  a  few
              tility on these  calls  in  the  black  community.    more  would  not   make   much   difference.   An-
              Many  people   expressed   surprise   that   PUPMC    other  objection  to  the  proposal  was  that  in
              should be so concerned about them.                    many cases the children  would  raise  a  fuss  if
                In another project  in  the  Pediatrics  Clinic,    unable to take  the  toys  home  with  them.  This
              we found  that  many  patients  unable  to  afford    objection can be answered  easily.  It  is  all  a
              immunizations were  being  referred  to  the  Dis-    matter of discreet selection of  the  toys.  These
              trict  4  Health  Center  at  44th  and  Haverford    are indeed  toys  which  children  would  not  ex-
              Avenue.  At  one  time,  someone  from  the   hos-    pect to take  home  with  them,  i.e.,  a  set  of
              pital  had  picked  up  free  immunizations   sup-    wooden  blocks  or  a  black  board   mounted   on
              plied by  the  city  and  brought  them  to  pUpMC    the wall. Or, inexpensive toys could  be  supplied
              for  administering.  However,  it  was  felt  that    which  could  be  taken  home  by  all   children.
              this was not worth the time  of  a  paid  employee    Such  items  can  be  bought  wholesale  at  half-
              so it was discontinued.  We  felt  that  this  was    price, and  the  necessary  funding  can  be  made
              bad  policy  on  the  hospital's  part,  as   many    available  through  organizations  such   as   the
              patients  referred  to  the  Health  Center  would    Ladies Aid Society, etc.
              never bother to make the extra  trip.  Of  course,      After the Pediatrics Clinic,  we  turned  to  an
              it was argued that  this  was  not  any  fault  of    examination   of   the   Emergency    Room.    The
              the  hospital's;  but  such  an  attitude   showed    Emergency  Room  at  PUPMC,   like   many   others
              genuine lack  of  understanding.  People  in  Man-    across the country, is becoming  a  sort  of  com-
              tua are faced with  many  other  priorities  which    munity doctor  on  call  24  hours  a  day.  Thus,
              they usually  place  above  thaf  of  good  health    in  addition  to  non-ambulatory   emergency   pa-
              care. The only time  they  would  bother  to  come    tients, many patients  come  in  with  dog  bites,
              to the institution was when they  are  ill.  Thus,    colds, earaches, indigestion, etc., and they  man-

              24


        age to keep the waiting area filled  at  all  times.     Turning  to  the   out-patient   waiting   area   in
        it is nothing f or a patient  with  a  dog  bite  to    general,  we  have  noted  the  need  for  a   number
        sit from 9 p.m. to 3  a.m.  waiting  for  a  tetanus    of  changes  and  have  been  able  to  effect   them
        shot. To  be  sure,  the  long  wait  could  not  be    in some cases.
        blamed  on  the   nurses   and   interns   who   are     First,  during   the   summer   heat   spells,   the
        always  working  to   capacity.   What   is   dearly    out-patient  areas   are   unbearable.   Temperatures
        needed  is  additional  employees  for   the   Emer-    near  the  100  degree  mark  have   been   reci)rded
        gency  Room,  not  to  say  anything   about   addi-    this  summer.  The  entire  waiting  area  is  served
        ,tional facilities. It is  hopeed  that  paramedical    by  two  small  fans.  Air  conditioners  should   be
        personnel  can  be  hired  to   screen   out   those    installed;   (the   nurses   who   have    air-condi-
        patients  who  can  be  treated  without   the   aid    tioned  cubby  hole,  responded   to   this   sugges-
        of a doctor.                                            tion  sharply:  "Well,  what  did  people  do  before
         It  was  unfortunate  to   observe   that   several    you  had  electricity?")  It  is  realized  that  the
        interns  assigned  to  the   Emergency   Room   were    circuits  in  the   out-patient   areas   are   being
        apathetic   towards   the   patients.   They   would    utilized  to  capacity,  but  something   should   be
        often  verbally  compare  the  patients  to  a  herd    done about the  situation.  It  is  certainly  not  a
        of  cattle  and   administer   inappropriate   care.    very healthy condition as it exists now.
        They  openly   expressed   disgust   with   patients      Secondly,  lighting  is  extremely  poor   in   the
        they  saw  repeatedly.  This  exemplifies  a   prob-    out-patient  areas.  One  would  think  the  hospital
        lem  not  only  for  the  hospital  but  of  medical    was  trying  to  drum  up  business   for   the   Eye
        education  in   general   which   turns   out   such    Clinic.  If  the  overloaded  circuits   negate   the
        products. In  one  case  in  particular,  an  intern    addition of more  lights,  then  either  the  ceiling
        refused  to  become   legally   involved   in   what    or the lights could be lowered.
        was clearly a  case  of  child  abuse.  Fortunately,      Thirdly,   unlike   the   waiting   room   in   the
        this attitude was  not  characteristic  of  all  the    ground  level  of  the  Private   Wing,   out-patient
        interns.                                                areas   are   not   supplied   with   magazines.   We
         There are several  obvious  faults  in  the  opera-    instituted  the  placement  of  magazines  in   these
        tion  of  the  Emergency  Room  which   can   easily    areas  this  summer  and  hope   the   project   will
        be corrected.  For  instance,  at  night  the  Emer-    be   continued   by   the    Volunteer    Department.
        gency   Room    handles    compensation    patients.    Still  needed,  however,  is  a  selection  of  maga-
        They  are  given  first  consideration   and   their    zines  which  circulate  almost   exclusively   among
        names  are  placed  ahead  of  all   other   waiting.   black people-Jet, Ebony, etc.
        persons. The unf  ortunate  part  is  that  most  of      Fourth,  at  the  beginning  of  the  summer,   the
        these  compensation  patients   are   white.   Thus,    restrooms  in  the   out-patient   area   were   very
        to  the  black  patients,  it  appears  that   white    unsatisf  actory.  At  times  they  were  so   filthy
        patients receive  preferential  treatment,  as  they    and smelled so  badly,  that  it  was  an  insult  to
        do not have  to  wait.  This  situation  does  noth-    use  them.  After  dropping  a  few  hints   in   the
        ing  toward  improving  the  hospital's   image   in    right  places,  we  are  happy  to  note  that   con-
        the eyes of the community.                              ditions  have  improved  considerably  in  the   past
          Another  hang  up  in  the   Emergency   Room   is    month.
        the  "temporary"   appointment   cards   which   are      Fifth,  a  program,  which  has   been   instituted
        dispensed  to  patients  referred   to   a   daytime    at.Jefferson  Medical  Center  and  is   planned   at
        clinic. Patients se e the  date  filled  in  on  the    Temple,  is  a  milk  and  juice  service  in  clinic
        card (if they  are  able  to  read)  and-think  they    areas   during   peak   hours.   At   Jefferson    no
        already  have  an  appointment.  You   can   imagine    charge is made to  the  patients,  but  it  could  be
        their chagrin when they  show  up  for  clinic  only    instituted for a small  fee  if  necessary.  Proceeds
        to find that it is closed or that the  date  written    from the sale could be used     .for  a   scholarship
        in on the card is an  incorrect  one.  The  appoint-    fund, etc. Many patients arrive in     Ithe   hospital
        rne,nt  must  be  confirmed  by  a  telephone  call,    without  breakfast,  not  realizing  the  long   wait
        and as we  have  already  noted,  this  simply  adds    ahead of them.
        to the  critical  telephone  line  shortage  in  the      Sixth,  one  aspect  of   the   clinic   admissions
        morning hours at the clinic.                            desk  which   bothered   us   was   the   fact   that
                                                                                                                   25


                                          numbers   and    letters    diate  community   compete   for   the   positions
                patients were called by                  certainly    which require one to be on the  job  five  days  a
                rather than by their names. This was                  eek from 10  to.3. If it can be  done  at  Temple,
                a very dehumanizing  experience  on  the  part  of    w                                            eeded
                the patient. Recently,  we  have  cooperated  with    it can be done at PUPMC. All that is n
                the clinic admissions desk in instituting  a  sys-    is a little initiative.
                tem of registration  whereby  the  patient's  name     Consider the  case  of  R.obert  P.,  a  black  14-
                is used, not his number or letter.  We  hope  that    year-old  who  lives   about   two   blocks   from
                this procedure will be continued in the fall.         PUPMC.  Robert  was  one  of  two  students   rec-
                 We  have  also  done  some  work  on  the  second    ommended  by   Salzberger   Junior   High   School
                level  of   hospital-community   relations-improv-    for  volunteer  work  at   PUPMC.   Having   spent
                ing the hospital's image  with  the  community  at    some time here last year  as  a  patient,  he  was
                large. We  first  considered  the  possibility  of    excited  about  working  in  the  hospital.  As  a
                putting  more  community  people  into  the   hos-    matter of fact,  I  talked  with  several  of  his
                pital, either on a salaried or a volunteer  basis.    friends who said that all  he  ever  talked  about
                Looking first  at  the  employment  situation,  we    was hospitals  and  doctors.  Robert  reported  to
                found  room   for   improvement.   For   instance,    the Director  of  Volunteers  and  was  told  that
                there were  80  vacant  positions  for  nurses  in    he might be placed in  one  of  the  laboratories.
                the hospital in July.  Forty  of  these  were  for    A few days later,  he  received  a  letter  f  rom
                R.N.'s.  Twenty  were  for  senior  nurses'  aides    PGH  saying   that   he   had   been   recommended
                and 20 were for junior  nurses'  aides.  To  qual-    to  them  by  the  Volunteer  Director  at  PUPMC.
                ify  as  a  senior  nurses'  aide  at  PUPMC,  the    He worked  at  PGH  this  summer,  and  the  labo-
                candidate must have  two  years  of  previous  ex-    ratory  jobs  at  PUPMC  were   given   to   white
                perience as a senior nurses' aide,  yet  there  is    boys (probably  sons  of  doctors)  of  about  the
                no program  here  where  the  necessary  2  years'    same  age.  As  many  positions   as   PUPMC   has
                experience can be gained. Also, the  hiring  prac-    open for volunteers, Robert  P.,  a  student  from
                tices of  the  hospital  are  very  much  open  to    the  community,  was  recommended   to   PGH.   In
                criticism. Applicants  for  employment  are  often    mid-July, Robert, who  still  wanted  to  work  at
                rejected  because  they  wear   "large,   dangling    this hospital, applied  for  employment,  only  to
                earrings"  or  "too  much  eye  shadow."  We  were    be rejected on  account  of  his  age.  That  same
                never  able  to  procure  the  necessary  informa-    week,  another  14-year-old  was  hired   by   the
                tion to  determine  the  percentage  of  employees    Dietary  Department  as  part  of  some  sort   of
                from  the  immediate  community,  as   there   was    Youth Corps  Program.  But,  this  same  hospital,
                no way of finding  out  that  information,  so  we    several days  before,  bad  no  place  for  a  boy
                were told.                                            of  the  same  age  and  of  a  very  enthusiastic
                  We  also  were  interested  in  recruiting  more    -nature.
                black  volunteers  at  PUPMC.  During   the   sum-      Still  another  aspect   of   hospital-community
                mer  months,  PUPMC,  a  hospital  in  the   midst I  relations on this level  is  the  cooperation  be-
                of  a  black  community,  had  no   black   volun-    tween  hospital  and  other   community   institu-
                teers.  During  the  remaining   months   of   the    tions. We have  successfully  opened  up  a  chan-
                year,  PUPMC  has  only   one   black   volunteer.    nel  betwen  PUPMC   and   Drew   School   located
                The  Volunteer  Director  admitted  that  no   at-    about two blocks east  of  the  hospital,  through
                tempt has been made  to  organize  an  active  re-    discussions  with  the  principal.  As  the   same
                eruitment  program.  As  a  matter  of  fact,  the    families make  use  of  both  institutions,  there
                neighborhood  Presbyterian   Churches   have   not    is certainly value in mutual cooperation.  In  the
                even  been  approached.  It  is  thought  by   the    fall,  both  institutions  are  beginning   commu-
                director that the most  reliable  volunteers  from    nity  advisory  committees  on  which   a   repre-
                the  black  community  are  just  not  dependable.    sentative  from  each  institution  will  sit.  An
                Though this may be the  case  in  some  instances,    agreement  is  in  the  works   between   Hematol-
                and  it  may  be  true  that  most  black   people    ogy and Drew  School.  Hematology  plans  to  test
                from the community  cannot  afford  to  volunteer,    the school children for  anemia  in  return  gain-
                the  fact  remains  that  at   Temple   University    ing data for its research on  sickle-cell  anemia.
                Hospital,  black  candystripers  from  the   imme-    It  is  presumed  that   PUPMC   could   cooperate

                26


        similarly   with   the   community    institutions-   Indeed,the impatient  advocate"  will  come   under
        schools, churches, YGS Health Clinic, etc.            a great  deal  of  pressure  from  members  of  the
         Another  way  the   hospital   could   serve   the   establishment who  will  feel  threatened  by  this
        community-at-large  is  in  the  area   of   family   new approach of  the  hospital.  To  prevent  this,
        planning  or  sex   education.   A   representative   it will probably be  necessary  that  the  "patient
        from  Mantua  City  Planners  met   with   us   and   advocate" be  contracted  through  a  third  party,
        discussed the great need for service of  this  type   such   as   diversified   university   settlements.
        in  Mantua.   The   SHO   group   at   PUPMC   this   Though this will  certainly  be  a  difficult  step
                                                              for PUPMC to take, I  believe  that  it  is  neces-
        summer  has  attempted  to  get  an   unwed   moth-
        ers' group going.  It  is  felt  that  these  young   sary to assure  that  what  happened  to  hospitals
        girls  who  face  so  many  problems   would   find   in  Newark  and  Rochester  does  not  occur  here.
        it of value to share  their  experiences  with  one
        another. We have also met with  a  clinical  teach-     Presbyterian-University of Pennsylvania
        ing nurse  at  PUPMC.  Out  of  this  meeting  came                 Medical Center (11)
        a  number  of  suggestions  and  ideas,   including
        a possible sex  education  program  to  be  set  up                    Jerry Lozner
        by Drew School  to  be  taught  by  student  nurses
        at PUPMC.                                               As  a  medical  student,  I   have   become   in-
         The  white  man  can   only   play   a   secondary   creasingly  aware  of  many  of  the   shortcomings
        role in improving the lot  of  the  people  in  the   in the health care delivery system.  I  joined  the
        black  ghettos.  It  is  these  people   who   must   Student  Health   Organization   and   became   in-
        become  cohesive  and  work   together   to   enact   volved  in   the   Philadelphia   Summer   Project,
        the  necessary  changes.  Fortunately,  the   corn-   because many  of  SHO's  goals,  as  I  interpreted
        munity  of  Mantua  is  showing   signs   of   this   them  for  myself,  have   been   extremely   mean-
        new  cohesiveness,  especially  through  such   or-   ingful for me. The ideas behind SHO      and    the
        ganizations   as   Mantua    Community    Planners.   Summer Project were many:
        It  is  easy  to  put  a  few  magazines  in   out-     1. To orient the health science  student  to  the
        patient areas or  to  roll  a  juice  cart  through   patient as a  social  being;  to  look  beyond  the
        the  clinic  areas,  but  these  changes  by  them-   patient to his  environment;  the  nature  of  pov-
        selves will accomplish little in the field of  hos-   erty and its effect on the patient  is  often  neg-
        pital-community  relations.   Unless   the   people   lected. The  products  of  such  an  education  are
        of  Mantua  have  a  voice  in   enacting   changes   physicians  and  nurses  who  are  skilled  in  the
        in  PUPMC's  policies,  such   changes   will   not   techniques  of  their  professions,  but  who   are
        be  appreciated.  Without  this  community   voice,   woefully  ignorant  of  the  sociological   factors
        the hospital can make  no  positive  moves  in  the   which affect the   .lives of their patients.
        direction  of   improving   the   rapport   between     2. To develop  a  new  model  of  health  science
        the hospital and  community.  I  believe  that  the   education,  with  a  high  degree  of  student  ad-
        time  has  come  when  the  consumer  should   have   ministrative leadership and  new  ties  Nvith  com-
        a voice in defining  the  policy  of  the  hospital   munity groups, which  could  be  applied  to  medi-
        which   provides   community   health   care.   One   cal  training  programs  throughout  the   country.
        method   of   instituting   this   new    community     3. To demonstrate  an  active  interest  in  com-
        voice   would   be by filling the  position  of  "pa- munity  medicine,  a-nd.change  in  health  science
        tient    advocate" with   a   Black   American   from education;  to  recognize  failure   of   curricula
        the     community. Hopefully,  this  person  will  be to come to grips with the biosocial issues  of  the
        able to set  up  acommittee   of   community   lead-  day . . . abortion,  population  control,  poverty,
        ers   which   will function  together  with  a   par- racism,  euthanasia,  drug  addiction,  war,   etc.
        allel    committee of  hospital  personnel  in   mak-    4.  To  become  personally  involved  with   the
        ing new  policy  as  well  as  redefining  existing   social issues, so  our  understanding  can  be  in-
        policy.                                               creased  and  our  opinions  become  informed   and
          To   be    sure, there  is  the   imminent   danger vital.
        that this  individual  will  be  absorbed  and  be-      5.  To   implement   a   multidisciplinary   ap-
        come an  additional  organ  of  the  establishment.   proacb to health care.
                                                                                                                27


                                                                                                     foliated with the        UniversitY         of         Pennsylvania
                                                        new          breed          of          health     ago     really     implied     some      kind      Of
                      6.   To   help    develop    a                       new                    pri- several years to         this         particular         Olnmun'ty'
                                       ho    is    prepared     to     adopt courage                 porflnitment                of       economically       de-
                   professional        W                l  lif  e   and   en elp                     but ,coniprised Principally d                downwardly-mo-
                   orities     in     his     professions his    cannot     h                        prived Afro-Arnericans all  .                     outsiders
                                       do likewise. T                                                                                iective
                   his    fellows     to                ed    patterns    of health                           ericans.11 As ob.                 -th          the
                                       ely   to   irnprov                                            bile White-Anl       be concerned WI
                   lead         ultiTnat                                                             looking in, we were to      v     and     hospital-     Why
                    care.                                       year's                         Chicago                           it@         -nt?            Why
                                                  Irorn    last                                      rapport    between     commun lionexiste
                                       student          nted,             44Today's             rnedi-                   most              sed      only      to
                       A         Ynedica                                                             was  such  a  rapport  al   .sbeing     u
                    Summer         Project         cOrIlm                  r                  diseases were several  of  the  e-"D'c e       Pediatric       Clinic?
                    cine   man   tries    to    Put    P(                  s          of           the ited  extent,  especially  th   that       we       would
                                                                                               @..F
                     in    context;    to    see    alcOl                  ill te                    @ 1,T               we agreed                  t        the
                                       the   ghetto;                       ch                   create Anct from the outset,                                some
                     despair         of. al  injustice                                               go beyond just becoming aware ot         wha
                     of     the     soel                           or           hostile            pa-  were, to also set the seeds for               "the
                     slum    housing;     to     see    a          which                       society problems     . It was hoped that we,           kers
                      tient   in   terms   of    the    a                  man                     who concrete solutions        community          wor
                                                        doctor    's       a                         student  fellows,   and   the
                      fosters.     The     new      breed medical      help       is       ,       right                 congruent      enough      to      hear
                                                                                                     would be personally                   were          saying,
                      considers      that       receiving                  ct        of         niedi- ,vhat persons in the community             ough        to
                                       onsiders   that   the    only    aFpe medicine."                     be personally congruent ell
                      and     who      cis   a   privilege   is    practicing nd,          I          set and would              .  g  to  each   other."   This
                       cine         that      -range     goals     in     mi                         hear  what  we   were   BaY'n    o     the      institution
                       With  these  long           some              realistic              short-term precaution and commitment t     id    be    leaving    ir
                       down  for  myself                                   .ect                   which and to the community we wou             er   a    'rnOrl
                                       the  summer   and   f   or   a   Pro'                                                     ake the sumrn
                       goals    f     or     ly       health       !cience        students,        but 10   weeks   would   help   Mxperience    for     all     in
                        involved not On                 @,,        high        school         students valid     and      worthwhilee
                                       .ty   workers    a                                                                                             .   4.   a
                             col,,Triuni                                                             volved.                        carae     to     was      th
                        as         well:           seeds       for       students       to       start The first    ;realization    Inipose     their      value
                            1. To plant the             achieve            their            long-range white people can no longer   i
                        thinking     how     to      best                                                      ple.   The    black    people    have    a    ver
                                                                                                     on black P@O                   -     of      their      own
                         goals.                                     conln-Lunity                  rap-           e and tradition
                                To implement in any Way                                              strong cultur               ud, along with  a         grown
                                                              comynunity                       rapport
                                                        Tis or                                       xhich   they   can   be   )ro           is      realization
                         port       with        institute                                            need to help themselves. With th          cus    of    Tned
                          with health science 13erso'nnel-                 the        people        ol recalled the words of a black cau
                                                        ogether         @ith                                                        this    vearg    6'lf    whi
                             3.   To   arrive    at)    t     eecis       for       better       serv-   dents from earlier
                                       munity,    concrete    n                                      cal Stu                     rojects   do   'not   have   tb
                          the        com                stitute       these.needs       as       prac- students   on   ,ulnrner    Pthe    projects    again    tu:
                                       dto     help     in improving        the        health        care           understanding,                   aternalis'@
                          ices        an                                                             kind Of                     mer of white P
                          tices       in specifically   nce system.                                  into    yet    another    sum re rnindlessy.  self  ness  sei
                           delivery      and       grieva poverty        area        high         school another     sumriier      whe
                                                                                                                                 6vert     palliation,     anOt@
                              4.       To       encourage                       into               the                ard   in   c                             jgg(
                                       ts to continue their education                                ice finds its rew                           the           n
                                  studen                                                             summer in the sun learning how
                            prof essions.               some      of      mv aspirations              as live.@@
                               These      then       were                  Hospital              sorie Hospital    personnel    were    inf     ormed     of     c
                                       -n    working     at     Presbyterian 1)       consisted       of       through   a    letter    asking    f    Or    tl'
                            I       bega eks    go.    our    working    grou,                       elf, presence               i   icisrns.   Community    peo
                            lo        we  a_            nts,      Frank      Greer       and       MYs suggestions   and    er    t' y   word   of    mouth    @
                            two      medical       stude. y      workers,      both      of       Nvhorn learned of our presence b                  unity     m@
                                       two     corninunit                  ity     of     the     hos-
                                       ithin   the    so-called    corntnull                         through attendance at ,everal COMM
                             and                                                                                                 inning  to   make   initial   c
                             live      wWe    were    f     ortunate     enough     to     have     two ings.     We     were     beg
                                  pital.                            to      assist      and      guide
                                    very interested preceptors,                                      tacts                                      al   was   thro,
                                                                                                                                 ,to the hosPit .
                                       0    eff     orts.                                             My    first    insight     iet  which  -is  given  to   all
                                                                         UF
                              us in  ur                                    ,   that    the    @ledical
                                                        informed                                     its      welcome       PamPhl                     following
                                 The           preceptors                  d    about     the     sig-        S.  on the first pagey the
                                                        iallY       concerne                                ent                             4eare    for     the
                              Center      was       espec                  .es    for     the     Corn- Pat'   d.   "Founded   in    1871    to
                                       ance    of    its    health    servic                         state    .                  no   patient    excluded    fl"
                                   nific                                   s    decision    to     re-        s   ed,         with
                                                        The        hospital'                         af- and di abl
                               munity      at      large.     phia        when        it        became
                               main    in     West     Philadel


                                            ry   or   color,'    coffee would  be  dangerous  as  far  as  the  safety
        benefits by reason of creed, count
        The  Center  has  built  its  reputation  on  medical    of the babies was concerned.
        and surgical aid, nursing  care  and  the  'spiritual    From  the  Pediatrics   Clinic,   we   expanded   our
        consolation'  provided  its  patient."  This   state-    observations   to    the    Pre-Natal,    Post-Natal,
        ment,  of  course,  wa@  highly   inconsistent   with    Family   Planning   Clinics,   and   the    Receiving
        the  feedback  we   were   getting   from   community    Ward.   The   community   workers   began   to    get
        people about the  hospital.  It  was  felt  that  the    together  a  group   of   unwed   mothers   for   the
        Medical Center, since  it  once  catered  to  a  cer-    purpose   of   having   a   meaningful    interchange
        tain  class  of  white  people,  had  remained   high    in  the  discussion  of  common  problems  and   baby
        and mighty.  Only  now  that  this  class  of  people    care.  Frank  and  I  began  looking  into  the   ap-
        was  gone,  were   community   people   welcome.   It    pointment  system.  I  began   to   look   into   the
        was  felt  that  the  hospital  was  using  the  com-    nature  of  the  appointment  card  which  is  rather
        munity.  The   research   and   experimentation   go-    confusing,  especially  for  patients   who   receive
        ing  on  here  at  the  hospital  instilled  fear  in    it after 5 p.m.  The  card  indicates  that  the  pa-
        many   of   the   community   people.   They   feared    tient is referred to  one  of  the  specific  clinics
        organ  transplants  or  losing   blood   for   sickle    on  a  particular  day,  but  few   patients   remem-
        cell  anemia  studies.  Many   people   didn't   know    her that they must call  in  the  next  day  to  make
        that  DPA  was  recognized  by  the   hospital.   One    their  actual  appointment.  The   small   print   at
        person  believed  that  the  first  black  baby  born    the  bottom  of  the  card  reminding  them  of  this
        in the hospital  was  delivered  only  5  years  ago.    can  often  be  overlooked.  The  card  should  state
        Others said that  they  would  rather  go  to  Phila-    at  the  top  in  large  letters,  "THIS  IS  NOT  AN
        delphia  General  Hospital  for  their  own  reasons.    APPOINTMENT;        FOR        CLINIC        APPOINT-
        The  basic  problems  seemed  to  be  a   poor   rap-    MENT    CALL    EV    2-4200,    EXT.    308,     BE-
        port,  poor  communications,  and   a   poor   under-    TWEEN   9-10   A.M.   Provision   should   be    made
        standing on both ends.                                   so  that  when  they  do  call  there  is  more  than
         Still  other  people  we  talked  to  discussed  the    one  open   telephone line  to  receive  their  calls.
        confusion in  the  out-patient  areas  and  the  long    Too  often  the  lines  are  busy  for  such  a  long
        waits.   Others   didn't   understand   the    Glover    time  that   patients give   up   and   forget   about
        Clinic  and  its  heart  surgery.   We   found   that    their    appointments or  come  in  at   the   printed
        many  of  the  people  who  came   to   clinic   were    tentative  time  only  to.  find  that  they   cannot
        really not  the   ones   who   needed   medical   care   be taken.
        most. Preventive   medicine   was   something    that     This  problem  can  be  solved  in   several   ways.
        many  people  either  were  ignorant   of   or   con-    The  most  obvious  solution   would   be   to   move
        sidered  unimportant.   The   major   concerns   were    the  appointment  books   down   to   the   Receiving
        the day-to-day affairs, and  a  laceration  or  gush-    Ward at night.  It  is  not  necessary  to  move  all
        ing blood would be one of those.                         of the clinic books.
         We  spent  our  first  2  weeks  at   the   hospital     Among  the  people  we  came   into   contact   with
        finding  out  more  about  each   other   and   meet-    were  the  Director  of  Public  Relations,  the  Di-
        Ing  many  people  in  the  hospital,  both  in   Ad-    rector  of  the  Volunteer  Service,   the   Director
        ministration  and  on  the  medical  staff.  We  were    of   Personnel,   Director   of    Admissions,    and
        becoming  increasingly.  aware   and   sensitive   to    many  others.  All  of   these   people   were   very
        the  problems,  and  we   started   discussing   what    willing to  help  us,  although  some  did  not  seem
        we could do about them.                                  aware  of  what  the  problems  were  or  that  prob-
          We  Worked  out  of  the  Social  Service   Depart-    lems  even   existed,
        me,nt, and  we  received  a  lot  of  help  from  the      I  took  care  of  getting  together  a   Hospital-
        staff  of  that   department.   We   attended   Pedi-    Community   Newsletter.   The   purpose    of    this
        atrics  and  Well  Baby  Clinics  and  spoke  to  the    newsletter  'was  to   let   the   community   people
        mothers  as  they  waited  for  the   physician.   As    know  what.  facilities   were   being   offered   to
        we  talked,  we  observed.  We   thought   at   first    them  here  at  the  hospital,  what  job  and   vol-
        that  it  might  be  a  good  idea  to  serve  coffee    unteer  opportunities  were   available,   and   most
        to@th                                               re   important,  how   to   go   about   making   an   ap-
          I  ege  mothers  as  they   waited,   but   we   we
        advised that because of the er
                                         owded   space,   hot    pointment.  There  was  no  pamphlet  of   any   kind
                                                                                                                     29


                                                       how            to all about.  And  I  could  hardly  find  words  to
                 available to the out-patient to tell him              answer the intern who  called  these  people  ani-
                 use  the   clinics.   Pertinent   telephone   -numbers, als  and  looked  at  our  future   as   extremely
                                        nts    could     be     directed in
                 suggestions, and complai                        Perhaps futile. When the  4-year-old  male  came  in  with
                 to the Social Service Department.                                  tracted     from     a     6-year-ola
                 then,   by   working   together,   we   could   attempt gonorrhea  con         ss   could   and    would
                 "to  bridge  the  gap  between  institution  and   com- female, I knew that progre
                 munity."                                              come through education. I  hoped  that  it  wasn't
                 The   followup   on   the   newsletter   brought   sev- true that the  United  States  could  be  compared
                 eral    interesting    responses.    Major     response to a poker game in  the  Old  West;  when  a  cow-
                 from  the  community  is  yet   to   come,   but   many boy  was  caught  cheating  he  would  either   be
                 people  were  no   doubt   pleased   to   learn   about 'Killed by the others at the table,  or  his  win-
                 the  hospital's  interest.  Several  nurses  from   the nings would be split up  among  them.  Our  racial
                 Receiving   Ward   commented    on    one    particular Problem  has   been   compared   to   that   poker
                 statement   in    the    newsletter,    "The    Medical game.  The  blacks  have  found  that  the  whites
                 Center   through   the   Receiving   Ward   tries    to have been cheating them,  and  either  we'll  have
                 function  as  the  family   doctor   for   the   commu- to shoot it out with each other,  or  be  prepared
                 nity,  24  hours  a  day,   7   days   a   week."   The to  share  what  we  have.  We  must  be  prepared
                 community   had   been   informed   of    a    constant now to dispel the idea of  white  racist  institu-
                 service;  the   Receiving   Ward   was   staffed   only tion.   Now   that   communities   are   demanding
                 sufficiently   to   supply   an   adequate    emergency relevance,  institutions  must  stop  ducking  be-
                 service.  Here  arose  another  incongruity   in   com- hind  elegance.  The  hospital  must  be  prepared
                                                                       to listen to  the  needs  of  the  community.  And
                 munications which demands evaluation.                 if  sex  education  is  an  important  need,  then
                 Frank  and  I  looked  into  the   areas   around   the steps  should  be  taken  to  fill  that  need.  I
                 hospital where our out-patients come     -fr          M. have given the  clinical  nursing  instructor  re-
                 About  3,500   patients   used   the   clinics   during source  material  from  the   large-scale   health
                 the  month  of  April,  and  we  plotted   their   geo- education  program  being  carried  on  at  Lanke-
                 graphical  distribution  on  a  map.  It   was   indeed nau Hospital.  Miss  H.  has  contacted  a  family
                 difficult  to  define  the  community   of   the   hos- planning  registered  nurse  who  would  be   glad
                 pital.  Mantua   wasn't   the   hospital's   community; to  take  the  program  under  her  auspices,  al-
                 in  fact,  there  was  a  proportionately  small   num- though she would have  little  time  for  actually
                 ber  of   people   coming   from   the   Mantua   area. running  it.  Mrs.  S.  has  indicated  that  Drew
                 Powelton  Village  had  been   torn   up   by   reloca- School would  be  an  excellent  source  of  young
                 tion,  another   sore   spot   in   community   discus- people. So, this then is one  program,  the  corn-
                 sion  of.  the   -hospital,   and   there   were   many pone-nts of which  can  easily  be  put  together.
                 patients coming from miles away.                       We  also  were  concerned  with  the  fact   that
                  With  the  start   of   the   Young   Mothers'   group few  people  from  the  community  were   actually
                 and   the   availability   of   cafeteria   rooms   for
                                                                       employed by the hospital at levels  above  kitchen
                 legitimate  community   meetings   in   the   evenings, and  maintenance  staff.  We  did   realize   that
                 we  realized  that   the   hospital's   commitment   to many  people  from   the   community   could   not
                 the   community   fell   within   the   definition   of present the  necessary  qualifications.  Yet,  the
                 health  in  its  broadest   terms.   We   contacted   a
                 clinical  nursing  instructor   about   the   possibil- hospital could use 20 more senior  nurses'  aides.
                 ity  of  involving  the  student  -nurses  in   a   sex The problem is that  to  be  a  nurses'  aide  one
                 education   or   health   education    program.    This must  have  2  years'  experience  as  a   nurses'
                 was   something   that   members    of    the    commu- aide.  An  aides  training  program  possibly  run
                 nity had expressed a need for.                        by the nursing school would be  a  valuable  asset
                   It wasn't until the  first  night  that  I  spent  in to hospital and community.
                 the   Receiving   Ward   that.   I   became   impressed Our  main  focus,  then   became   closing   the
                 with  how  cruel   and   brutal   life   can   actually gap  between   institution   and   community   and
                 be.  After  seeing  a   gunshot   wound   and   several what  might  be  done  to  improve  the   rapport.
                 lacerations,  I  felt  my  stomach  sort   of   turning we  began  seriously  investigating  the  area  of
                 over  inside.  I  even  asked  myself   what   it   was patient relations.  We  found  that  several  pro-

                 30


        grams  in  patient  relations  and   community   re-     tee  would  consist  of  community  leaders  drawn
        lations were already  in  existence  at  other  hos-     together by the patient advocate;  the  other  and
        pitals in Philadelphia.                                  parallel  committee  would  be  composed  of   ad-
        The assistant director of ambu a        y      serv-     ministrative and medical staff  of  the  hospital.
        ices  at  one  near-by  hospital,  was  on  of   the     Together,  these  two  committees  could  function
        people we got  in  touch  with.  There  he  has  es-     to work on new  policy,  as  well  as  improve  on
        tablished  both  a  patient   relation   coordinator     existing policy. In  other  words,  for  the  hos-
        and  a  community   relations   coordinator.   Their     pital to be  really  accepted  by  the  community,
        main intent is  to  make  the  patient's  stay  more     the  community  must  be  involved  in   desicion-
        comfortable.   Small   overtures-juice   and    milk     making.
        for patients who  have  to  wait,  magazines,  clean     Another   valuable   resource   person   we   came
        toilet facilities, furniture and toys for the  pedi-     in contact with  was  the  Assistant  Director  of
        atrics  playroom,  etc.-receive  quite  a  favorable     University  Settlements.  He  introduced   us   to
        response.  In  poverty  areas  particularly,  favor-     his  "Design  for  Service  Delivery  that   Rein-
        able,  as  well  as  unfavorable,  impressions  move     forces  Constructive  Tension  Between  a   Health
        quickly  by  word  of  mouth.  He  has  been  aiming     Center  and  Its  Consumer   and   Supports   Com-
        to add the humanistic touch  to  the  services  ren-     munity  Power."  He   emphasizes   the   following
        dered in the out-patient area.                           premises:
        The   Community   Relations    Director    at    an-     "1.  Individuals   within   a   residential   area
        other  hospital,  which  is  white,  Catholic,   has     need  their  own  effective  community   organiza-
        quite a difficult task  for  himself.  As  the  only     tion structure if they are  to  deal  meaningfully
        black person on  an  administrative  level  at  this     with the problems they are experiencing.
        hospital, he faces the  impossible  or  rather,  ex-     "2.  A  geographic  area  needs  a   broad   based
        tremely difficult job of helping.a   white   Catholic    community association that  proceeds  in  a  demo-
        institution  relate   to   a   predominantly   black     cratic manner  and  is  controlled  by  residents.
        Protestant  community.  He  hopes  to   have   serv-     "3.  A  citizen  organization  is   representative
        ices  rendered  by  the  hospital  which  not   only     of a community  as  long  as  it  remains  unchal-
        keep the  community  healthy,  but  happy  as  well.     lenged.
        He  has  organized  a  dance  for   the   teenagers,     "4.  Public  and  private   service   institutions
        study areas  for  the  students  in  the  community,     that are  truly  accountable  to  their  consumers
        and  an  enrichment  program  for  the   youngsters.     will  choose  to  support  rather  than  undermine
                                                                 community structures.
         At still  another  hospital  the  director  of  pa-
        tient  relations  has  done  an  admirable  job.  In     "5.  Institutions  that  desire  horizontal  rela-
        response to a  noise,  dirt,  and  confusion  letter     tionships  need  to  provide   independent   funds
                                                                 for a community organization service."
        drawn up by  several  physicians  in  the  hospital,     He  has  come  into  contact  with   PUPMC's   As-
        she organized a  committee  to  look  into  some  of
        the inadequacies of  the  hospital  as  far  as  pa-     sistant Administrator  and  hopefully  their  con-
        tient relations,  and  to  try  to  respond  to  the     versation will be ongoing.
        Patients' needs. The  head  of  each  staff  in  the
        hospital is  always  ready  to  address  himself  to          Proposal For Position of Patient
        a problem as  it  comes  up.  The  hospital  quickly                       Advocate
        recognized the  usefulness  of  her  work,  and  her
        department  has  now  expanded   to   four   people.     Goals:
          Here  at  PUPMC,  we   have   presented   a   pro-     1.  To  be  a  human  link  between'the   institu-
        posal for the position  of  patient  advocate.  This     tion and the  immediate  community,  so  that  the
        is  a  community  person  who  could   function   in     care of patients  will  acknowledge  their  human-
        the field of patient relations  and  actually  be  a     ity and affirm their  dignity  as  persons;  hope-
        human  link  between  the  hospital  and  the  corn-     fully, this will make the patients' hospital visits
        MunitY. This step  of  course  would  only  be  like     as comfortable as possible.
        Placing a foot in the  . door  toward   a   solution     2.  To   work   imaginativel   with   professional
                                                                                            y

        to the pr
                 oblems  we  are   confronting.   Two   com-     personnel  in  the  continuing   evaluation,   re-
        rnittees  would  have  to  be  formed.  One  commit-     shaping  and  development  of   health   services.
                                                                                                                  31


                                                           the           So- social  dimensions  of  their  medical   problems   as
                   Departmentally, working out of either                   -it  might  be.  In  other  words,  the  hospital   has
                   cial Service Department  or     the     assistant      ad                            ilable   to   the    com-
                                            be     the     most     suitable resources which it makes ava            re       not
                   ministrator's ofrice would                              munity but, because these resources a
                   context.                 many      of      whom       are limitless,  it  wishes  to  make  the  most   economic
                   3. To advise patients,   cedure,     of     the     steps use  of  them.  At  the  same  time,  while  the  com-
                   confused by  hospital  pro                              unity  is  not  equipped  to  treat   its   Own   ill-
                   to  be  followed  in   gaining   admission   to,   locat- in
                   ing and  using  the  clinic  facilities  in  the  Medical nesses, it  does  know  what  its  illnesses  are  and
                   Center;  to  be   the   patients'   advocate   with   the could  help  the  hospital  identify  needs  to   help
                   hospital   in   reporting    grievances    about    serv- facilitate and economize  in  the  delivery  of  serv-
                   ices,  and  to  carry   out   in   depth   followups   on ices.  If  channels  for   informing   the   community
                   specific  patient   problems,   as   well   as   specific about  medical  services  could  be  opened   up   and
                   tasks  related  to  making  the   patients'   stay   more if  channels  for  listening  to  the  needs  of   the
                   comfortable.                                            community  could  be  developed,  delivery   of   med-
                   4.  To  continue  to  inform   the   hospital   of   com- ical care could be greatly simplified.
                   munity   health   needs    by    facilitating    communi- PUPMC   has   been   struggling    to    define    its
                   cation   between   community    leadership    and    this relationship   with   the   community   f   or    many
                   institution.   This   would   involve   setting   up    ayears. Now that it finds  itself  placed  in  an  area
                   committee   of    community    leaders    which,    func- comprised  principally   of   Black   Americans,   the
                   tioning   together   with   a   parallel   committee   of Medical  Center   which   held   itself   aloof   from
                   hospital   personnel,   could   work   on   new    policy the  community  bears  the   stigma   of   discrimina-
                   formation,   as   well   as   making    needed    changes tion   against   the   community.   This   makes   the
                   in existing policy.                                     practice   of   good   medicine   difficult.   Turning
                   5.   To   be   a   liaison   between   this   institution now   toward   the   black   community,   little   has
                   and   the   other   institutions   serving   the   commu- been  done   to   acknowledge   or   deal   with   the
                   nity.                                                   hostility generated  out  of  a  history  of  unf  or-
                   Since   the   goals   outlined   above   will    probably tunate community relations.
                   prove   too   much   for   one   person,   we    conceive Affiliation   with   the   University   of   Pennsyl-
                   of   handling   these   goals   in    two    phases    or vania  was  a  function  of  the  hospital's  decision
                   through  two  people.   For   instance,   initial   focus to stay in  the  community  and,  at  the  same  time,
                   might  be  on  the  first   three   items,   which   pri- a   kind   of   commitment   to    the    community-to
                   marily   affect    community    people    already    mak-                          Our    recently    acquired
                                                                           us it and to be used by it.
                   ing  use  of  the  hospital's  facilities.  Items  4  and '4research"  image  sometimes   gets   in   the   way,
                   5   represent   a   second   phase   in   the   project's generating  fear  in  many  of   the   people   living
                   development.   This   phase   would   not   include   the in  the  immediate  area.  Nor  are  we  as  aware  of
                   specific  in-hospital  tasks  required   in   the   first the  ego  destruction  of  the   Black   American   as
                   phase,  but  would  deal   with   the   hospitals   rela- we  might  be,  which  makes  it  difficult  for   him
                   tions   with   the   community-at-large.    This    phase to  cross  the  threshold  of  a  predominately  white
                   might  possibly   involve   the   hospital   in   activi- institution.
                   ties  which  fall  within  the  definition  of   "health" The  position  being   proposed   would   begin   to
                   in its broadest terms.                                  open  up   some   channels   for   conversation   with
                                                                           the  community.  Of  course,  by  providing   a   per-
                   Rationale                                               son to fill such a  position,  we  by  no  means  feel
                    PUPMC    is    becoming    increasingly     aware     of that this negates  the  entire  hospital  staff's  re-
                   the   need   for    cooperation    between    institution sponsibility to  be  always  listening  for  the  con-
                   and   community   for   the   efficient    delivery    of cerns  of  patients  and  to   be   interpreting   the
                   health   services.   The   hospital   feels    frustrated hospital  to  them.  Furthermore,  it  is   our   hope
                   because    a     medically     unsophisticated     commu- that, in  his  language  and  presence,  the  advocate
                   nity  often  overlooks,  misuses,  or   does   not   make will  be  performing  a  teaching  function  for   the
                   the  best   use   of   the   services   available;   many hospital  personnel  and  will  be   affecting   their
                   community   people   feel    frustrated    because    the attitudes  towards  community  persons  in   a   posi-
                   hospital  does  not  seem  to  be  as  sensitive  to  the tive, healing way.

                   32


          It is significant that  the  hospital's  decision     Perhaps  this  experience  of  observing   health
       to  stay  in  the  community   was   made   in   the   professionals,  the  health  delivery  system,  and
       absence  of  any  serious  conversation  with   com-   the  local  communities  which   receive   services
       munity  leaders.  It  seems  clear  that   hospital-   will, in the long run,  have  the  greatest  impact
       community   relations   could   be   improved    im-   on these  students,  more  than  any  formal  facts
       measurably  if  the  hospital  were  to   take   the   and  skills  which  were  picked  up   during   the
       community  into  its  confidence   regarding   plans   summer.
       already  made   for   renovation   and   development     The  following  six.articles   present   observa-
       of facilities. It might also prove  useful  for  the   tions on health professionals.  Articles  in  other
       hospital to seek  further  conversation  with  corn-   parts of  this  report  present  indirect  observa-
       rnunity leaders in the  ongoing  task  of  decision-   tions  on  health  professionals:  comments   about
       making.  Granted,  there  are  ways   of   defending   the  Jefferson  Mental  Health  Program,  the  Con-
       the monolithic  stance  of  a  medical  center,  but   sortium's recreation  project,  the  philosophy  of
       these  can  only  be  posted  with  complete  disre-   the  Temple   Day   Care   Center,   Gray's   Ferry
       gard for  the  need  to  involve  community  persons   community,  and  the  "Saga  of  Fidel  Cruz,"  all
       in decisions which have to  do  with  the  life  and   relate to this topic. In the articles of this  sec-
       f uture of the community.                              tion, students  address  themselves  straight  for-
                                                              wardly to health  professionals  and  their  fellow
                     Possible C?,edentials                    students.
                                                                Bill Halperin  discusses  a  forgotten  group  in
          1. The person  should  reside  in  the  immediate   Philadelphia,  the  poor  whites,  a  group   which
       community   and   have   an   in-depth   understand-   previously  had  been  excluded  from  SHO's   con-
       ing  of  the  community  surrounding  the  hospital.   cern. How to relate to  this  group  remains  prob-
          2. The person will need  to  be  especially  sen-   lematic for SHO and it  is  one  which  all  health
       sitive to the feelings of  other  persons  and  able   professionals and  reformers  will  have  to  face.
       to  perceive,  on  many  levels,  the   nuances   in     Both  Jefferson   Mental   Health   workers   and
       human relationship.                                    Temple   Mental   Health   workers   were   person-
          3.  The  person  should  be  a  Black   American,   ally involved in  organizational  probleriis.  Phil
       preferably between 25 and 45 years of age.             Harber  and  Anne  Sheehan  discuss  the  dual  re-
          4.  The  person  will  understand  or  have   the   ward  system  which  is  common  to   organizations
       ability to learn hospital procedure.                   which deliver services.  Responsibility  to  client
          5.  The  person  will  be  articulate  enough  to   and responsibility  to  the  serving  organization,
       communicate  verbally   both   with   patients   and   in theory, coincide and  produce  no  conflict  for
       professionals.                                         the serving professional.  In  actuality,  however,
          6.  The  person  will  acknowledge  a  dual   re-   conflicting  goals  and  expectations  abound.  An-
       sponsibility:  to   community   and   to   hospital-   other  common  problem   of   service   professions
       and will possess  the  personal  resources  to  work   is  the  determination  of  the  appropriate   mode
       within this tension.                                   of  service  and  the  development  of  appropriate
                                                              attitudes in the practitioner  toward  the  client.
          SHO AND HEALTH PROFESSIONALS                        This  problem  is  accentuated  when   practitioner
                                                              and client are characterized by  not  only  differ-
                         Karen Lynch                          ent needs but  also  different  values  and  social
                                                              backgrounds.   Bart   Butta   and    Robert    Lewy
          About 80   of  the  project  workers  were   stu-   make  some  observations  on  this  conflict   area
       dents who    will   someday   flnd   themselves   in   as  a  result  of  their  work  at  the   community
       roles  similar  to  those  of  the  health   profes-   "Trouble   Clinic   of   the   West    Philadelphia
       sionalg  with  whom  they  came  in   contact   dur-   Mental Health Consortium."
       ilig  the  summer.  Through   the   summer   project     The  experience  reported   by   Darryl   Robbins
       they  have  been  able  to  examine  the   role   of   as a  summer  staff  member  of  Eagelville  points
       health professional  differently  from  their  usual   out  the  importance  of  personal   feelings   and
       vantage   point   as   students   and    prospective   relationships  to  others  within  and  outside  of
       health professionals.                                  professional roles.

                                                                                                               33


                                                               t        Mantua          rnigrant  of  20  odd  years  had  been  robbed  in-
                     The article by project workers a                                   numerable times.                           rnniunity
                                                 escribeg    another    alter-          One cannot consider this a poor co
                     community     Planners      d-community         relations-                              e    residents    would     see
                     native    to     professional ides     technical     compe-        or call it low class. Th                     euphem-
                     This    organization     prov     on     of     community          this as an insult. They demand other        problems
                     tence in the design and executi            del   of   the          isms-lower income. Howevery the
                                                 e effort is a MO                       remain  the  same:  a  high  drop  out  rate-1   per
                     plans.    This     cooperativ                                                                          ida   ed    anO,
                     potential    alignment     of community      people      nd                   college; mayiY dilaP         t
                                                 Ken    Logan     and     Phil          cent 90 On to                         block       or
                     skilled        professionals.                                      vacant homes; uiemployment. One
                     Graiteer   present   a   vignette   of   the   comlnul"ty          which  I  helped  a  resident   try   to   orgailize
                     and MCP projects.                                                  Tot Lot  had  only  two  Of  13  families  supporte(
                           A  difficult  problem  in   any   human   situation
                     is  arriving  at  ai,  understanding   of   the   effects          by wage earners.  just   beginning   to   per,-ei,:,
                                            -nd  behavior  on   others.   Stu-          The community is  -  It  is   beginning   to   under
                     of one's attitudes a        point   out   the   sometimes          that it has problems    ust   be    badgered    int,
                     dents'     comments      here            ssional    atti-          stand that the police ril               ople     a]:
                                                 ces of profe                                      ab   doned cars. The pe
                     deleterious        consequeri the    organizations    which        towing away   an     rs    are    not    abandoniii,
                     tudes    on    clients    and ders  about  the  effect   of        realizing that     outside           their     neigl
                     they    serve.    One     won students    themselves,    as        and stripping all the cars, but that
                     these     experiences      on                           -          bors are  responsible.  A  late  model  Pontiac  wit
                     they  begin  to   assume   the   role   of   health   pro          a flat  tire  and  a  smashed  f  ender  was  t,,rnE
                                                                                                                 days   later.   I    watche
                     fessionals.                                                        into a worthless shell  2                  ove    tl
                                                                                        a -neighborhood youth Of 12 or 11 rem
                           The    Unexplored:    SHO    Working    in     Poor          radio.  A  public  parking  lot   on   Moyer   StreE
                                                                                              tial  street,  is   abandoned   by   the   ci'
                                                 o  munities                            a residen   not   used.   A   woman   told   me   tb
                                     White C rn                                         because it is
                                                                                        your battery  would  be  stolen  by  your  next  do,
                                        William Halperin                                iieighbor.   She   was   not   angry.   She   merely
                                                                                                                as quite normal.
                                                              it     is     a      ghetto cepted  such  behavior broadly     defined.     For
                           Fishtown has been left out.                                        al   behavior    is
                           bounded    by    the    Delaware    River,     Norris     Ave- Norm   oholis'rn is  not  perceived   as   a   prc
                           nue,   and    Front    Street.    Front    Street    is    the stance, alc           t  all  who  drink  ieed   ,
                           "demilitarized   zonepy   across   which    -no    black    or lem.  Most  believe   tha        ady   themgeIN
                           Puerto   Rican    people    move    into    Fishtown.    Fish- other shot in the morning to Ste     are     thOu@
                                                 f   white,    lower    income    Arneri- to get their shoes on. Black-outs
                           town  is  a  ghetto   0                           St-        to  be  normal  for  those  who  drink.  A  sOciOIc)
                           cans.   Many   are   white    Anglo-sax0l'    Prote          graduate    student    is    presently    attempting
                           ants;    there    are    Irish,    Polishp    Slovaks,     and    information   on   the    residents'    knowle(
                           others.     Some     are     recent     immigrants,     others collect olism,  mental   health   and   other   welf;
                                                 rica   five,   six,   and   seven   gen- of alcoh                     p
                           have   been   in   Arne                                      problems.  But  it   would   be   quite   reasonable
                                                                                               little    knowledge    about    these     arE
                           erations              is   a   combination   of   old    brick expect                              this     area.
                           The           community                                      There are no health agencies in
                                                 ries,   and    small    stores.    Resi-                       left  out.  Fishtown  is   i
                           row    houses,    facto            e.             Philadelphia Ps Fishtown    has     been         v.   It    was
                           dents are working class peopl                                outside the model cities boundar
                           trucking industry, for example,       is      centered      in                       choosing.    To'@e    imPlis
                           this  area.   In   a   sense,   things   are   -not   changing included  by  its  own     homes-model          ci
                                                                         no           new Fishtown  has  vacant
                                                 y-no new housing,                                                            housing.     0
                           for    the    communit.                                      means rehabilitation and open
                                                     s,    little     mobility     either                   acks    and    Puerto    Ricans.
                           public works program
                                                                   r           themselves housing means bl
                           econotnle-              raphically fo                        in  this   community   that   a   true   race   riot
                                     ally or geog     sense     the     community      is                                                  . it;
                                       ildren. In a                                     occurred  in   recent   years.   This   was   precip
                           or their ch                           are             becoming                           iz  in.  More   recently
                           ebanging-motorcycle         gangs                            by a black family movin-
                                                                                                                                  attempting
                                                 ue   sniffing   is    more    prevalent;
                           more    popular;     gl                                      black kids were "Cut UP" when
                                                                       ner          candy
                           vacant homes are set afire. in one cor                       go  swimming  in  the   Fishtown   pool.   Black   f
                           and    grocery    store     which     was     crowded     with     erceived  as  a   major   problem.   A   local
                                                 custoixiers  in  it,  a   Polish   irri- are p
                           more     than     three

                           QA


         dent employed  by  the  state  explained  this  fear    they  are  bigoted.  Working  in  poor  white   com-
         as   a   defense   mechanism.   Fishtown   residents    munities  is  just  coming  into   vogue   for   the
         have  very  little  except  their  patriotism   (one    social activist.
         of  the  highest  Marine   enlistment   rates)   and    On  another  level,   some   modicum   of   aid   is
         their  supposed   white   superiority.   Integration    now  directed  towards  the  black   community   be-
         of  poor  blacks  who,  by  most  criteria  (income,    cause  of  pressure  from  that  community  in   the
         education),  are  the  Fishtown  residents'   equals    form  of  lobbies  and  insurrection.  The  children
         would destroy their last  defense,  that  irrational    of the  white  poor  can  be  playing  in  dangerous
         belief of white  superiority.  Therefore,  in  fact,    housing shells, but there  is  no  urgency  for  the
         Fishtown  leaves  itself  out   of   many   programs    city to act.  When  our  leaders  talk  of  poverty,
         which  could  prove  to  be  beneficial.  But  there    they mean  black  people  who  have  been  left  out
         are other reasons it is left out.                       because of white racism.
          The community  is  "solid"  in  a  negative  sense.     The   government   responds   to   pressure.    The
         It acts  together  to  keep  blacks  out.  Community    War  on  Poverty  once   was   earnestly   concerned
         solidarity does not  work  in  positive  directions.    with   poor   whites,   urban   and   rural.   Urban
         A very  eager,  unselfish  shift  worker  was  asked    blacks  have  now  gained  most  of   the   war   on
         how  much   he   was   being paid  to   help   better   poverty's  attention.  Blacks  may  appreciate   the
         the  community.   The   only community        worker,   efforts  of  white  people  in  getting  the   civil
         who is  also  my  preceptor,  was  accused  of  hav_    rights   movement   moving.   Now   their    problem
         ing real  estate  interests. But   then   again   the   is  to  determine  the  path  of  their  own  commu-
         accuser  thought  that   two major  evils   are   the   nities.
         international    Communist    menace     and     the     Poor   white   communities   continue   to    exist
         teaching  of   Darwinism   in   the   schools.   The    and grow.  People  live  in  despicable  conditions.
         community  does   not   seem   either   worried   or    Perhaps in  addition  to  facing  our  own  institu-
         astonished  that   the   Delaware   Expressway   not    tions,  we  must  catalyze  the  reaction  of   poor
         only  has  demolished  many  homes,  but  will   run    white  America  by  building  a  new  human   rights
         on   a   graded   mound   through   the   community.    movement there.
         The  Fishtown  Civic   Association   with   its   88
         members  is  trying  to  face  some   problems.   It
         is  investigating  trying  to  gain  a   mini-school    The Effect of Inappropriate  Reinforcement
         like the one  in  Mantua  and  trying  to  have  the
         abandoned   homes   in   the    expressway's    path        System on Program Establishment
         torn  down  before  they  burn.  Fishtown  is   left
         out because it hag never  gotten  itself  "together"          Anne Sheehan and Philip Harber
         for  constructive   purposes.
          The third reason  that  Fishtown  is  left  out  is    A Case Study
         that  the  government   and   other   establishments
         leave it out.                                            Miss  Anne  Sheehan   and   Mr.   Phillip   Harber,
           There  are  several  possible  explanations.   The    students  in  the  Health   Sciences,   participated
         most  obvious  is  exemplified   by   SHO's   summer    in  the  Philadelphia   Student   Health   Organiza-
         Project.  Letters  were  sent  to   agencies,   com-    tion's   Summer    Projec't of 1968; they I  were  as-
         munity groups, and I                roughout     the    signed    to    the    Temple    Community    Mental
                                  eaders th
         city.  Since,  there  is  only  one  social  service    Health  Center  to  work   and   learn   under   the
         agency  and   one   embryonic   civic   association,    preceptorship  of  the  Chief   of   the   Community
         chances  were  not  good   that   there   would   be    Organization,   Section   of   the   Mental   Health
         a  response  to  SHO's  offer.   The   proliferation    Center.  Their  prime   activity.,for   the   summer
         of  community  groups  and  projects  in  the  black    was  the  establishment  of  a  Child  Care  Service
         community  is  not  paralleled  in  the  white  com-    for the West Nicetown-Tioga Neighborhood .
         munity.                                                 Family    Health    Center.    This     Neighborhood
           @Fishtown  does  not   even   attract   the   most    Health  Center  is  an  Office  of  Economic  Oppor-
         Sir-nple-minded    do-gooders.    Fightowners    are    tunity   Healthright   community   medical    center
         dismissed   from   our   social   concern    because    serving  a  population  of  about  30,000   persons.
                                                                                                                    35


                                                                  opening Neighborhood  Health  Center,   were   called   to
                   Throughout the summer of  1969,  its                 meeting  with  Miss  S.  and  the  PSHO   persons.
                                                      the            mid-a                                    ved       by
                   date was delayed from early July to                  At this meeting, the project was appro
                   dle of August-                                       Dr. C. for  presentation  to  the  Executive  Com-
                   The  SHO  participants  attended   a   tour   of   the mittee  and  to  the  Neighborhood  Board  of  Di-
                   Neighborhood    Health    Center    which     included rectors for approval.  A  final  revision  of  the
                   meeting  Miss  S.,  Director  of   the   Social   Work proposal  was  prepared   in   consultation   with
                   Department.   At   her   invitation,   they   attended Miss  S.  The  proposal  was  approved   by   both
                   a  staff  meeting  at  which   numerous   staff   mem- groups; Mr. J,, Assistant  Director  of  the  Pro-
                   bers  presented  the  problem  of  the   desire,   and gran-1, was to present the proposal to the  Phila-
                   funds,  for   summer   employment   of   high   school delphia Antipoverty  Action  Council  and  to  the
                   students  being  present,   without   any   ideas   of ffice  of  Economic  Opportunity   for   approval.
                   how to utilize these  individuals.  At  the  close  of0
                   the   meeting,   the   SHO   participants    presented Miss  W.,  acting   Director   of   PAAC   delayed
                   the  idea  of  establishing  a  service  to  care  for approval.  Dr.  C.  presented  the  proposal   for
                   children  while   a   family   member   is   receiving unofficial approval to a  visiting  OEO  official.
                                                      Id           Health After a  delay  of  about  a  week,  Miss  W.  ap-
                   medical attention at the Neighborhoo                 proved  the  proposal.   The   implementation   of
                   Center.;   this   Child   Care   Service   would    be the program then began.
                   staffed  by  area  high  school  students,  who   will
                   also   participate,   in   a   training   program   to This  paper  will  attempt  to  analyze   one   of
                   qualify  them   to   act   as   recreational   leaders the causes for  the  difficulties  encountered  in
                   and  to  facilitate  establishment  of  good   cornmu- gaining  approval  of  the  program.  The   imple-
                   nity   relations   for   the    Neighborhood    Health rnentation of the program will not  be  described;
                   Center.  The  idea  of  working  with   a   group   of nor will other causes of difficulties  be  consid-
                   high   school   students   had   been   suggested   by ered. No attempt is being  made  in  writing  this
                   Miss  S.  to  the  PSHO  participants  on   the   pre- paper to  provide  a  comprehensive  view  of  the
                   vious  day.  Dr.  C.,  Director   of   the   Neighbor- SHO  participants'  activities  during  the   sum-
                   hood  Health  Center,  stated  that  the  idea  repre- mer  of  their  placement  at  the   Temple   Com-
                   sented  a  sound  solution  to  the  problem  and   he munity  Mental  Health  Center.  Since  the  cause
                   agreed  that  the  Child   Care   Service   would   be of the  problem  lies  primarily  in  the  medical
                   a useful  part  of  the  services  to  be  offered  by establishment"  ostensibly  engaged  in   deliver-
                   the   Neighborhood   Health   Center.    He    author- ing medical and social services  to  the  poor  of
                   ized  the  PSHO  students  to  write  a  proposal  for North  Philadelphia,  the  paper  will  focus   on
                                                                        itestablishment," rather than "community."
                   the  Child  Care  Service   with   the   guidance   of
                   Miss  S.  When   she   was   contacted,   she   agreed Since   the   "private   entrepreneurship"    form
                   to  provide  the  guidance  and  suggested  that   the of medical service  does  not  function  in  North
                   .students write a  proposal  to  be  presented  to  her Philadelphia, service  is  provided  (when  it  is
                   in  a  week's  time.  The  students  then  wrote   the provided) by relatively large  institutions.  This
                   proposal.   Upon   its   completion,   the    proposal results in a separation  of  the  recipient  of  a
                   was  presented  to  her;   she   carefully   read   it service from the purveyor  of  the  service;  this
                   and  made   certain   revisions.   There,   was   some separation may be temporal (it  was  difficult  to
                   lack of clarity as to  the  next  step  to  be  taken; produce enthusiasm  for  the  proposal  since  en-
                   it   was   decided   that   the   proposal   must   be thusiasm lor action  at  the  early  stages  would
                   approved  by  the  groups  along  the  lines  of   au- bring no immediate benefit) ;  physical  (most  of
                                         blems   evolved;    these    in- the "high"  administrators  do  not  live  in  the
                   thority. Numerous pro
                   eluded inability to find  a  reasoInable        location area they serve;  their  offices'  walls  and  air
                   for  the  Child  Care  Service,  question  as  to  the conditioners  separate  them   from   the   people
                   date   that    the    Neighborhood    Health    Center they are.mandated to serve)   social  (many   of
                                                                                                             ot   identify
                   would open, resistance to the   idea    by     certain the 'professional" employees cann
                   staff  members,  and  many  details  such  as   insur- with the problems  of  those  they  serve)  ;  bu-
                   an6e.  The  relationship.  between   the   PSHO   stu- reaucratic  (the  duties  of  many  prevent   them
                   dents  and  Miss  S.  became   appreciably   strained; from  meeting  the  people  they  serve),  or   of
                   finally, Dr.  C.  and  Mi.  0,  Administrator  of  the another nature.

                   36


          This   separation   produces   an   inappropriate     munity, although  it  has  been  said  that  only
          reward system. Because the  employee  in  an  ad-     three of the 15 positions  on  the  Board  to  be
          rninistrative  position  receives  rewards   from     filled by community residents are actually filled
          other administrators,  rather  than  the  "commu-     by people residing in  the  area  served  by  the
          nity" to be served, he acts to please the  admin-     Center;  more  importantly,  the  Board  and  ad-
          istrator, rather than to deliver real service.        ministration associated with it  are  highly  de-
          There are  two  determinants  of  the  nature  of     fensive; their greatest reward  is  lack  of  any
          the reward system: the  individual's  responsive-     form of opposition. This naturally leads to  fear
          ness and the  structural  design  for  operation.     of change.
          The  former  of  these  determinants  is  largely     An example of  the  way  in  which  fear  of  in-
          determined by the latter; to the extent  that  it     novation operates to delay  service  is  provided
          is not determined by the latter, it is  extremely     by the Child Care Supervisor. One  of  the  first
          difficult to manipulate. The latter  reason,  the     tasks assigned to her  by  the  Director  of  the
          structural design, is artificial and,  therefore,     Social  Work  Department  was  to  write  herself
          subject to manipulation.                              a job description. Later, she was  able  to  rely
          There  are  several  structural  causes  of   the     on that document to justify  her  delays  in  the
          separation of recipient of  a  service  from  the     establishment of the Child Care  Center,  stating
          purveyor thereof; the most significant  of  these     that  her  job  description  precluded  her  from
          is the role definitions for  employee  positions.     doing some  of  the  things  necessary  for  easy
          Also contributing to the separation  is  the  in-     establishment thereof.
          crease in the proportion of time  spent  on  non-     Factionalism is  another  result  of  responsive-
          service administrative  work  as  the  group  de-     ness to  something  other  than  the  quality  of
          livering service increases in size.  Furthermore,     service provided.  When  one  can  receive  rein-
          racial and social barriers  accentuate  the  bar-     forcement  only  from  within  one's  "unit"  and
          riers  between  patient   and   health   services     can increase one's  bureaucratic  status  by  in-
          personnel.                                            crease in the size of one's "unit," it is natural
          The  inappropriateness   of   the   reward   sys-     that there is more interest in  the  "unit"  than
          tem reduces the quality of  care  delivered  and,     the  community.  This  was  evident  in   several
          perhaps more significantly,  reduces  the  possi-     ways.
          bility  for  meaningful  change  in  the  methods     The  Mental  Health   Center   and   the   Neigh-
          of health care delivery.  While  the  West  Nice-     borhood  Health  Center,  do  not  now  cooperate
          town-Tioga  Neighborhood   Family   Health   Cen-     to any significant degree,  while  it  would  ap-
          ter is itself, an experiment in health  care  de-     pear logical  and  even  necessary  according  to
          livery and incorporates  several  innovative  ap-     OEO Guidelines* that the two cooperate.
          proaches on a broad  level,  its  staff  shows  a     In providing  psychiatric  services,  the  Neigh-
          marked reluctance to  experiment  with,  or  even     borhood Health Center  is  seeking  to  establish
          think about,  changing  the  way  they  do  their     its own psychiatric service.  There  is  a  basic
          individual  jobs.  "Job  Description"  for   each     mutual  distrust  and  dislike  between  the  two
          employee  is  quite  sacrosanct;  employees   are     organizations which became  quite  evident  at  a
          bound to their specific tasks as  with  the  most     staff meeting of both centers. It has  been  said
          stringent labor  contract.  Since  the  Neighbor-     that at a  meeting  of  the  Neighborhood  Health
          hood Health  Center  is  seeing  a  minimal  num-     Center's Social  Work  Department,  the  director
          ber of patients, the staff has  no  real  contact     explained her reservations about  the  establish-
          with those  to  be  served;  many  administrative     ment of the Child Care  Service  Program  on  the
          officers stress  plodding  along  without  "caus-     grounds of  a  fear  that  the  Director  of  the
          ing any  trouble."  This  probably  results  from     Mental Health  Center  would  attempt  to  direct
          ,the fact 'that they are  in  no  way  responsive     one  of  "her"  programs  through  the  SHO  par-
          to the 'needs of  the  community;  they  Ire  re-     ticipants.
          sponsive to  an  Executive  Comm  tee,  com  osed
                                          it        p
          @rFelY@  of.@administrative  medical   personnel,      Healthright funds are to be used only as aI"last dollar"  wife
          and to                                          s.@y  no other service or support  is  available:  Ne.ighborhood  Health
              .   a   "Neighborhood   Board   of   Director     Centers are to cooperatd with, and utilize, the services of  ether
          This last body  supposedly  represents  the  com-     community service groups wh never Possible.
                                                                                    e

                                                                                                                37


                                                                                           ture might be reduced  since  the  structure  wol'Icl
                                                                    Temple                      elevant    to    the    individuals     gratifl-
                                  ,so    animosity    between     the                                                             acy        are
                    There   is    a                 the                         Neighborhood be wholly irr isadvantages     of      bureaue-r tic      ini-:
                                                                                           cation. The d
                 University       Hospital       and                the                reac-       is   summer,   the    btireaucra       ,lines
                 Health    Center.    This    is     evident     fro, iversity"            wil kiionvn; til      LT  established
                            ,taff   to   including    "Teraple    U-n                      portaiice  of   working   along   bvious.   Maytifac-
                  tions Of F                                                               f authority"  became  quite0           ut    as     a
                  oil  their  sign.                                 itive              serv-0      iid    resistance    came    abo
                                                                                           tured delays a            8s     the      established
                                  ssity   to   have   one's   POs   ,                                                                1
                     The      -nece                of the  i 4unit                    results result of attenPts to  bypa
                  ice   viewed    as    a    service services           which            would lines of autho"ty' the    Proposal     for     the
                  in    the     exclusiOll     Of     many,,     product.     A     possible A, Iescribed earlier,                          taff
                   not  be  visible   as   a   "unit                ring                 for Care Service was presented at a F
                                       al   to   even   consider   ca
                   reason for refus                merni)er       visits       an        OPD Child ng.   The   Director    of    Social    Work    might
                   children,kvhile     a      family                the               Neigh- meeti
                   clinic   at    any    other    hospital    (before ervice               it- have  suspected  a  "conspiracy?y between          the
                                                   opens          fors                     SHO   participants   and.   the   Director   of   the
                    borhood      Health       Center                                                                               e      latter
                    self)     may     have     been     the     consequent      lack      of Neighborhood Health Center when th
                                  ion   of   the   service   as   one    of    the    Neigh- approved  the  idea  without  first  consulting  her.
                        identificat ealth     Centel:.      While      the      nature      of @'Vhile  the  above  e-,ample   is   concerned   wity
                    borhood       H                a-.v    in    part    account    f     or                     nes  of  authority    ,       tb(
                    the   f   unding   situation   m-               that             94serv- assumed  (informal)                  lines.   Afte-
                     this  answer,  it   is   interesting   to   note                      following is concerne                  Neighbor
                          o      the       community,@       was       not       considered. the proposal was al                  e
                     ice t                         nl,  other  problems                    are hood Health Center                 approval     0
                        Besides     f     actionalis                ard              system.                                      oned   earlier
                     caused     by     the     inappropriate     reNv f              responsi- PAAC, CAC, and 0                   OFO   office',
                      one  of  these   is   a   great   diffusion   0                      the proposal was  prese
                                                      se          administrators          at                  led  on  it.  it  has   been   sui
                      bility. This occurs becau                     v             themselves before PAAC had ri  the    Social    Work     Depar
                      all  levels  are  not   required   to   justif-                rovide. gested by a member of elay    resulted    from     tb
                                  s of the actual benefit they P                           ment that Miss N'V.'s r
                      in       term                                 to            personally                         the    "proper     channels
                      It is, therefore, riot necessary               an               avoid- f ailure  to  work  through
                       make    any    real    contribution.    Hence,                      in   the   absence   of    more    appropriate    rei
                                                   onsibility      for      any      projectI                           are   forced   to    set
                       ance    of    personal    res                establishment          iorcement, many persons      t   of    their    occuP
                       develops.      The      resPo                                       ego satisfaction as a resul
                                  hild    Care    SE                red       by       Many, tional status. This  may  in  part  account  f  Or  t
                       of   the   C   e       follow                al     listing:      Di- inflexibility   concerning   job   descriptions.   PI
                       of whom tb                                                          Direc-                            freque      exploit
                        rector     of      Neighbor] Department,    I                      orhood fessional distinctions are      ntly
                        tor    of    Social     Work                                       to increase the professionals' sense      of      wor
                        Board of Directorsy SRO participants,                              Execu- In   conversations   with   persons   at    both    i
                        tive        Committee,        Program        Development         and Mental   Health    Center    and    the    Neighborhc
                                       I'Ljnit,       Patient       Care        Coordination                         0    participants     detec
                        Evaluation                                  it,      Child      Care Health   Center,   the   SH   d   to   mental   hea
                         Committee         Administration         TJn erty              Action a sense of inferiority atta                     S. I
                         Supervisor,       Philadelphia       AntiPOv                      Area assistants and to family                y    he,
                         Commission,           Community           Action            Councileexample, the names of in(                  s     of
                                  ce    of    Economic    opportunity.    All    of     thes workers do not appear i
                         B,    Offi           v     in      establishing      the       Pro-                as do the names o           all   ot
                          have   been   invO.1    ed                delay       it       was staff meetings          d.   Mental   health    as,
                          graM.   Since   at   the   time    of    anIY                    if individuals    who    atten            s   equal,-
                          impossible     to     Pinpoint     the     responsible      parti, ants seem to be considered more a
                                  s  impossible  -to  speed   action.                      per- prof  essiolials  than  are  the  family  health   w(
                          it     wa -natural    outcome     of     the     lack     of     any ers.   It   appears   that   the   Neighborhood   'He
                             A           itment  to  a  projer-t  is   a   great   indif   -                                      tant  to  dest
                           sonar Comm                                                      Center   personnel   are   more    regis
                           ference to one's work.                   in     North      Phila- tion   of   Professional   superiority    than    are
                              Medical     and     social     services                      staff   members   of   the   Mental   Health    Cent(
                                                                    complex          bureau-            -   eni   of   establishing   respongiVE
                            delphia   are   pro    ed    by    fairly                      rele- The probl
                                                                    were                made                         eeds   of   the   community
                            cratic    structur,                     tendency     to     for- to   the   wishes   and   n          egtablishniei
                            vant  to  one's   r                                            struc- not    been    answered     with     the
                            nialize    relatioi                     reaucratic


                                                                                                 tioned       cannot
           the  "Neighborhood  Board  of  Directors."  It  has   do what many of the aforemen
           been  said  that  80  percent  of   the   positions   do.
                                                            a-   It  is  unfortunate  that  those  who  are  closest
           allotted on this body for community represent                                           tly   most    re-
           tion  are  held  by  outsiders.  Furthermore,   one   to the community and consequen
           may  question  if  the  Board  members   do   truly   sponsive  to  its  needs  are  those   who   cannot
           represent  the  community;  one  may  question   if   communicate  well  in  the  language  the   "admin-
           the "poor poor" are really  inarticulate  in  Board   istration" has  chosen.  This  problem  is  perhaps
           affairs.  Many  persons  (social  workers   partic-   related to  that  of  status,  since  exclusion  of
           ularly) claim  to  represent  the  community;  that   one's "underlings" on the  grounds  of  their  lan-
           they do often appears doubtful.                       guage may  be  used  as  an  ego-builder  by  many.
           The  system  is  such  that  the  persons   closest   It  is  natural  for  the  real  interests  of  the
           to   the   community-mental   health    assistants.   community  not  to  be  served  when  the   service
                                                                 system  refuses  to  speak  the  community's   lan-
           family   health   workers,   some   nurses,   etc.-
           really have the  least  voice.  When  the  proposal   guage. In general, one  gets  the  impression  that
           was first presented,  enthusiastic  reactions  came   interest in the  commuriity's  reactions  is  nega-
           from  some  members   of   this   group.   However,   tive  in  character:  only  a  fear  of   community
           the fate of the proposed  Child  Care  Service  was   disapproval leads to a  solicitation  of  the  com-
           in no way dependent  on  their  reactions;  rather,   munity.   The   phrase    "getting    a    proposal
           it depended  on  the  wishes  of  high  adminitra-   through  the  Board  of  Directors"  was  too  fre-
           tion officials. While their  support  was  hearten-   quently used.
           ing, it  was  really  insignificant  in  comparison    Despite  these  problems,  it  appears  that   the
           with the  power  afforded  by  Dr.  C.'s  interest.   Mental Health Center  is  making  valid  beneficial
                                                                 contributions  to  the  community  and   that   the
            Many of  the  persons  who  could  be  most  valu-   Neighborhood Health  Center  will  do  so  when  it
           able in instituting beneficial changes in the  sys-   finally begins to provide f ull-scale service.
           tem are prevented from  doing  so  due  to  a  lan-    The  organizational  plan  of   the   Neighborhood
           guage  problem.  To  institute  change  within  the   Health Center is a fine step in  the  direction  of
           i@system," it  is  necessary  to  speak  the  "sys-
                                                                 responsiveness  to  service  rather  than  to   the
           tem's  language.  The   "system"   speaks   a   bu-   i 4administration"  of  the  "system."  It  is  unfor-
           reaucratic language of its own.                       tunate that it is not  implemented  to  allow  this
            The  SHO   participants   encountered   difficulty   actually to  occur.  Several  questions  should  be
           in  talking  the  language  of   the   Neighborhood   answered.  Why  should   administrative   positions
           Health  Center.   Such   terms   as   "philosophy,"   (e.g. Director  of  Social  Work)  carry  more  re-
           I'goal," "objective ... .. staffing patterns ... ..   pro- ward than  service  positions  (e.g.  social  work-
           cedtiral  steps"  have   very   specific   meanings   er) ? Why should  a  physician  not  really  listen
           which  are,  in  some  cases,  different  from  the   to  what  a  Family  Health  Worker  has  to   say?
           generally accepted meaning.                           Why  must  the  organization  rely  on  token  com-
            Besides  the  terms  developed  by  each   organi-   . munity representation  to  justify  their  intru-
                                                                 sion  into  the   community?   Why   are   "appear-
           zation to be  used  internally  only,  there  is  a   ances" rather  than  real  service  the  basis  for
           prejudice  against  improper   grammar   and   mon-
           osyllabic words.  In  writing  an  acceptable  Pro-   reward?  Why  is  health  care  in   North   Phila-
                                                                 delphia inadequate?
           posal, it was necessary to use  quite  formal  con-
           structions and  language.  The  need  to  write  in
           a  sophisticated  manner  leads  to  the  exclusion          Profession'als' Values and Their
           of  many  family  health  workers,  mental   health             Consequence on Serving
           assistants, and  others  who  have  quite  valuable                        Clients
           ideas, from the  rank  of  those  who  can  develop
           a  Program.  These   persons   are   stymied   when           Robert Lewy and Bart Butta
                                 ie-ate on the language  level
           they cannot commun
           established  by  the  'high"  administration.  Only     The  main  problem  of  the   West   Philadelphia
           the  SHO  students'  academic   high   school   and   Mental  Health   Consortium   is   the   preoccupa-
           college education placed them  in  a  position  -to   tion on the part of  the  staff  with  their  roles
                                                                                                                   39


                                                                                                        al.    It    is    unfortunate    that    such
                                                                                       ople   in    gener                dt)       by        obtaining
                                                             are    "ethically"    Obli-p               come    itcertifle           . e          Pro-
                a,    white    professionals    Who     _class     get     of     valuesP               al  training  in  order  to  r's             .-
                                   ce         a         middle P,yhological                             submit     that     such     formal      train
                gated    to    enfor          oriented
                            middle-class                              r             whom
                                                             nity    fo
                and                                          MMU                            11      redu( their effectiveness.
                                   bers     of     the      co                         Ing  w           n  our  opinion,  is  lot   to,   as         is
                theory    on     mem                                                                                                             ,old-
                this      is      totally       inappropriate.        ed              on The      solution,1   adually    force     olit
                    Consider    an    interchange    which     transpir                present procedure, gr             -.tionalists      aid      e-
                                                             d   requested   a   Psy-h'- lineup  professionals  and  tracti-      13eople.11         As
                 August      12.      A       student       ha        sortium          place   them   piecemeal   with   "Young   -     imply
                 atric  evaluation   of   an   alcoholic   by   a   co"                                   the   new   arrivals   are    s
                                   The     psychiatrist's      response      ,vas      amentioned above,        d    UP    as    their    guilt    be-
                       psychiatrist.                         and        ,        profes-                                          d   is    a    corn-
                                   pathY,         indignation,                         isolated and swallowe
                  mixture    of    a                         . f that his        prof        ound       zed.  What  is  require   ,  cilities       so
                  sional-trainiII6,-bred                 belie        a           fellow comes       mobili I  of  the  CoDsortiurn  f  a  .ely         and
                                   Id   only   be   meaningf   ul    to                plete      overhau  sionals    are     irnraediat
                  insights       cOu                                  illing          to 4. at white profe,                 tionally            compe-
                  member   of   the    guild.    He    ,vas    not    w                th               esponsible to enlo           procedure
                                   ruits        of         his training     with      "Mr- invariably   r   oiess,onals.,,    Such    a
                   share    the    f                                                   tent        ,noypr            egsio-nals    at     the     Con-
                   Temple Student-t@                         cornmor,   at   the    West would   release   those    prof
                      Instances      like       this       are Mental     Health      COn- sortiuln     whose     originality     and      dissatisfaction
                                                             y                                                           e   been,   by   virtue    of
                   Philadelphia                       COmmun't g   people   become    con- with    present     methods     hav ofessio-nals,        sub-
                   sortium.        Even        the        youn        nd          tradi- their   responsibility   to   other                         such
                                                             of discipline a           d                        point    t
                    vinced   of    the    value              ed,      classroorn-oriente merged. It is a MoOt        r,                    o       are
                    tiorial,          bilhly          structur aik  of  flexibility,   re- a   iireleage"    would    occu                           seek
                    groupwork            methods.            Tility    and     innovation incapable   of   it    should    be              tradi-
                                                             mu                                           an     institut'
                    sponsi,veness      to       the       corn ost cynical.            the   safety    Of
                    from    such    individuals     is     alm        with           ne@ tionally oriented.
                                   ho     enter     the     Consortiun'
                        People     w                         Ls  of  indifference   anci
                                   met      with       feelin-
                     ideas       are  dermined, isolated and their                 ideas                      Eagieville
                     are   subtly    un                      ,laeks    who    lack    the
                                   s   ed    to    death.    B
                     are   discu   S                         re  of  -lass  origin  seem
                     "property      values       by       natu        ofessiorial           Debbie      Finkelstein      and      Darryl       Robbins
                                            .   the   course   Of    Pr                                                   a      treatment      center
                     to   acquire    them    in              em  with   the   enthusiasm
                      training     and     prof     els     th                              Although     Eagleville     is           d   that    alco-
                      of   a   convert.    Certain    Professionals    at    the    Con-    for  alcoholism,  it   must   be   realize               mple,
                                                                      0     this     aP-                             mntom      of       more       co
                                   are       not       totally committed t                  hoiisiu  is  orly  11   Sy   -        hich   is   the   in
                            sortiuln                         confide their      doubts      pri-        in  living,  part   of   w   .cate.   We    fee
                      proach,       but       will        only or s ch  behavior  is  not,  problems        iduals      to coramuni                  empha
                       vatelY.     The        reason         fu       iob;       rather@    ability    of indiv                        ugt
                                                                                                        a-                           cohol
                                        f   ear   of    losing the                          that  the  F-  vleville  SRO   project   ria   isril   bLi
                         realistically,                      ciently guilt-ridde-n          that size      lot only  the   problems   Of   ai
                                   ople       'are       suffi                                                           ance   of   being   aware   o
                       such       pe eff   ectivelY    silenced.      roach   is    that    also   stress    the    import                           d
                       they      are                                                                                 bus    our     project     expaii
                           A   fallacy    in    this    entire apP    n                tional our   own   feelings.    T       of     human      awar(
                        the,@peuti       effectiveness        and        eve        eTnO    from alcoholism to the area                 project,     v
                                      c                      professional      training.    iiess.  Therefore)  as   a   part   Of   our gleville.    01
                        adequacy         depends          upon                                                                       'E'
                                                             areas  of  nonverbal  Corn-                                                             I
                        Recent       work        in        the        rapy   (e.g.   the    have   brought   several   groups    to    -
                                                                      e                                   ups    was    the    Soul    ty    and    ZU
                         municat,ion     and     cross-cultural      th it   clear    that  of these gro                                gangs      tb:
                                                             ank)  made                                 two      North   PhiladelPlI
                         work       of        Jerome        Fr                              Nation,
                                                             nteraction with an  emotion    iiswing together."
                         what  heals   is   all              I        dual.   The   Pro-                             or    the     gangs        coming
                                   mpetent      persuasive       indivi looks:   1.    The    Arrangements           f   ekend  of  July   19-21,   19
                         ally     co                         prejudice over                             ille  for  the  we             mbers   of    t
                         fessional                    training of lionprofessi0yals@ 2. the Faglev                       two  staff   me
                                        s              parents                              were     riade     through            ration.        Memb,
                          adequacy a     as    parents    of     many     professionals,    liartranft@  Conmunity           Corpo-        up    thera
                          inadequacy                         ations    of    therapists,                   anft      staff sat  in  on  a  gro
                          and    3.     our     own     observ        e   Hospital   who    of the Ilartr            Ile  and,  being   impressed   wi
                          former     alcoholics,     at      Fagl'evill re highly eff  ec-  session     at     Eaglevi               itnessed  in   tl
                           have   -no   formal    training    but    11 ir  patients   and  the    group    therapy    techniques    w
                           tive   in   their,   dealings    with    the

                           A in


         group  and  in   the   SHO   groups,   realized   that        Mantua and Mantua Community
         these  techniques  would  be   applicable   to   work-                     Planners (1)
         ing  with  the  gangs.  A  great  deal  of  gang  war-
         ring  was  going  on  in  the  community  and  it  was         Ken Logan and Philip Graitcer
         felt  that  a  talking  out  of  hostilities  and   an
         honest  expression  of  feelings  would  be  of   some    The   Mantua    community    is    an     underdevel-
         benefit.   Furthermore,    the    community    workers   oped  residential  area  located  in  West   Philadel-
         were  concentrating  on  a  $250,000   Federal   grant   phia.  It  is  a  community  of  about  22,000  people
         for   building   and   maintaining   clubhouses    and   most   of   whom   are   of   Afro-American   descent.
         saw  the  weekend  as  a  time  for  the   gang   mem-   The   geographical   boundaries    of    Mantua    are
         bers  to  evaluate  their  roles  as   clubhouse   mem:  31st  to  42d  Streets  on  the  east  and  west,  and
         bers  and   to   suggest   clubhouse   leaders   a-nct   Hamilton   Street   to   Mantua   Avenue    and    the
         administrators.                                          Penn  Central  Railroad  tracks  on  the   north   and
          The  gang  weekend   was   successful   as   far   as   south.  The  income,  health,  education,  and   hous-
         the   gangs   themselves    were    concerned.    How-   ing  levels  are  far  below   the   City's   average.
         ever,   the   weekend   highlighted   the    divergent   There  are  over  400   abandoned   houses   in   this
         opinions  and  approaches  of  the   Hartanft   staff.   90  block  area,   and   over   one-quarter   of   the
         A   great   deal   of   intra-organization    conflict   habited   homes   are   considered   substandard   and
         emerged.   It   was   suggested   to   the   Hartianft   overcrowded.    Statistically,     Mantua     presents
         staff  that  they  put   themselves   into   a   group   one of the  bleakest  pictures  of  a  ghetto  in  the
         session.                                                 city.
           On  Friday,  July  26,  1968,  a   member   of   the     As is true in all aspects  of  life,  the  poor  are
         Temple   Graduate    School    in    Group    Dynamics   provided  with   the   least   services.   Mantua   is
         led  an  all  day  group  session  with   members   of   served  by  the  16th  District  of  the  Philadelphia
                                                                  Police.  Patrol   cars   are   generally   seen   only
         the  Eagleville  and  Hartranft  staffs.  A  list   of   along   33d,   34th,   Lancaster,    Haverford,    and
         suggestions  for   more   constructive   youth   week-
         ends  resulted  from  the   day's   discussion.   How-   Spring   Garden   Streets.   The   police   are   slow
         ever,  the  Hartranft  rift  only  widened.   It   was   to  respond  to  emergency   calls   and   complaints-
         revealed  that  when   the   clubhouse   money   would   if they  respond  at  all.  It  is  generally  assumed
         be  received  and  when  the   clubhouses   would   be   that the police want to  get  involved  as  little  as
         built had not  yet  been  established.  If  the  money   possible  with   the   community.   There   are   com-
         is  delayed,  and  because  of  the  emphasis   placed   munity  relations  meetings  at  the  Police   Depart-
         on  the  clubhouses  by  the  Hartrauft  staff,   -not   ment  at  which  attendance  is  good  -   about   30.
         only  would  the   relationship   between   the   com-   Nothing  seems  to  come  out   of   these   meetings,
         munity   workers   and   the   gang   be    endangered   and   the   establishment's   answer   is   generally,
         but  the   gang's   resentment   might   also   extend   "Of course we'd like to help in this matter        ...
         to the community at large.                               if only we could get a larger appropriation        ...
                                                                  already  we  are  2,000  complaints  behind  .   .   .
           When   Hartranft   left   Eagleville   that   Friday   why  don't  you  people  use  your  'political   pull'
         night,   the   problems   within   the    organization   by banding together."
         were  still   unresolved.   Although   Eagleville   is     The  PTC   runs   the   31   bus   through   Mantua;
         willing  to  continue   working   with   the,Hartranft   its schedule  is  sufficient,  but  its  route  avoids
         organization   and   although   gang   weekends    had   much   of   Mantua.   Few   in   Mantua   have   auto-
         been   proposed   as   a   continuing    program    at
         Eagleville,  Eagleville   has   not   been   contacted   mobiles.  Trash  and   garbage   collection   is   but
         by Hartranft for any futher action.                      once a week and  is  totally  inadequate  for  such  a
                                                                  densely  populated  area.  (Most  areas  of  the  city
            Eagleville has resources in  the  forms  of  staff,   have  one  trash  collection  and  two  garbage   col-
         residents,  and  group   t.echniques.   The   Eagleville lections in a week.)
         staff has  shown  itself  to  be  adaptable  in  work-      Stores  for  the  most  part  are  marginal   owner
             @W
         ing@  ith  SHO,   camp   counselors,   and   Philadel-   operated   corner   grocery   and   variety    stores.
         P@l'a@  gangs.  We  have  found  that  resident   par-   There  is  one   large,   clean,   moderately   priced
         ticiPiatiOn is invaluable in a group situation.          Thriftway   on   Haverford   Avenue.   -   There   are
                                                                                                                      41


                                                                               venereal  disease)  mental  healthg  physica@health
                                             Tnating          Mantua          on comprehensive    medical     care),     alcoholism'
                       several large stores proxi Lancaster                   Avenue. addictions, tuberculosis. Unless           education
                       the west. These are  on antua,     most      of      Nvhich drug. iiditions  improve   at   the   same   tirne@
                       There are many bars in IVI ners      by       local       bar- and living co it  in  health  care  ',,ill   be   mini-
                       are run f or absentee ow                                any irnproveme
                       tenders.                 ill         Mantua.          The mal and temporary.    problems     Of      health
                       There are several schools                               An eff ective attack on the          us         and
                              chool     is      the      largest      elementary        ible without a simllitaneo    d       eco-
                       McMichael S    ast.    There    are    also    a    Cath- care is imPOSS       11 the social an
                       school in the East CO the         Belmont         Elemen- comprehensive attack on a  overty    and     ill-
                       olic School for the Deaf,                               nomic conditions which breed P        t        com-
                               and       the        Ma,tlia-powelton        Mini ness. It is perhaps f or this reason tha
                       tary School,                                            unity  involvement  in   the   planning   of   Com-
                       School. al    facilities    are    provided     b     citym
                                                             y
                       Recreation                        These               are prenensive  health  care  services  has  been  mini
                       operated playgrounds and Tot Lots.                      rnal -  a  more  pressing  need  is  shown  in  the
                       in   fairly   poor   shape   and   unsupervised    except assault on  the  problems  that  bring  about  Pov-
                                           -nd.Mantua                   Community
                       for McAlpin playgrou                                    erty. We have been  involved  Nvith  legal,  hotis-
                                             tw      city      parking      lots                         e    have    done    some
                       Planners has  converted 0                               ing, and zoning matters. W
                       into    basketball    courts.    MCP     runs     several research in the planning of V.D. clinics@.       mental
                       basketball leagues on these courts.   Several           health clinics, and physical  health  clinics,  but
                                             the      process      of      being             1)art     from     the     community-
                       pocket parks  are  in               e              Mantua this has been a-           we   think   may    be
                       built by the Mantua Workshop and th                     we are writing proposals that
                       community.   MCP   and   Young    Great    Society    and ective in Mantua.
                       Haverf   ord-   Center    all    maintain    recreational eff .  onl  one  way  I  can  see  as   a   viable
                       programs for Mantua youths.                             There is   y             done   -   that   is    by
                       in   Mantua   there   are   three    general    praction- means of getting things   e  in   the   form   of
                                             of    whom     take     DPA     pa- direct  action.  This  may  b
                       ers and one dentist all                                 harrassment,  picketing  or  by  doing   it   your-
                       tients,   but   they   have   very   limited   hours   of self. Whatever the tactic7 in    an    underdeveloped
                       practice.   (Each   averages   about   four   hours   per community it is  impractical  for  one  to  believe
                       day.)   The   community   turns   to   these   men   only that either the city or  the  grass  roots  members
                       in emergencies.                                         of the  community  will  undertake  action  without
                       on   June   1,   Young    Great    Society    established a slight amount of encouragement.
                       a   medical   center   on   33d   Street.    Though    it After  a  discussion   with   a   member   of   the
                              o   give    very    adequate    emergency    serv-      community  I   realized   that   the   inei-
                       appears ts   not   used   by   the    majority    of    the Mantua             ase  in   Mantua   was   un-
                       ices, it i                                -         loca- dence of  venereal  dise    to  lack  of   health
                       community due to: I. lack of publicity; 2               usually high. This was due
                                             ssociated     with     the     name         crowded  living  conditions,  and   lael,
                       tion; 3. the  stigma  a                                 edu ation, ,
                       YGS.   In   essence,   YGS   Medical   Center   is   just Of ae-n adequate treatment facility.  (The  closest
                       what  it  says  -a  YGS   facility.   It   can   not   be facility  is'   at   500   South   Broad   Street.)
                       considered   a    community    project    or    facility.                              with  Dr.  L.,   thE
                       Mantua   is   also   served   by   District   4    Health A meeting was arranged                          at hiF
                                                                               head of V.D. Control, and I    proposed          th
                                              already    burdened     in     its            (V.D. control)    establish  a  clini(
                       Center. This center  is            located          quite department  .
                       district of 200,000 people, and is                      in the Mantua area. Dr. L.    felt  that  this  wa@
                       far   in   walking   distance   from   Mantua.   District impractical sinceIpeople  do  not  want   to   b(
                       4  is  not   served   by   public   transportation   con-     alking  into  a  "V.D.  Center."   An   alter
                                             District   4    does    not    seem seen W      was  proposed  -   part-time   facili
                       venient   to    Mantua.           he            community nate solution                       t  4400  RaIv
                       interested in reaching out to t                         ties should be set ul) in District 4 a
                                                                                                           this center is  not  i'
                       either.                              health    is     not erford Avenue.  Though
                        As much as I hate to admit it?       '                              a          ched by  walking.  Also,  I
                                                             jobs,        educa- Mantua, it c ii be rea                          publi
                       the major priority in Mantua -                                                   the      city       supply
                                                                               was    suggested    that
                       tion,   housing,   anci the    elimination    of     Police health  educators  in  Mantua  to  provide   hygier
                       brutality  certainly   are   much   more   essential   to                        cize the  new  V.D.  clin:
                                                          ntua.     Some      of education and to Publi
                       improving the daliv life in Ma                                    ict 4.
                                                                               at Distr
                       the  health  problems   are   (in   order   of   priority

                       A9


          it  was  asked   that   the   President   of   Mantua    of   helping   Mantua   plan   and    develop    com-
          Community Planners  write  a  letter  officially  re-    munity  services  for  the  people  of  Mantua.   The
                                                            -D.    Mantua   Workshop   is   the    community    ingtitu-
          questing that the city establish more V                                                       s   the   active
          facilities.  This  was  completed   in   the   middle    tion doing the planning, serving a
                                                                   liaison  between  the  people  of  Mantua   and   the
          of July.                                                                                    roviding       the
          The  next   move   was   up   to   the   Health   De-    City,  directing  the  research,  p
          partment-once  a  week  I  received   a   call   from    technical  skills  -  and  harnessing  white   energy
          the  Senior  Public  Health  Officer   who   informed    and  concern.  It  is  within  this  community  orga-
          me  that  he  brought  the  matter  of   establishing    nization  that  our   work   has   been   done.   The
          a  V.D.  clinic  in  Mantua  to  a  meeting  of  such    legitimacy  and  credibility  of  the  planners   and
          and so and that he felt quite sure  that  a  facility    the  workshop  as   effective   community   organiza-
          would be established shortly.                            tions largely rest  on  their  indigenous  character.
          I   have   been   receiving   this   run-around   for    Hence,   SHO   students   have   assumed   an    "in-
          f  our  weeks  now  -  I've  received  calls  of  en-    visible"  role,  behind-the-scenes  and   supportive,
          couragement  that  it  %vas  only  a  matter   of   a    developing  proposals   rather   than   a   "visible"
          short  time,   I've   received   letters   ("We   are    role  on  the  streets  doing  anything  like  active
          currently  dealing  with  this  request"),  and  I've    community organizing.
          even been visited  by  the  coordinator  for  several    From  the  outset,  SHO,  as  a   matter   of   prin-
          health districts. But results  are  all  that  counts    ciple, has consciously placed itself  in  a  subordi-
          ; . . and there  is  no  V.D.  facility  at  District    nate  position  to   community   groups.   The   pre-
          4 yet.                                                   ceptor,  speaking  for  the  community,  raised   the
          A    community    mental    health    program     has    issues,  identified   the   problems   and   directed
          also  been  devised.  This  was   originated   by   a    SHO   workers'   activity.   Thus,   SHO    attempted
          psychiatrist at District 4, and has since        been    to  prevent  still   another   white   middle   class
          modified  by  work  done  this  summer.   Ideas   for    organization   from   flooding   the   ghetto    with
          modifleation   of   the   original   proposal   arose    its   own   values.    However,    our    preceptor's
          from    discussions    with    psychiatrists     from    first  question  was,  "What  do  you  want   to   do
          Temple   Community   Mental   Health   Center,    the    this  summer?"  "What   are   you   interested   in?"
          City  Department  of  Health,  and  several   psychi-    In  reality,  the  process  of  defining  issues  has
          atrists in  private  practice.  The  proposal  as  it
                                                                   been   somewhere   between   these   two   positions.
          stands  now  is  an  amalgamation  of   their   ideas    It  is  f  air  to  say  that  the  community  wanted
          that  have  been  modified  to  fit  the  community's    action  in  various  areas,  although  the  preceptor
          needs as I see them.                                     and  SHO  workers  really   verbalized   the   issues
           Basically the  source  of  patients  for  this  cen-    and  defined  the  problems.   Our   preceptor   sug-
          ter  comes   from   many   "informers"   in   Mantua.    gested ideas.   Our   process   of    research    was
          These  may  be  -neighbors,  block   captains,   bar-
          tenders,  gang  workers,  civic  leaderg,  or  corner    essentially  one  of  gaining  an  overall  apprecia-
                                                                   tion  and  sensitivity  within  the  problem   areas,
          store  owners.  They  advised  the  troubled   person
          to seek further help at  the  mental  health  center.    then  focusing  on  one  aspect  and  narrowing   our
          At  the   center   there   are   several   indigenous    inquiry.  Our  object  was   to   produce   concrete,
                                                                   functional,   empirical   statements   for   communi-
          workers  and   a   staff   psychiatrist   who   shall
                                                                   ty   action   rather   than    general    theoretical
          select  out  those  patients   who   need   intensive    i 4
                                                                   analyses."
          treatment, sending them  to  f  acuities  that  exist
          in  the  city.   The   remaining   patients   will'be    Our projects have    varied  f  rom   individual   to
          dealt  with  at  the  center   using   group   and/or    individual.   Most   of   our   research   has   been
          individual methods.                                      done   separately.   The   students   have   communi-
                                                                   cated   more   than   the   community   worker    and
                                                                   youth  intern.  Our  work  has   been   tailored   to
                Mantua and Mantua Community                        our individual  skills  and  interests.  Again,  much
                            Planners (11)                          of our effort has  gone  into  preparing  feasibility
                                                                   proposals  for  specific   projects.   The   projects
            SHO    workers    in    the    Mantua     Community    will  be  implemented  by  the   people   of   Mantua
           I  miners  project  have  grappled  with  the  issue    and  for  the  people  of   Mantua.   Much   of   our
                                                                                                                       43


                                                                             entire bail  "business"  to  be  dirty  and  a  com-
                      ggresearch" has involved talking with key resi         munity bail bondsman  a  good  idea  for  the  f  u-
                      dents  of  'Alantua.   Another   large   part   of   the ture - 4  or  5  years  away  -  rather  than  f  or
                      research  has  been  establishing   contact   and   then
                      negotiating  with  city  officials  -  both  in   public now:  As  an  alternative,  a  plan   was   designed
                      health  and  in  other  fields  such  as  housing,   the to integrate  the  Philadelphia  Bail  Project  into
                      police  and  elected  officials.   A   third   part   of Mantua's  needs.  The  Bail  Project   attempts   to
                      our  inquiries  took  us   to   useful   resource   per- release  defendants  on   their   own   recognizance
                      sons   outside   Mantua   and   outside   the   web   of in  lieu  of  bail.  The  process   requires   close
                      city   government    -    to    health    professionals, community  connections  to  speed  up  the   verifi-
                      lawyers,   and   other    experienced    people.    Only cation  of  information  obtained   from   the   de-
                      a  small  part  of  our  research  took  place  in   the fendant  at  the  Detention  Center  and  House   of
                      library.                                               Correction.  Thus,  a  system  was   devised   using
                      The   following   is   a   brief   run-down    of    our block captains as the persons to  contact  to  start
                      projects.  In   some   our   part   is   completed;   in the verification process.
                      others it is just beginning.                           6. Landlord-Tenant Pi-oblems:
                      1.   Ment(ti   Health:    Development    of    a    pro- A.   Individual   Cases:   Individual   cases   were
                      posal  for  a  "Trouble  Clinic,"   a   walk-in   clinic referred  to  the  SHO  law   student   by   various
                      utilizing    indigenous    workers     -     bartenders, community   workers-seven   or   eight   cases   al-
                      cornerstore    owners,    _varig    workers,    barbers, together.  Each   case   involved   expediting   the
                      community    leaders,    and     recreation     workers- problems  ivith  rather  than  for  the   individual
                      as   "listeners"   and   as   counselors    to    handle involved.  The  cases   concerned   landlord   prob-
                      threshold  problems  and  as  liaisons  to  the   store- lems,  insurance  fraud,  problems  with  the   city
                      front   clinic.   These   "listeners"   would    operate Water   and    Tax    Departments    and    problems
                      in  the  community  and   refer   individuals   to   the with  realtors.  The  cases  led  to  good  coopera-
                      clinic.  Within  the   clinic   would   be   located   ation  from  Community  Legal   Services   and   iso-
                      psychiatrist,  medical   services,   a   lawyer,   voca- lated  individuals  within  the   City   government-
                      tional    services,    and     experienced     community and  apathy  and  hostility  from  the   "establish-
                      personnel.                                             ment" as a whole.
                      2.   Compi-ehensive    Medical    Facility:    A    pro- B.     Community     Escrow     Agent:     Pennsyl-
                      posal  is  being  written  for   a   community   medical vania's  rent  withholding  statute  allows  a  ten-
                      facility,  hopefully  serving   all   of   Mantua.   Lo- ant  to  divert  rent  from  his  landlord   to   an
                      cated  in  a  rowhouse   it   would   break   down   the escrow agent when the city  certifies  the  tenant's
                      barriers-transportation,    size,     whiteness,     im- dwelling   "Unfit   for   Human    Habitation."    A
                      personality   -   between   Mantua    and    the    sur- proposal  was  prepared  to  facilitate  rent  with-
                      rounding medical institutions.                         holding   using   the   Mantua    Community    Plan-
                      3.   TB   Examinations:   On    two    occasions,    SHO ners  as  an  escrow  agent.   The   plan   involves
                                                                             close  coordination  with  L  &  I  (not  very  easy
                      workers   scheduled   the   City's   TB   mobile    unit
                      for  visits  to  Mantua.  Sites  were   selected,   pub- to  obtain),  immediate  contact  of  tenants  whose
                      licity  was  prepared  and  distributed   and   recruit- dwellings  are   "unfit"   and   negotiations   with
                      ing was done a personal basis.       The          target landlords to  prevent  the  cost  of  repairs  being
                      group   was   composed   of    persons    bypassed    by transferred to the tenant  in  the  form  of  higher
                      other TB checks, i.e., those   not   in    school    and rent.  While  L  &  I  has  been  reluctant  to  do-
                      on  jobs  where  periodic  TB   tests   are   scheduled. operate, the plan will go  into  effect  this  fall.
                      Approximately 200 such tests were given.                 C.  Housing  Clinic:  A  proposal.is  being   pre-
                       4.   Social   Disease:    With    community    pressure pared   for   a   Community   Housing   Clinic    to
                      a   Venereal   Disease   Program   was   instituted   at which   residents   with   housing   problems    can
                      the District 4 Medical Center.                         come  for  advice  and  action.  The  clinic   would
                       5.  Bail:   A   feasibility   proposal   was   prepared provide a variety of services,  e.g.,  directing  an
                      for  establishing   a   community   bail   bondsman   to emergency  repair  unit,  providing  legal   advice,
                      serve  Mantua.   This   would   be   a-black   business- running   educational    programs    for    tenants,
                      man   working   to   serve   the   community   and.   in action  as  an  escrow  agent  for  Mantua,   giving
                      business  for  a  profit.   The   proposal   found   the advice  on  establishing  credit  and  mortgage  op-

                      44


         portunities, providing a list of  dependable  con-    though they developed plans  for  an  interesting,
         tractors  from  Mantua  to  do  repair  work   and    feasible project.
         rehabilitation and finally acting as a real estate    The  entire  mental  health  system  of  Philadel-
         agent  f  or  Mantua-locating  vacant  apartments,    phia isn't disorganized, as  the  reports  of  two
         arranging home purchases, etc.                        PSHO  workers  on  one  psychiatric   service   of
         7.   Community   Parks:    The    community    has    Philadelphia   General   Hospital   show.    Harry
         started construction of several parks.  Legal  re-    Hirsch  and   Rich   Bernstein   present   comple-
         search has been done in the  area  of  structuring    mentary points of view  on  their  work  with  the
         effective  community   control   and   maintenance    Neighborhood  Youth  Corps   on   the   recreation
         of the parks.                                         project.
         This  is  only   a   quick   summary;   much   has    Jim  Padget  and  Steve  Ager  present  an  inter-
         been left out. It would be  tiresome  to  describe    esting account  of  their  experience  at  Horizon
         individual  encounters  with  the  "establishment"    House,  a  residence  within  the  community   for
         and not really  very  illuminating.  Not  surpris-    recently discharged mental patients.         Their
         ingly,  the  establishment  has  been   lethargic.    insight  into  motivations  and   the   apparently
         Several  individuals  within   the   establishment    simple problems facing  these  patients  may  lead
         such as  Walter  Lear,  individuals  on  the  City    to  greater  sensitivity  in  working  with  these
         Planning   Commission   and   individuals   within    patients.
         Community  Legal  Services   have   been   invalu-    None  of  these   problems   is   new;   the   ap-
         able. On the  whole,  however,  the  city's  atti-    proaches  in  confronting   them   are   new   and
         tude has  been  one  of  "disposing"  of  problems    serve  here  as  examples  for  future   programs.
         rather than "resolving" them.
                                                                 Organizing Mental Health Services
         VARIOUS       MENTAL        HEALTH        PROBLEMS
                                                                     Michael Geha and Gail Jones

                        Karen Lynch
                                                               When  we  arrived  at   our   project   site,   we
         At five sites,  SHO  project  workers  were  deal-    found  a  complete  state  of  chaos.  The  entire
         ing with  problems  of  mental  health.  Three  of    mental health set-up  in  Philadelphia  was  being
         these sites are represented in this  section.  Re-    reorganized  with  a  new  program  taking  effect
         ports  of  the   other   two,   Temple   Community    July  1,  1968.  Changes  in  the  physical  plant
         Mental  Health  and  the  Trouble  Clinic  of  the    as well as in the personnel  were  in  high  gear.
         West   Philadelphia   Community   Mental    Health    Needless to say, little  thought  had  been  given
         Consortium, are presented  in  other  sections  of    to  the  PSHO  project  After  meeting  with   Mr.
         the report,                                           J. it was obvious  that  the  only  real  planning
          These articles discuss  various  aspects  of  the    was that which  produced  a  letter  to  Ron  Blum
         complex  processing  of   mental   patients   from    and an arrangement for -a  two  o  clock  appoint-
         the point  where  they  are  first  identified  as    ment  with  Dr.   W.   at   Philadelphia   General
         i 4mental  patients"   to   the   psychiatric   wards Hospital.  When  we  arrived  there,   we   waited
         and  then  eventually  back  to   their   communi-    hours for  him  to  show  up.  As  it  turned  out
         ties.  The  experiences  of   PSHO   workers   not    chaos existed at  the  Philadelphia  General  Hos-
         only  showed  them  the  intricacies  of  adminis-    pital too. The entire Jefferson  Hospital  service
         tering this process and the problems of  staffing,    had been moved  from  the  seventh  to  the  sixth
         maintaining,  providing,  and  coordinating  serv-    floor along with a complete shift  of  the  staff,
         ices, but also involved them in  the  present  re-    including a  new  nurses  staff  and  new  interns.
         organization  of   mental   health   services   in    and  residents.  By  the  weekend  we  had  little
         Philadelphia.                                         in the way of a project.  Everyone  was  very  in-
          Michael  Ge,ha  was  not   simply   involved   in    terested  with  words  only,   including   sugges-
         that process of  reorganizing  services  in  Phil-    tions  as  to  whom,  except   themselves,   would
         adelphia, but suffered the  consequences  of  that    be best  suited  to  help  us  with  our  project.
         ,,,,reorganization process. The Jefferson  project    All  we  needed  wag  someone  to  spend   a   few
         never really  got  underwa  for  the  summer,  al-    hours  giving  some  direction.  On   Tuesday   of
                                                                                                                45


                                                                              There was little planning  and  thought  Put  into
                                              d      someone      who       was ott?, project. Gail and I tried, but we know  much
                     the second week we  f  oun           him                we                          work  or  f   or   that
                     interested, Richard S., Ph. D.  With              tructure too little about community
                     set up a structure for a project. This s             ended matter  even  what  it  Consisted  of,   to   kiow
                               the proposal which is aPP                                    and  as  we  tried  we   could   get
                     is described in Once    this    war,     done,     ,ve     began which way to 90, going   on   and    which
                     to this paper.                                           no one to tell us what was  s   may   have    been
                     t                  .     t.     Three     weeks      later direction we should take (thi
                     o cook with our       projec                                                                      is   that
                               ted,   depressed,and         very         unhappy         really  knew)  -   MY   Opinion
                     we were defla            to    find    tnvo    Or    three because no one c mental  health  election  this  fall
                     because we were only  able structure.     As     I      look unless the publi                     tstand-
                     patients who fit into  our             g.              The and Jr. Corps Service  at  PGH  proves  ou roject
                               realize what went wron                                                    is fall,  the  p
                     back now, I                                              ing for Jefferson students th            eet  next
                     most crucial point, because there are many,              is site  should  be  abandoned  as   a   proi f    work
                               t    our    ideas    were    molded    into    a        it  is  not  dropped,  a  lot   0
                     the fact tha             d    just    arrived    at    the summer. If at the  start  of  the  project  pre-
                               man    who    ha                               hould be done
                     project by a                          bout             thes                         ational  data  for  the
                     PMHC,   and who knew less than I a     s             going paring some type  of  inform           is in the
                     Jefferson catchment area and what wa                     roject worker so that the  know       what
                                              I     Hospital.      We      knewp                         es  provided   by   the
                     on at Philadelphia  Genera                          HosPi- community  and  the   servic
                     what the ward at Philadelphia General
                     tal  was  supposed  to  have  in  the  way  of   patients, agencies.
                               t   it   actually    had.    if    the    mental                                            for
                     but not wha                            it    is    de-   proposal: Summer Training Program
                     health community was operating as I                                  i al  S  hool  Students
                     signed   to    operate,    our    project    would    have      Med c        c
                     worked.  What  I   fail   to   understand   is   why   Dr-
                     M.   and   Mr.   J.,   both   of   whom    knew    exactly Goals                    d  to  give   students   an
                     what  was  going  one  failed  to  realize   Nvhat   would This  program   is   designe            tal   P   a-
                     happen if we tried this type -of project.                opportunity  to  study  a  series  of   men
                                                                                         n   eight   week   period   during    which
                     What  I'm  trying  to   -gay   is   that   the   idea   we tients over a                          readjust-
                               cellent,   but   not   resolute   with   respect time  these  patients  will  be  making  aes    follow-
                     had was  ex nds   of   patients   are   in    the    Psychi- ment  to  their  families  and   communiti
                     to what  ki              phia      General       Hospital- ing  release  from  a  mental  hospital.  A  secondary
                     atric  Ward  at   Philadel us   to   me   is    that    most goal  is  to  gain  some  f  eedback  from  the   stu-
                     What  has   become   obvio                                                                   of   the   Jeffer-
                                                  ed   to    be    going    On, dents regarding two subdivisions
                     people know what is suPPOs                                                                        economic
                                               ek       of        communication so,,  catchment  area:   the   low   sOcIO     e
                     but there is such a total la          s      what       is Negro  ghetto  (area  B)  and  the   low   sOc'o   co-
                     between People that 110 one know                                  te ghetto (area C) -
                     really  going   on   anywhere   but   right   where   they nomic  whi
                     themselves  work.  Thug,   Dr.   M.   had   no   idea   we
                               ng in the first place, Mr.    J.          didn't Procedure  sted  tnat   Dr.   Mock   at   PGH,    or
                     were  coTni              situation       was-at        PGH it  is   reque
                     know  what   the   patient                                           his  staff,  refer  to  the  summer   stu-
                     and  poor  Dr.  S.  had  not   been   in   the   community members of
                     long,  enough  to  know   anything   but   what   he   had dents  a  total  of  20  patients  who  are  preparing
                     read about  it  in  the  appropriation  for  the  staff  -to  return  to  their  homes.  Hopefully  this  sample
                     ing  grant.   The   lack   of   communication   came   out of  20  patients,  ten  in  the  two  designated  sub-
                     even   more   sharply   when   he   attended    a    staff divisions  of  the  catchment  area  can  be   located
                     meeting  of  people   from   all   the   different   agen- one week  prior  to  their  anticipated  release  from
                     cies   involved   in   community    mental    health    in the hospital.  Students  then  will  review  the  case
                     the   Jefferson   catchment.    No    one    knew    about records  of  each  patient   in   regards   to   demo-
                     anything   in   the   other    agencies.    Service    was graphic   characteristic   personal   history,    pre-
                     being    unnecessarily    duplicated,    resources     un- vious  alienations  and  s@mptoms  of   present   psY-
                                                                                                                       h patient  to
                     used  in   one   agency   were   needed   badly   by   an- chosis.  Students   will   interview   eac
                     other,   but   because   no   one   was    "aware"    they get  acquain@d  with  the   patient   and   to   learn
                     were unused.                                             his  plans  for  leaving  the  hospital  and  for  re-
                                                                              entry  into  the  commu'll  -   Students   will   also
                       I  don't  think  there  is   any   way   to   sumniarize visit  each  f  amilY  prior  to  the  return  of  the
                     except   to   say   that   everything   just   "happened."

                     46


                                                                   8pects  to  be  maintained   throughout   the   ye3r-
          patient to the family homes. The interview                                   nterests   of   the    patients,
          with   the   families    will    be    directed    towards The widely varying i
                                           vious             experi- who  ranged  in  age  from  10  to  80  years   pre-
          learning about the family's pre                                                            lanning         an
          ences   with   the   patient,   their   expectancies    in sented  a  challenge  to  anyone  p
          regard  to  the  patient,   and   their   areas   of   ac- activity program.
          ceptance  or  rejection  of  the  patient.   In   addition
          to  a  description   of   the   family   situation,   stu- Resou?-ces
          dents  will  complete   items   22-30   of   the   Freeman The   Mental   Health   Consortium    had    engaged
          and    Simmons    questionnaire.    They     will     also five   supervisors   (of   whom   three   were   SHO
          study   the   community   setting   to   which   the   pa- workers)  to  work  under  Christine   Westfall   in
          tient  will  be   returning   and   in   addition   to   aplanning  and  executing  the  recreation   program.
          description  of  the   community   in   terms   of   rele- Thirty  high   school   students   from   the   West
          vant  variables,  also  describe   the   relationship   of Philadelphia area, working    in    the     Neighbor-
          the family to this community.                            hood  Youth  Corps,  were  paid  $1.40  an  hour  by
          Following   the   return   of   the   patient    to    his the  Youth  Corps  to  serve  as  recreation  aides.
          family,   the   student   will   interview   the   patient
                                                                   All but two of the  recreation  aides  were  female.
          in  the  family  setting,  one,  three,  five,  and  seven A  Consortium   sociologist   led   semiweekly   in-
          weeks   after   his   arrival   there.    The    interview service  training  seminars  for  the  five   super-
          will  consist  of  items  1   to   21   on   the   Freeman visors and preceptor. He  also  served  as  a  valu-
          and  Simmons   scale.   Relevant   items   will   be   ad- able  advisor  and  consultant   on   sundry   prob-
          ministered  to  the  patient  and   also   to   the   sig- lems  arising  during  the  summer.   The   seminars
          nificant   family   member.   In   addition,    the    pa@ dealt  with  the  background   of   mental   illness
          tient   will   be   rated   on   the   MAAC   scale    and and  practical   problems   encountered   in   group
          the Overall-Gorham Scales.                               wor .
          At   the   end   of   the   seventh   week,   after    all In  addition   to   these   human   resources,   the
          interviews   have    been    completed,    the    students physical facilities  available  proved  to  be  ade-
          Will   summarize   the   changes   over   time   that   he quate  for  the  program   needs.   Several   grassy
          has  noted  in  the   patient   and   also   his   impres- fields  on  the  hospital  grounds  were  used   for
          sions  of  the  barriers   to   further   growth,   wheth- outdoor  activities.  The  PGH  recreation   depart-
          er  they   derive   from   the   patient   himself,   from ment  and  a  small  budget  from   the   Consortium
          the  family  or   from   the   community   setting.   This provided  athletic  and   indoor   game   equipment.
          last  item hopefully,   will   give   feedback    to    the
          JeffersonyCommunity       Mental       Health       Center The  Consortium  bus  was  used  for  trips  to  the
          regarding community    factors    in    areas    B     and zoo,  Phillies  games,  and  weekly   swimming   ex-
          C    which influence   the    mental    health    of    the cursions  at  League   Island   Pool   (Philadelphia
                                                                   Recreation  Department).  A   request   to   use   a

          residents.
                                                                   beautiful   indoor   pool   in   the   nearby    PGH
                                                                   nurses'   residence   was   turned   down   by   the
          The    Recreation    Project    for    One     Psychiatric ,matron"-in-charge.
                Service: Two Points of View (1)
                                                                   Oi-ganization
                           Harry Hirsch                             Each  of  the  five  supervisors  worked   directly
          Problem
                                                                   with  a  team  of  recreation  aides.  Because   the
            Prior   to   this   summer,   no   program   of   recre- need for recreation activities is, in  fact,  great-
          ation  therapy  existed  for   the   80   in-patients   in est  on  evenings  and   weekends,   when   hospital
          Penn@s   Psychiatric   Service   located   in    Philadel- routine  is  at  a  minimum,  the  program  operated
          Phi   General   Hospital.   Patients    were    able    to on  a  seven-day  week:   1   to   9   p.m.   Monday
          spend   their   time   watching   TV   or    staring    at through Saturday;  9  a.m.  to  9  p.m.  on  Sunday.
          the    wall-neither    of    which     is     particularly Two  teams  of  recreation  aides  and  two   super-
          therapeutic.  As  part  of   a   series   of   moves   de- visors  were  on  at  any  given  time  within  that
          signed   to   upgrade   the   quality    of    psychiatric schedule.   These   arrangements    resulted,    for
          care   at   PGH,   a   pilot   recreation   program    was supervisors,  in  a   week   of   approximately   35
          suggested  for  the   summer,   with   succesgf   ul   as- hours and 2 days off out of every seven.
                                                                                                                      47


                                                                                   schedule  resulted  in  conflicts  between   site   obli-
                                                                                   gations    and    Sllo    meetings    conferences,    and
                      Activities             mprised       one       aspect       of          le   I    generally    placed    MY    allegi-
                      Structured activities co           go,                picnics, programs. Whi                  that             towards
                                 These  . included bin                             e to the project site above
                      the program.                softball,        trips         for @ill                                     ed          in
                      movies, bowling, volleyball,                               and OHO,  the  other  two   SHO   workers   tend
                      swimming, museum, zoo,   .baseball games,
                      arts    and    crafts.    Poetry    readings    and    psycho- the opposite direction.           ere,   f    or    the
                      drama  were   Used   a   few   times.   Much   of   the   Pro- Relations with the PGH staff w           Is         and
                                                             -ng       to        the most part, extremely cordial. The R.N
                      gram consisted of unstructured relati                        P.N.'s  were  very   cooperative   and   often   assisted
                      patients.    Card    games,    checkers,    ping-pong,     and in  urging  patients   to   participate   in   recreation
                      above   all,   discussions    among    patients    and    rec-                                                    ndly
                      reation    workers     filled     out     the     unstructured activities. Male attendants were very frie
                                                                                   and  often   participated   in   the   activities   them-
                      time slots.                                                  selves.   The   female   attendants,   on    the    other
                      Sitccess in Confi-onting Pi,obte?n                           hand,  were   usually   both   lazy   and   insolent   to
                      The    recreation    program     succeeded     fairly     well patients   and   were   often   uncooperative.    Interns
                      in    supplyin    a    varied    schedule    of     recreation and   residents   seemed   pleased   with   the   program
                               9                                provided           and   were   willing   to   confer    with    supervisors
                      activities.  Moreover,  the  program                                                                    fie        pa-
                      enormous    opportunities    for    patients    to    partici- about  problems  in   dealing   with   speci
                      pate   in   social   interaction    and.    thus    facilitate tients.  Some  initial   conflict   arose   between   the
                      their    recoverv.     Because     of     common     socioeco- student  nurses   and   recreation   aides.   Some   stu-
                                                                d              Youth                          I    (and    perhaps     jeal-
                      nomic    backgrounds,    the    Neighborhoo                  dent  nurses  were  resentfu  '
                      Corps   workers   were   able   to    -relate    quite    well ous)   of   the   rapport   which   the    NYC    workers
                      and    without    inhibitions    towards    many    of     the had   struck   with    the    patients.    The    student
                      patients.                                                    nurses,  despite  or  because   of,   their   psychiatric
                      The   success   of   the   NYC   workers   in    this    proj- training,  often  f  elt  less   confident   in   dealing
                      ect   is   significant   in   terms   of    meeting    person- with  the  patients   than   did   the   NYC   recreation
                      nel   needs   in   health   care   delivery.   The    success- aides.   By   mid-summer,   however,    this      conflict
                      f    ul     employment     of     inexperienced     recreation had   been   resolved.    Whenever    possible,    super-
                      aides   (and   supervisors)    in    the    recreation    Pro- visors  attempted  to  involve  hospital  staff  in   the
                      gram   suggests   that   people    lacking    formal    train- recreation  activities.  These  efforts   paid   off   in
                      ing in medical fields may,  nevertheless,       be        able dividends    of     enthusiastic     cooperation     from
                      to   free   trained   personnel   for   more   efficient   use most of the staff -
                      of manpower.                                                 The   patients   tended   to   refer   to   the    recre-
                      A    major    criticism    of    the    recreation     program ation  aides  as   "volunteers."   This   term   suggests
                      is   the   failure   to   establish   a    routine    activity that   patients   perceived   the    youth    Corps    as
                      schedule.    Supervisors    Planned    activities    on    the people   who   enjoyed   relating   to    the    patients
                      spot,   An   activity    schedule    would    have    provided rather  than   workers   who   put   UP   with   drudgery
                      a   structure   on   which    supervisors    could    f    all in  order  to  collect  a  pay  check.  Patients   appre-
                      back   on   when   in   doubt   of   what   to    plan,    and ciated   the   presence   of   People   who:   (1)   took
                                                                                                                          he        monotony
                      would    have    insured    a    more    varied    array    of time to stop and listen; (2) broke t
                                               ctually offered.                    of  a  hospital  stay,  with  planned   activities;   and
                      programs than was a                                                                     .er    to    manipulate    than
                       Closer       communication       between       SHO        and (3)  were,  at  first,  easi
                      project    receptors    would     have     been-helpful     in other  hospital  staff.   Patients   vvere   particularly
                              p                                                                                             e in  off  -the-
                      ascertaining   the   role    of    SHO    workers    at    the glad for opportunities to participat                  de,
                      project    sites.    The    7-day     working     week     was ward   activities.   Some    effort    should    be    ma
                      both  a   basis   and   subject   of   conflict.   SHO   work- however,  to   decrease   their   dependency   upon   the
                                                                uel     and      un-                          nly   source   of    organized
                      ers  were  not   prepared   for   the   "er                  recreation staff  as  the  o
                      usual"    summer    work    schedule     which     was     not recreation  and   help   patients   to   organize   their
                                                ance    publicity     or     project own recreation programs.
                      suggested in SHO adv
                      descriptions.   The   schedule   was    handed    to    super-
                                                                                   Conclusions
                                               ning     of     the     summer     as
                      visors at the begin
                                                                                                                              nfront     any
                      ,what   hod   to   be",   and   was   accepted   largely   due Although   this   project   failed.to   co
                      to   a   lack   of   viable    alternatives.    The    working major  injustices  of  the  health   care   system,   the


                             pilot    recreation     program    tients  who  were  not  physically  repulsive   nor
        establishment of the                within       the    verbally  hostile.  On  the  whole,  the   patients
        succeeded in filling a major gap                                ed  the  greatest  amount   of   attention,
        present system. This  site  afforded  me  the  expe-    who receiv
        rience of relating  to:  (1)  psychiatric  patients,    were under  30,  black,  and  white  males,  extro-
        (2)  "hard-core"  ghetto  youth,  and  (3)  the  bu-    verted  or  passive  men  who  were  receptive   to
        reaucracy of a large  city  hospital.  Finally,  the    and  thankful  for  the  attention  of  the  girls.
        problem  of  transferring  the  program   into   the    Thus, almost  a  third  of  the  patients  received
        hands  of  the  year-round  staff  remains   to   be    a  lot  of  direct  attention  from  the  NYC.   It
        confronted between now  and the             summer's    should be noted that this  is  only  a  generaliza-
        end.                                                    tion,  for  certain  members  of  the  Youth  Corps
                                                                felt very much  at  ease  with  the  less  sociable
                           View 11
                                                                men and women of all ages.
                   Richard H. Bernstein                         If an index of  success  for  the  recreation  pro-
                                                                gram   was   direct,   personal   contact   between
        The   group    which    our    recreation    program    Youth  Corps  and  patient  population,  our   pro-
                                                                gram has  failed.  While  it  was  hoped  that,  as
        came  into  contact  with   was   the   Neighborhood    the  students  became   more   at   home   on   the
        Youth   Corps.   This   group   of   underprivileged    wards  they  would  socialize  more  freely,   this
        black  high   school   students   was   a   constant    never  materialized  to  any  large  extent.   Even
        source of  fun  and  difficulty.  Formally,  the  25
        young  people  (two  of  wIhom   were    boys)    were  at  the  end  of  the  summer,  it   was   somewhat
        divided into five teams,  each  headed  by  a  white    common  to  find  three  recreation   aides   (i.e.
        supervisor   (three   of   whom   were   in    SHO).    NYC  members)  and   only   one   patient   playing
        Each  supervisor  was  supposed  to  encourage   his    cards together or to observe  three  or  four  rec-
        team to get  the  patients  involved  in  some  out-    reation  aides  watching  TV   or   sitting   alone
        door activity  or,  if  we  were  on  the  ward,  to    without patients nearby.
        engage  in  quiet  indoor  games.  Talking  to   the    Despite  this  fact,  I  was  very  interested   to
        patients   and   relating   to   them   spontaneousl    hear  that  an  experiment  in   Europe   indicated
                                                           y    that  wards   in   which   there   were   community
        was  very   much   encouraged   by   most   of   the    adolescents present  had  a  higher  rate  of  dis-
        supervisors.                                            charge and absence  from  in-patient  services  for
         Despite  the  admonitions  of  black   nationalists    all ages of patients than  control  groups.  There-
        and  militants,  we  found  virtually  all  of   the    fore, it might well be  that  even  if  the  recre-
        NYC  people  receptive   to   our   friendship   and    ation  aides  dance  and  talk  among   themselves,
        our  leadership.   Even   when   actual   resentment    sit alone, socialize only with  the  men,  or  just
        toward certain  supervisors  did  arise,  the  black    generally  do  their  thing,  the  old  ladies  and
        students  candidly  denied  any  feelings   that   a    sick  old  men  are   absorbing   the   atmosphere,
        given  supervisor  was   condescending   or   taking    which simply radiated  with  life  and  health  and
        advantage  of  his  authority,   they   were   quite
        surprised  to  hear  and   quickly   dismissed   the    youth.
        Possbility  that  the  supervisor   was   expressing    Health Problems
        a white supremacist attitude.                            After  discussing  with  others,  it  seems   that
          Regarding   the   effectiveness   of   the    NYC,    the  fundamental  problem  with  the  health   care
        I have  mixed  feelings.  Relating  to  patients  is    delivery system as far as I saw it       (on    the
        difficult. it is very easy to Ask  people  to  "just    eighth floor of the Mills Building  run  by  Penn),
        talk  to  anyone  who  looks   alone."   But   these    was  that  Penn  is  much   more   concerned   with
        Young  men  and   women   have   had   no   previous    educating  its  interns  and  residents  than  with
        experience  in  a  psychiatric   setting.   Further-    treating patients.  The  treatment  aspect  is  not
        more, they  find  it  very  difficult  to  carry  on    absent, of course, but various  conditions  on  the
        a  conversation  with  adults  in  their  own   com-    ward  indicate  that  Penn  is  educationally  ori-
        munity,  let  alone  in  a  community  of   emotion-    ented. Most critically, it is clear    that    there is
        ally  disturbed  adults.  As  a  result,   the   NYC    hardly   any   semblance   of   a   team   approach to
        students tended  to  gravitate  toward  the  young.;    patient treatment. If the medical staff  in  charge
        er patients, and more  particularly,  to  those  pa-    of  the  ward  were  truly  interested  in  helping
                                                                                                                  49


                     patients, they would  institute,  as  early  as  P03- Resoul'ces                endation   I   have   is
                     sible,  a   team   approach.   This   would   involve The   most   obvious   recomm             I
                     cementing  the  nurses,   student   nurses,   attend- to encourage the Consortium to put pressur.e     On
                                         recreational      and       occu-
                                                                         .University  of  Pennsvlvania   Medical   SchOO   to
                     ants, social workers, and working       group        to institute  a  team  approach  to  dealing  with  Pa-
                     pational therapists into a            of          the tients. This would mean coordinating  the  eff  orts
                     serve as the surrogate eyes and ears                                            ing,    ward    nursing,
                              above    staff    should     be     informed of the heads of student  nurs e   recreation    arid
                     doctors. The          y     and,     more      impor- social service department, th         that     all
                     about the patients, histor                          ccupational therapy department. so
                                           f,   and    have    some    say                           to both' romote ed
                     tantlY, should be aware o                           0           ther   in   order      p              u-
                                            4 6strategy"      for      each working  toge            aximum  care   for   the
                     in determining the staff's ore      observations       in cational  instruction  and  m
                             more and in                                             . gh  a   team   effort).   Furthermore,
                     patient. As ings    are    made)    the    strategy    may patients (throu      sychiatrists     working
                     various sett        vent,    the    doctors     ought Penn  ought  to  get  more  Pabout  90   percent   of
                     be altered. But in any e
                                        .   tion   with   the   rest    of on  the  ward.  At   present, and    residents,    who
                     to have some communica ake    the    most    efficient the   doctors   are   interns to   three-quarters   of
                     the staff if they are to in 'n     resources     latent spend    about     two-thirds.       onferences.
                     and prudent use of the huma                                                     clinical c
                                                                         their time in classes  or  in
                                                                                                      Consortium       should
                     in the staff                                        LastlY,  it  seems  that  the               schools'
                                       the    doctors    consulted    with ct as a consortium of several medical
                     In the ward setup,                  sure          howa          far as  I  could  ascertain,  there  was
                     the social workers, although I am not               services.  As                           urces    be-
                                            tors,    time    was     spent no coordination of efforts and reso      different
                     often. Over half the doc           achers         and                      rs (each run by
                     learning about patients from their te           notes tween the various flOO
                             ents. Doctors read the -nurses'             local  medical  schools).  Apparently,   the   known
                     fellow resid          harting    was    only     done political  rivalry  among  schools  has   been   al-
                     on patients; however, c      ramatic          changes lowed to be  expressed  within  the  rubric  of  the
                     when there were some fairly d                                                                    autono-
                     in the patients' physical  or  emotional  or  behavi- 'gconsortium' " Each floor is a perfectly
                                           t    conversations    or    ob- mous  unit,  totally  segregated  from  the  others.
                     oral condition. Pertinen            our        recre-                            to inefficient  use  of
                     servations made by attendants or                    -This  must  inevitably   lead         services   to
                     ation  teams  or   supervisors   were   not   discour resources and poorer delivery of
                     aged  but  never  really  encouraged.  We,  the  rec- the community-
                                        felt    very    much     alienated
                     reational Drog-ram,                 giving        our
                     from the urslg staff in so far as
                     personal  opinions.  While  nothing   was   said,   I                 Horizon House
                     felt  my  observations  were  listened  to  but   not
                     openly  welcomed.  I  should   say,   howevery   that         Steve Agar and Jim Padgett
                     several  nurses  did  spend  some   time   with   the
                            rs,    informing    them    about    patients.  Can you imagine yourself being         away   f   or
                     supervise                                              5 months, 3 years,  or  even  your  life  time  from
                     Perhaps  one   of   the   most   illustrative   exam-  the  society  that  you've  been'used  to?  I  can't
                     ples  of   the   attitude   prevalent   this   summer  either, but several people  whom  I  have  met  this
                     among  the  staff  was  demonstrated  at   the   very  summer  have   faced   this   problem..   What   are
                     first -meeting  we  supervisors  had  with  the  ward  these  new  buildings  thev  see?  The  strange  new
                     staff - We five met with the  head  of  nursing,  the  dress? The  changing  political  and  social  world?
                                                        meone         from  Can you put yourself in their places?
                     head of student 'nurses, and so
                     social service.  They  made  it  quite  clear  to  us   This has been  the  plight  of  most  of  America's
                     that  the  recreation  program  was  our   baby   and  mental  patients.  Our  system  of   mental   health
                     that we could  not  expect  and  should  -not  expect  care  has  been  what  we  thought  was  quite  pro-
                     any help from the  staff,  because  of  the  terrible  fessional and  indeed  it  was  for  its  time,  but
                                          th  other  things.  This  is   a  now the situation is no lonLrer  the  same.  A  step
                     burden they had wi
                     striking  example  of  the   way   communication   is  back into the  co,)nraunity  must  be  made  in  the
   u @i@             discouraged,  resulting  in  a  fractionating  of   a  clinical  treatment  of  the  mental   Patient.   He
                                                                                                     shipped  out  of  his  home
                     potential team  effort,  and  ultimately  in  causing  should   no   longer    be
                     .poorer care to the patient.                           territory into  an  impersonal,  factory-like  envi-
                     50


          ronment from which he  will  eventually  emerge@    mental  health  program  until  this  summer.  Now
          somewhat a stranger  to  his  former  situation.    we can see.
          A recent  research  project  in  which  we  have
          been involved deals with  the  product  of  such    PLANNING      AND       DEVELOPING       PROG.RAMS
          a system. We are trying to motivate  ex-patients
          (called "members" at  Horizon  House)  to  learn                    Karen Lynch
          about  and  search  out  their  communities.  We
          have divided a  low-functioning  class  of  mem-    Each project   and   each   new   program    which
          bers into three groups of 10.  One  group  is  a    is developed in an attempt to achieve  that  long-
          control. With  both  of  the  other  groups,  we    range  goal  of  improving  health   services   is
          discuss various activities, such as the Franklin    unique. Yet, the successes  and  failures  of  the
          Institute. One group of people is  urged  to  go    past are brought to each  new  project  and  these
          to these community activities by itself (client-    experiences  should  guide  future   plans.   Four
          led) while one of the PSHO  students  takes  the    such  experiences  are  included  in  much  detail
          other (staff-led). In this  manner,  we  may  be    here. They should be read  not  so  much  for  the
          able to show whichi if any, is the bett er    method case history of one proposal  or  one  program  as
          to get: the clients involved in  the  community.    for the successes and f  ailures  which  each  one
          As the  project  has  just  begun,  we  have  no    faced along the  way  and  the  action  which  was
          results as of yet. But  the  ultimate  knowledge    taken in each case.
          gained will not be concerned  with  which  meth-     At  Southwest   Center   City   Community   Coun-
          od is better. The result of this project will aid   cil,  project   workers   and   community   people
          members  treated  under   the   present   mental    knew the general needs of  the  area,  but  worked
          health system; but the.final  question  is,  "Is    in several different directions until the  finally
                                                                                                      y
          this system adequate?" We think not.                decided to  write  up  a  proposal.  The  Delaware
          Thus, we have  a  difficult  time  getting  J.R.    County  project  involved  two  students   prepar-
          even to go with the staff-led group. J. wants to    ing for  the  November  election  and  the  county
          go in order not to hurt our  feelings,  but  his    health  department  issue   which   was   on   the
          convenient sore feet,early rising  hours,  various  ballot.
          duties, etc., prevent him from joining the poor-     These  two  sites  were  involved  in   planning.
          ly attended group trip.                             The project  workers  at  Citizens  Concerned  for
          Therefore, our duty  of  motivating  these  peo-    Welf are Rights  were  setting  up  a  babysitting
          ple becomes a very difficult and trying job. Are    center and then presenting  proposals  to  various
          we convincing enough while telling them  of  our    organizations for funding. At St.  Chris,  a  pho-
          exciting  trip  the  following  day?  Should  we    tography club  was  set  up  with  a  dual  objec-
          pressure  them  into  coming?  These   questions    tive:  it  educated  children  during  the  summer
          and this research project wouldn't be as  neces-    and it was a  means  of  entering  the  community.
          sary if these chronically ill  people  had  been    A caref ul reading of  these  papers  should  pro-
          hospitalized short  term  in  their  own  commu-    vide both information and a feel  for  the  effec-
                                                              tive  approach  to  establishing  -new   community
          nities.
          In addition, a series of  social  functions  for    programs.
          male and female ex'-Mental patients  was  estab-     Changing    Direction     at     SWCCCC:     From
          lished at the  Horizon  House  residence,  which
          was very successful. TJ-nfortunately, a proposal                  Survey to Proposal
          to initiate a concomitant series of  sensitivity
          groups to enable the boys and  girls  to  better                       Ed Pisko
          understand   each   other's   motivations    was
          squashed by the powers that  be  for  irrelevant      There are two    health  science  students   now
          reasong.                                            working  with  the  Southwest  Center  City   Com-
          This  whole  new  field  of   community   mental    munity  Council   (SWCCCC)   at   present,   Carla
          health is finally beginning to  take  shape  and    Oswald   and   Edward   Pisko.   A    member    of
          results are  coming  forth.  We  never  realized    SWCCCC  and  its   Health   Committee   is   work-
          the consequences  of  our  country's  antiquated    ing closely with these students.
                                                                                                               51


                 The Initit&t Rote of SHO Worke?-s                      search was done into comprehensive health       care
                 The  initial  agreement  to  bring  in   the   stu-    in  general.  This  decision  was  also   based   on
                                                                        changing   concepts   about   what   is   considered
                 dents  was  made  between  Mr.   C.,   representing
                                                                        good quality medical care.
                 SWCCCC,   and   the   SHO.   This   agreement   was
                 made  with  the  knowledge  and  approval  of   the    These  are  changes  which   can   be   seen   right
                 Health   Committee   and   the   Executive    Board    in  this  community.  To  begin  with,  one   reason
                                                                        that the  two  hospitals  are  going  to  leave  the
                 of SWCCCC.  Mr.  C.  was  to  serve  as  preceptor,
                 defined  by  SHO  as  "an  individual,  usually   a    @rea in the next few  years,  is  the  belief  in  a
                 professional, who is responsible  for  the  activi-    he.alth center  complex  as  the  best  way  to  ad-
                 ties of the project workers at  the  project  site.    minister  hospital  health  care.  To  the   Univer-
                 He  will  meet  with  the  workers  regularly   and    sity  of  Pennsylvania,  who  owns  the   two   hos-
                 offer guidance and assistance,  while  not  direct-    pitals, there is a great deal of  value  in  putting
                 ing the actual activity of the workers."               the two hospitals  with  others.  Some  of  the  ad-
                 The  roles  of  the  workers   were   not   clearly    vantages  of  this  system  are  the  close  proxim-
                 defined by  SHO  or  SWCCC.  At  first,  it  seemed    ity  of  a  large  number  of  physicians  for  con-
                                                                        sultation, centralization of facilities,  and  prox-
                 that  their  role  was  to  do  a   health   survey
                 of  the  SWCCCC  area  west  of  19th  Street.  The    !Mity  of  the  medical  school  to  its  associated
                                                                        nospitals. Temple  University  has  a  similar  pro-
                 reason for this was to help in  obtaining  a  chil-
                                                                        zram  with  a  large  health  center  complex  being
                 dren's  clinic  and  program  similar  to  the  one    the anticipated end result. It is of  interest  that
                 in  existence  in  the  eastern  SWCCCC  area,  the    Temple  has   also   established   a   comprehensive
                 Rebound Program.                                       health center  in  the  community  of  North  Phila-
                 After  discussion,   a   questionnaire   was   com-    d.elphia.
                 piled  using  many  of  the  same  questions   that     Group   practice   is   considered   a   model   of
                 Dr. L., Director of Research, had  used  to  obtain    quality in the field of medical care.  Its  emphasis
                 information   about   the   persons   Rebound   was    on having  many  specialists  see  a  patient  guar-
                 serving.   Other   questions   were   added    that    antees  high  quality  care.  In  combination   with
                 seemed  pertinent,  and   the   questionnaire   was    a good hospital  for  in-patient  services,  a  per-
                 submitted  to  the   Health   Committee   and   ap-    son can be assured of the highest quality     treat-
                 proved after suggestions were made.                    ment for  illness  under  the  group  practice  sys-
                 However,  before   they   started   surveying   the
                 community  with   the   questionnaire,   they   de-    tem.   The   comprehensive   health   care   program
                 cided to see if this  was  the  best  way  possible    in  cooperation  with  a  good   hospital   provides
                 to  deal  with  the  problem  of  obtaining  health    this same model of    care,  but  with   even   more
                 facilities. Dr  'L.  revealed  that  her  question-    services   than   the   group   practice    hospital
                                                                        model.
                 naire  wag  used   to   gather   information   that
                 would  help  administer  and  evaluate   the   pro-    The Present Health Care System in the
                 gram that was  already  funded.  But  in  order  to        SWCCCC Area
                 obtain a grant for  new  facilities,  the  proposal     There  are   many   means   of   obtaining   health
                 should  contain  statistics  from  the  Census  Bu-    care  in  the  SWCCCC  area.  These   include   pri-
                 reau,  the  Philadelphia   Department   of   Public    vate  physicians  and  hospital  clinics.   However,
                 Health,  Philadelphia  School   District,   Depart-    at present the main concern  is  the  services  that
                 ment of  Public  Assistance,  and  police  records.    Graduate   and   Children's    Hospitals    provide.
                 Therefore,  a  health  survey  would  not   be   of    These services  include  in-patient  (hospital  bed)
                 great value at this time.                              and  outpatient   (clinic   and   emergency)   care.
                 Health Care System                                       1.  In-Patient  Care:  Children's   Hospital   has
                  The  next  move  was   to   see   how   one   goes    always  provided  quality   in-patient   care,   and
                 about  obtaining  a  health  clinic  for  an  area,    with their moving  to  new  facilities  these  serv-
                 since  it  became  evident  that  a  health  survey    ices  will  probably  improve.  It  would   be   ex-
                 was not the answer.  Since  the  original  goal  of    pected,  then,  that  many  people  would   continue
                 the  project  was  comprehensive         children's    to go  there  despite  the  distance.  The  alterna-
                 health  care,  the  idea  was  expanded   and   re-    tive is the  erection  of  a  new  hospital  in  the

                 52


        SWCCCC   area,   or   renovation   of    Children's.    into  the  program  including   training   of   COM-
        The  advantages  of  such   an   institution   would    munity  people  as  nurses   and   health   workers.
        be  many.  If  the  hospital  were  community   con-
        trolled,  the  hospital  could  employ  many   local    Present    Philadelphia     Comprehensive     Health
        residents  and  train  them  as  nurses  and   other      Care P?-ogi-ams
        health  personnel.  Funding   would   be   a   prob-
        lem.   Mercy-Douglas   and   the    University    of    There    are     presently     two     comprehensive
        Pennsylvania  has   been   mentioned   as   possible    health  care  programs  in  the  city  of  Philadel-
        sponso rs of the hospital.  The  city  could  also  be  phia.  Mr.  Robert  Fishman   wrote   the   proposal
        approached  as  a  sponsor,   but   community   con-    for  the  project  sponsored  by  Pennsylvania  Hos-
        trol would  then  be  difficult.  The  City  Depart-    pital, and the  proposal  is  available  for  anyone
        ment of Public  Health  is  still  mainly  concerned    to read in his  office.  Mr.  James  Snipe,  of  the
        with  preventive  medicine  and  not   with   treat-    Temple   Comprehensive    Health    Program,    com-
        ment,  although   this   philosophy   might   change    pleted   the   proposal   for   the    comprehensive
        when fund-, are available.                              health  program  there  and  he   may   still   have
        2. Oti,t-patient Services:  The    present    system    copies  of  his  proposal  available.  The  students
        of waiting for hours in    a  hospital   clinic   is    have  talked  to  both  of   these   gentlemen   and
        faulty.  The  service  is  very   often   impersonal    certain things were emphasized.
        and the followup  is  poor.  If  the  community  de-    Mr.  Fishman   spoke   of   two   alternatives   for
        cides to  have  its  own  hospital,  and  it  wishes    obtaining   a   comprehensive   health   care   pro-
        to  incorporate  out-patient  services   into   that    gram.  One  alternative   is   for   the   community
        hospital,  it  is  important  that  the  unsatisfac-    to write  a  proposal  and  submit  it  to  the  OEO
        tory qualities of hospital  out-patient  clinics  be    office to  obtain  a  grant.  The  United  Neighbors
        eliminated.  The  alternative  is   an   out-patient    Settlement  House  tried  this  in  1965  and   they
        facility   which   would   provide   emergency   and    failed to  obtain  a  grant.  This  year  Mr.  Fish-
        treatment  facilities  and  be  housed  apart   from    man  wrote  the  proposal  for  the   community   in
        the  hospital.  The  Federal  Office   of   Economic    affiliation  with  Pennsylvania  Hospital  and   ob-
        Opportunity   funds   comprehensive   health    care    tained the grant.
                s, and  the  program  could  be  set  up  to
        program
        serve all the people in the SWCCCC area.                 Mr.   Fishman's   suggestions   on   obtaining    a
        Advantages of Comprehensive Health Care                 health center were -first to  interest  an  institu-
         The   acceptance    of    the    Rebound    Program    tiori in the area and  then  to  work  closely  with
                                                                that institution in writing  the  proposal  for  the
        which  provides  comprehensive  services   to   chil    comprehensive   health   program.    The    existing
        dren   in   the   eastern   SWCCCC    area    demon-    Health  Committee   or   a   subcommittee   of   the
        strates the  value  of  this  service  to  the  com-
                                                                Health  Committee  could  be   the   agent   working
        munity.   The   Rebound   Program   could   be   in-
        corporated  into  the  larger  program  that  serves    with  the   institution.   Mr.   Fishman   mentioned
        everyone.   The   comprehensive    health    program    that  the  SWCCCC  area  falls  in  the   boundaries
        is a  combination  of  two  concepts  in  the  prac-    of  the  Jefferson  Hospital  Mental   Health   Pro-
                                                                gram.  Therefore.  a   comprehensive   health   pro-
        tice  of  medicine.  The  program  provides  for   a                                        ion   of    thos.e
        primary physician  who  acts  as  a  family  doctor.    gram would be a logical extens
                                                                services. But Children's  Hospital,  as  a  part  of
        In addition, there are  other  specialists  on  call                                         also   involved
                                                                the University of Pennsylvania is
        and this provides  the  advantages  of  group  prac-    in  the  area  with  the  Rebound  Program.   There-
        tice.  Arrangements  would  be  made  with  a   hos-    fore, they should  also  be  approached  as  a  pos-
        Pital  for  in-patient  care  when  these   services    sible   sponsor.   Hahnemann,   Mercy-Douglas,   and
        are  needed.  The  program  provides  for  a   great    the  City  Department  of  Public  Health  are  also
        deal  of  involvement  of  the  community   in   the    possible sponsors.
        planning   and   running   of   the   program.   The
        present   Pennsylvania   Hospital    program    pro-      Mr.  Snipe  confirmed  what  Mr.   Fishman   said.
        vides   for   complete   community   control   after    He  added  that  from  the  very  beginning  it  was
        three   years.    Therefore,    whatever    programs    important  to   work   with   the   Area   H   Anti-
        the   community   wished   could   be   incorporated    Poverty    Committee    and     Community     Action
                                                                                                                   53


                              Council,  since proposals  will                           have        to        be         ap-                  Table    I.-l96O    Population    Characteristics    for    SWCCCC
                              proved     and     submitted     by     these     groups.     Also     in                                                    Census Tracts and                       Philadelphia.
                              his proposal he mentioned                         . the            importance            Of                                                                            3o-B              30-C       delphia
                              working       ,yith       city       agencies       concerned        with
                              health    and    welfare     and     state     agencies     of     health                                       Total population .... .......          7,220           9,240        7.067           2,002,512
                                                                                                                                   and                                                                             ;8.4                      26.4
                              and  welfare,  and  community  physicians                                                                       Percent Negro                   ......   96.8          82.8
                              dentists.                                                                                                       Percent white                 ........     2.7         16.9                 1.4                73.3
                                                                                                                                              Percent   other    races                   0.5           0.3                0.2              0.3
                              Wi-iting  a Pi-opos(tl                                                                                          Income:       Employment,        Education,        Occupation
                              Initially  a  health  survey was                                    going          to          be
                              done    to     establish     the     need     for     a     comprehensive                                       The   income   level   of   the    area    is    extremely    low.
                                                                                                                                              Over   a   third   of   the   families   in    the    area    have
                              health     program.     However,     if     a     proposal     for      a
                                                                                                                                              yearly    incomes    of    less    than    $3,000.    Over    half
                              health     center     is     written,     existing     statistics     are
                              usually     used.     The     following      section      shows      sta-                                       earn less than $4,000 annually.
                              tisticg      demonstrating      the      need      for      a      health
                              center.     These      figures      could      be      expanded      with                                       Table   2.-1960   Income   for   SWCCCC    Census    Tracts    and
                                                                                                                                                                                Philadelphia.
                              Philadelphia        Department         of         Welfare,         School
                              District, and Police Records.                                                                                                                                                                                iFa-
                                                                                                                                                                                                  SO-A   SO-B             30-C               delphia
                              So,ui,ces                                                                                                       Number  of  families              ........         1,562  2,056             1,537              500,515
                                                                                                                                                  Percent    under    $3,000    40.0                     36.9             47.9             17.1
                              Although        the        members        of        the         Southwest                                           Percent between
                              Center         City          Community          Council          (SWCCCC)                                              $3,000         and         $3,999..          19@l    15.3            15.2                     9.6
                                                                                                                                                     over        ..................... @-.          40.9  47.8            36.9             73.3
                              and     other     residents     of     the      SWCOCC      area      are                                           Percent          $4,000          and
                              generally      familiar      with      the      characteristics       and                                       Median         family         income....         $3,526         $3,854         $3,139           $5,782
                              problems     of     the     area,     a      statistical      description
                              better     documents     the     needs     and     makes     it      pos-                                       The     median     family      income      for      the                             area      is
                              sible     to     objectively      cornpare      the      SWCCCC      area                                       over    $2,000    below    that    for    Philadelphia    as     a
                              with      the      rest      of      Philadelphia.      The      original                                       whole.    The    average    family    size    is    4.6                             persons.
                              boundaries       of       SWCCCC-South        Street        to        the                                       These    facts    alone    declare     the     need                                 for     low-
                              north,      Broad      Street      to      the      east,      Washington                                       cost,   high-quality   medical    facilities    in    the    area.
                              Avenue     to     the     south,     and     the     Schuylkill     River                                       Part   of   the   reason   for   this   low   income    is    cer-
                              to     the      west-simplify      this      task.      These      bound-                                       tainly      unemployment.       Unemployment       rates       for
                              aries     almost     exactly     correspond     to      the      outlines                                       both   men   and   women   in   the    labor    force    in    the
                              of    the    three     census     tracts     which     comprises     this                                       SWCCCC    area    are    double    those     for     the     whole
                              area-30-A      and      30-C      in       the       eastern       SWCCCC                                       city.
                              area and 30-B in the western part.
                                                                                                                                                  Table  3.-1960  Unemployment  for                              SWCCCC                       Census
                              Thus,         the         census          data          from          1960          can          be          used                          Tracts              and              Philadelphia.
                              for              general               information               about               the               population
                              characteristics,                 income,                  employment,                  and                  hous-                                                       30-A                30-B    30-C     d
                              ing.               Although                this                information                may                have Percent of male civilian
                              changed          to           some           degree           since           the           1960           census   labor  force  unemployed                      ...... 12.2               13 .3   17.0             6.4
                              was         taken,         it         is         presumed         that          it          still          repre- Percent of female civilian
                              sents         the         area         to         a          great          extent.          Health          sta-   labor  force  unemployed                      ...... 12.1               12.6           8.5       6.5
                              tistics            data            are            available            from            the            preliminary   Further         reason         for         the         low         income          level          can
                              Philadelphia  health  statistics  for  1967.                                                                    be         found         in         the          educational          level          and          occupa-
                              Population                                                                                                      tions          of          the          SWCCCC          residents.          The          area          as
                                                                                                                                              a       whole       has        a        median        of        less        than        ten        school
                                The          population          of          all           three           census           tracts           is years          completed           for           persons.25           years           or           older.
                              redominantly               Negro.               The               percentage               of               Negro Overall,           there           are           more           than           300            blue-collar
                              p
                              persons         in         the          area          is          over          three          times          the workers           for           every            100            employees            on            white-
                              percentage  for  the  city  as  a  whole.                                                                       collar         jobs         in         the          SWCCCC          census          tracts.          This
                              54


                                         he       number       of        blue-collar     jury     for      these      infants      is      substantially      higher
            is   more   than   double    t                                                            he     city.     The     percentage     of      these      in-
            to    white-collar    workers    for    the    city    as    a    whole.     than for t
            Housing                                                                      fants      born      illegitimately       is       drastically       higher
                                                                                         in    the     SWCCCC     area     than     for     the     entire     city.
            'While    only      36.1      percent      of       the       households     This    fact    may     suggest     the     need     for     sex     educa-
            in    the     entire     city     rent     their     dwellings,     over     tion       and/or       planned        parenthood        programs        in
            half    of    the    residents    in    the     SWCCCC     area     rent     the community.
            their     homes.     This     places      an      additional      strain      Many      of      the      mothers      in      the      SWCCCC       area
            on    the    already     very     low     income.     Moreover,     less     have     inadequate      medical      'care      before      the      birth
            than  two-thirds  of  the          housing      units       in       the     of     their     children.     A     mother's     care      is      consid-
            three       SWCCCC       census       tracts       are        considered     ered     inadequate     when      she      has      no      care      until
            sound.   Worthy   of    note    is    area    30-B    in    the    west-     the    last     three     months     of     her     pregnancy     or     no
            ern      part      of       the       SWCCCC       community       where     prenatal     care     at     all.     The     percentage      of      birth
            14.7    percent    of     the     homes     are     dilapidated     (de-     in      the      SWCCCC       area       preceded       by       inadequate
            fined     by     Census     Bureau     as     not     providing     safe     medical     care     for     the      mother      is      nearly      twice
            and      adequate      shelter;      requiring       extensive       re-     that   for   the    city    as    a    whole.    This    lack    of    care
            pair     or     rebuilding).     Furthermore,     over      10      per-     to     the     mother     contributes     greatly     to      the      pos-
            cent      of      all      SWCCCC       residences       are       over-     sible     immaturity,      birth      defectg,      and      birth      in-
            crowded     with     more     than      one      person      in      the     jury of the infants.
            house    for    each     room.
            Table    4.-1960    Housing    for    SWCCCC    Census    Tracts     and     Table    5.-1967     Birth     for     SWCCCC     Census     Tracts     and
                                          Philadelphia.                                                                   Philadelphia.
                                                 30-A     30-B      SO-C    delphia                                            3A-A      30-B       30-C     delphia
            Percent   of   housing   units                                               Number of births ..       .............. 100    142        125       36,112
            owner occupied  .     ....... ......... 17.5  40.7      18.9      58.7            Birth rate per 1,000
            Percent   of   housing   units                                                        (1960)      population      .- 13.9    15.4       17.7           18.0
            renter occupied        .................. 75.6 54.3     72.6      36.1            Pe. reent   of   live    births
            Percent   of   housing   units                                                        immature       .................. 17.0 13.4       15.2           11.6
            judged        sound ......   ........ 47.3    62.2      62.8      87.3            Percent    of    live    births
            Percent   of   housing   units                                                        congenitally
            deteriorated      ........................ 44.7 23.1    35.1      10.6                malformed        ................ 1.0       .7    4.0            1.1
            Percent   of   housing   units                                                    Percent    of    live    births
            dilapidated      .. ........  ...............   8.0 14.7  2.1        2.1              with   birth   injury   ... ...    ....   ....    1.6            .4
            Percent   of   housing   units                                                    Percent    of    live    births
            with    1.01    persons    per                                                        illegitimate     ................ 37.0 38.7       56.0           17.0
            room    or     more ...... .........  ..... 10.2 12.8   12.3         7.0              preceded     by      inade-
                                                                                                  quate    pre-natal     care .... 31.0  20.6       36.8           16.8

            Health
                                                                                            Death     rates      for      1967      are      also substantially
             More     important     than     these     facts     are      th'e     ob-   higher     in     the      SWCCCC      census      tracts      than      in
            vious     health      needs      of      the      people      of  the        all      of      Philadelphia.      Moreover,      a      greater      per-
            SWCCCC      census      tracts.      With      the      poverty      im-     centage      of      deaths      in      the      SWCCCC      area       is
            posed     on     the     residents     already     shown     by      all     caused       by       preventable       and       -infectious       disease
            the      above      information,       health       problems       place     than  in  the  city  as a whole.
            a    further    strain    on    incomes    that     have     no     room
            left    to    stretch.    Health    status    is     indicated     below       Table    6.-1967    Deaths    for    SWCCCC     Census     Tracts     and
            by     statistics     on     birth,      deaths,      and      incidence                                      Philadelphia.
            Of preventable  disease for  1967.
             The      live-birth      rate      in      the      SWCCCC       census                                            3A-A       SO-B     30-C      delphia
            tracts    is    about    the    same    or    slightly    lower     than     Number of deaths           ................ 137     149    109       24,443
            for     Philadelphia     as     a     whole     (based      on      1960              Death   rate   per    1,000
            Population      figures).      Although       the       birth       rate              (1960)           population .... 19.0     16.1    15.4           12.2
            is     lower,     the     incidence      of      immaturity      (weigh-              Percent   of    deaths    from
            i                                                                                     tuberculosis       ..............   2.2      .7       ....       .6
            119   5    lbs.    8    oz.    or    less    at    birth),    congenital              Percent   of    deaths    from
            Inalformations      (birth      defects),      and       birth       in-              syphilis      ...................... .7      ...      ....       .07
                                                                                                                                                                   55


                                                                                     1.     Protecting     you     against     disease,     both
                  Table 6-Continued                                                  chronic and contagious.
                                                 SO-A    30-B   3@C         delphia  2.   Controlling    the    environment    so    that    the
                        Percent of deaths  -                                         conditions   under    which    you    live,    work,    and
                          from influenza                                             play are healthful.
                          and pneumonia   ---------- 3.6   2.7    1.8         2.8
                        Percent of deaths                                            3.    Finding    those    who    need     treatment     and
                          from nephritis and                                         arranging   for   their   care,   if   they    would    not
                          nephrosis (kidney                                          otherwise receive it.
                          disease)  ..............  .7      .7     .9         0.6    At   the   present    time,    public    health    services
                        Percent of deaths
                          disease of early                                           in    Delaware    County    are    administered    by     a
                          infancy   ............... 1.6    2.0    4.6         3.6    multiplicity   of   governmental    units    and    levels,
                                                                                     in   addition   to   the   numerous   voluntary   agencies.
                      These f acts show that the         SWCCCC      area      is    Boroughs,   First-Class    Townships,    and    the    City
                      a   very   impoverished   area   in   its   general   char-    of   Chester   receive    the    majority    of    services
                      acteristics and an area very       much    in    need    of    from   municipal   health    boards    and    health    of-
                      more and better health care.       The   fact   of    Chil-    ficers   (38   in   all).   Second-class   Townships    and
                      dren's   Hospital's   relocation   in   1971    has    been    the   two   boroughs   which   have    surrendered    their
                      established.   This   presents   a   vast    decrease    in    programs   to   the   State,   are    serviced    by    the
                      the   health   services    available    to    the    SWCCCC    State   Health   Department   from    its    Chester    of-
                      community,   while   all   evidence    shows    need    for    fice  and  the  regional   office   in   Philadelphia.   In
                      an  increase.  All   the   facts   taken   together   indi-    addition,   the   State   consults   with   the   municipal
                      cate  a  critical  situation   in   which   the   residents    boards   to   aid   in   the   problems   when   necessary,
                      of    the    SWCCCC    area    must    make    some    move    and   has   directed   supervision   over   certain   types
                      to  acquire  an  additional  health   facility   in   their    of   programs,    which    are    primarily    State    re-
                      area   before   1971.   There    are    various    possible    sponsibilities.
                      channels   the   community   can   take   to   reach   that
                      end but they all require action Now.                           In,t?-oditction
                                                                                      It   is   an   incontrovertible    medical    fact    that
                                  What Is Public Health7                             in  our  complex  society  public   health   is   a   vital
                                      (Delaware        County)                       governmental     service.     The     question     remains,
                          Jan L. Baxt and Sheldon A. Halpern                         however:   "Why   should   public    health    be    admin-
                                                                                     istered    on    a    countywide    basis    in    Delaware
                        Positive   physical,   emotional,   and   social    well-    County?   We    already    have    a    State    Department
                      being,  not  just  the   absence   of   disease.   In   the    of   Health   Center   and   38   municipal    boards    of
                      simplest   terms,   "public   health"   is   people   band-    health,   as   well    as    numerous    voluntary    agen-
                      ing       together-primarily       under       governmental    cies.   Why   do   we   need   a    County    Health    De-
                      auspices-to    solve    health    problems    which    they    partment.?"
                      cannot solve alone.                                              First,   it   must   be   emphasized   that   a   county-
                        Whenever   two   or    more    persons    are    affected    wide  administration  of   health   services   is   not   a
                      by   the   same   disease,   this    becomes    a    public    new,  untried  experiment.   Rather,   it   is   the   norm
                      health   concern   in   the    broadest    sense.    Public    throughout   the   country.   Eighty   percent    of    the
                      health   services   are   directed   towards    the    pre-    counties   in'   the   country   are   served   by   county
                      vention  of  disease  for   all   members   of   the   com-    health     department.      Delaware      County,      like
                      munity,   while   private   health   care   is    concerned    many    other    counties,    is     undergoing     changes
                      with  curing  a  specific   illness   in   an   individual.    which    make    the    establishment    of    a     county
                      Private   medicine    and    public    health    complement    department    both    possible    and    more    important:
                      each   other.   The   family   doctor   treats   an   indi-       1.  A   population   boom   is   altering   the   nature
                      vidual  case  of  hepatitis,  while   the   Public   Health    of our community by:
                      Department    traces    down    the    source    of    con-       (a)   Quickly   turning   the   eastern   end   of   the
                      tamination and eradicates it.                                  county   into   a    single    densely    populated    unit
                          In  brief,  the  responsibility  of  a  Public   Health    with   all   of   the   problems   which   normally   occur
                      Department includes:                                           in areas of this type, and

                      56


          (b)  Accelerating  the  rate  of   development   in    nonresidents,  The  obviousness   of   the   answers
          the semirural western portion of the county.           implies that everyone must   be   concerned    about
          Both  areas  require  sound   planning   and   com-    the quality  of  the  restaurant  inspections,  com-
          prehensive  health  programs  to  cope  with  these    municable  disease  control,  etc.,  all  over   the
          problems, but neither is  possible  under  the  ex-    county-not just to be  a  public  spirited  citizen,
          isting   fragmented   municipal   structure   which    but  to  be  sure  of  his  own  and  his   family's
          bears little relation to patterns of  work,  trade,    health.
          or recreation.                                         3.  Untrained  health   officers:   Experience   has
          2.  Increasing   mobility   of   population,   with    clearly  shown  that  public  health   work   is   a
          people moving in and  out  of  the  county  at  in-    highly  professional  undertaking.   There   is   no
          creasing rate.                                         substitute  for  professional  and  technical   com-
          3.  The  accelerating  pace  of  change  and   dis-    petence.  As  the  Stebbins  Report   said:   "Cheap
          covery  in  public  health  practices   which   re-    public  health  is  expensive-failure   to   provide
          quires the combined efforts of a  team  of  trained    adequately  for   the   professional   guidance   of
          specialists.  All  of  the  services  and  programs    health  programs  results  in  inestimable   waste."
          administered by  a  modern  public  health  depart-     With  that  in  mind,  consider   the   fact   that
          ment  are  interdependent-when   one   portion   of    there are  no  professionally  trained  and  experi-
          the cortiprehensive  program  is  missing,  all  of    enced  public  health  directors  operating  in  the
          the other  programs  become  less  effective.  Pro-    county.  The  present  municipal   health   officers
          viding the full range  of  public  health  services    range  from  salesmen.  or  retired   policemen   to
          in  a  professional  manner  is  beyond  the  scope    nurses,  santiarians,  and  physicians,  with  vary-
          of  an  untrained,   part-time   municipal   health    ing   backgrounds   in   public   health.   However,
          officer, and the fiscal ability of any one  munici-    none  of  these  have   qualifications   the   State
          pality.                                                mandates  for  the  Director  of  a  County   Health
                                                                 Department,   namely,   a    physician    who    has
          Inadequacies  of   Municipal   Health   Departments    taken  postgraduate  public  health  training,   in-
          Let  us  now  look   at   some   specific   reasons    cluding  a  master's  degree  and  a  residency   in
          why  municipal  health  officers,   regardless   of    public health and  who  is  certified  in  the  spe-
          their  diligence,  cannot  adequately   serve   the    cialty of public  health  and  preventive  medicine.
          county's health needs.                                  It  would  seem  that   having   a   physician   or
          1. Fragmented   programs:         In       Delaware    nurse listed as a  municipal  health  officer  would
          County  approximately   75   administrative   units    guarantee  a  sound  public  health.  However,  this
          are involved in the provision  of  official  health    has  not  been  the  case.  Upon  consideration   of
          services,  including:   38   municipalities   which    the  following  facts,  the  reasons   will   become
          have  health  officers  and/or  boards;  the  State    obvious:
          Health  Department,   which   serves   the   county      1.  Each  of  the  16  doctors  who  acts   as   a
          through  its  Chester  office  and   its   regional    municipal health officer  does  so  on  a  part-time
          office in Philadelphia; the  various  local  school    basis;  none  is  trained  in  public  health  work,
          districts;  county   government,   which   adminis-    which  differs  greatly   from   private   medicine.
          ters a variety of  services;  and  11  other  State    Each  is  heavily  involved  in  big  own   practice
          departments   engaged   in    various    regulatory    and is thus hard  to  reach  in  emergencies.  Also,
          and  supervisory  activities.  Thig  is  a  cumber-    he  is  not  usually  available  to  participate  in
          some   administrative   structure    without    any    day-by-day  planning  and   coordination   of   pro-
          central point for the coordination  or  integration    grams  with  other  public  and  private   agencies.
          of these closely related services.                     Finally, by virtue of his office, he is  potentially
           2. Uneven  quality:  When  there  is  great  vari-    subject to serious conflict. If he is  fearless,  he
          ation among  local  boards  of  health,  nobody  is    is likely to lose  some  of  his  private  practice.
          really protected,  because  health  problems  over-    If he is timid, he cannot be  a  succssf  ul  health
          lap the boundaries  of  our  small  municipalities.    officer.
          How  many  Delaware  County   citizens   spend   no      2. None  of  the  12  nurses  employed  as  health
          time  outside  their  own  municipality?  Is  there    officers  are   graduates   of   accredited   public
          any  municipality  which  prohibits  entry  to  all    health  nursing  programs.  As  registered   nurses,
                                                                                                                    57


                      all  are  trained  primarily  for  clinic  and   bedside Meaningless Boundaries small        municipalities
                          not  for   public   health   work   in   the   corn- The boundaries of our
                      nursing,                                                        drance   where   public    health    prob-
                      munity, especially sanitation.     al             boards act as a hin erned.  pollution,  disease,   and   rate
                      3. Since the programs of niunicip                      lems are conc        e   township   line,   but   a
                      of  health  are  concentrated  largely   in   the   area do -not turn back at th st.   To   combat   public
                      of  sanitation,  they   rarely   utilize   the   medical municipal health officer mu
                      skills  of  the   28   doctors   and   nurses   employed health  problems,  the  entire  county  must  count
                      as  health   ofricers.   Their   skills   and   training as  one  "community."  Moreover,   adjacent   full-
                      would  have  much   greater   relevance   in   a   well-                                     te       more
                                           rogram        which        included time county departments can coopera
                      rounded public health p                                effectively than part-time local officials.
                      the   planning    and    administering    of    personal
                      health services.                                       Small Range of Services
                      Pa)-t-time Health Office@)-s                           Many  problems,  such  as  rat  infestation,  lael,
                                                                             of  health  education,  and  communicable  disease,
                      Public   health   has   reached   a   degree   of   com- require  a  combination  of   professional   disci-
                      plexity  in  which  the  part-time  local   health   of- plines  and  services.  A  county  health   depart-
                      ficer is  not  able  to  discharge  his  duties  as  the ment normally  supports  a  range  of  these  serv-
                      executive  officer  of  the  local   board   of   health ices. A brief description  is  given  below,  along
                      adequately.  It  is  impossible  for  him  to   acquaint with  the  problems  caused  for  Delaware   County
                      himself with the    many     technical     advances     in by  the  lack  of  a  County  Department   to   run
                      public  health  and  still  find  time   to   carry   on these services.
                      his  normal   gainful   occupation.   Nevertheless,   at 1.  Vital  statistics  and   communicable   diseas@
                      the  present  time  there  are  only   four   full-time, cont?,ol: Under the present system,  we  have  lit-
                      municipal   health   officers   in   DelaNvare   County. tle reliable data on  the  incidence  of  commurii-
                      Of  the  39  municipalities  with   health   boards   in cable disease or  of  chronic  diseases,  accidents
                      1966,  only  four  were  paying   their   local   health or   environmental   hazards.   There   are    many
                      officers  $2,000  or  more  in  salary,  six  were  pay- points  at  which  the  current  reporting  systeir
                      ing   between   $1,000   and   $2,000,   eight   between falls down. This is not  a  reflection  on  eithei:
                      $400   and   $1,000,   and   18   under   $400.    Three doctors or health officers, but  on  an  incredibly
                      reported no salaries at  all  tinder  the  local  health complicated  reporting  system,  which   could   bE
                      officer category.                                      corrected by a County Department.
                      Spokesmen     for     municipal     health     interests a.   Morbidity   statistics,   including   communi-
                      herald   their   availability   for   nighttime    emer- cable diseases, are  reported  by  doctors  to  thE
                      gencieg.  This  obscures  the   difficulty   of   reach- municipal   health   officers,   a   time-consuming
                      ing   many   of   these   officials    during    daytime task since  a  doctor's  patients  come  from  many
                      hours,  when  most   people   would   avail   themselves municipalities, and their  postal  addresses  ofter
                      of  their  services.  Besides,  how  beneficial  is  the confuse, rather than  help,  in  determining  theii
                      presence  of  a  public  officer  at  midnight,  if   he residences.
                      is  untrained?   Few   real   public   health   problems b.   The   municipal    health    officer    sends
                      emerge  or  can  be   dealt   with   on   an   emergency weekly report to the state office in  Chester.  Th(
                      basis during these hours.                              statistics  are  then   forwarded   to   Harrisbur@
                                                                             for analysis.  Eventually,  they  are  returned  t@
                      Poo?- Financial Base                                   the municipal health officer,  by  which  time  ani
                       A   modern   public   health   program   is    composed epidemic on  which  he  would  act  might  well  bf
                      of   many   interrelated,   highly   complex,    techni- over.
                      cal  services  which  can  be   provided   only   by   a c. A breakdown in reporting from          a   fev
                      trained  staff  of   specialists.   According   to   the municipalities  could  create  a  great  distortion
                      Stebbins  Report,  an  adequate   financial   base   and in the prevalence of any disease-and         raan
                      minimum   population   of   100,000    or    more    are municipalities  do  not  file  annual  reports   o.
                      essential  to  provide   these   services   efficiently. communicable disease tvith the state.
                      No  municipality  in  the  county  could  aff   ord   to This    breakdown    in    comunicable    diseas;
                      provide the program and staff necessary.               reporting  is  potentially  quite   dangerous.   Al
                      58


        ready, Delaware  County  is  lagging  behind  more      inspect, and how often. Almost  none  take  the
        progressive  counties  in   communicable   disease      initiative to report more than the barest  out-
        control. For example,  in  1960,  Delaware  County      line of activity to the public.
        experienced 12  cases  of  meningitis,  more  than      Other  aspects  of  environmental   sanitation,
        tnvice the rate of the state  as  a  whole.  Also,      such as clean water, clean air,  and  radiation
        there were over  500  cases  of  measles  reported      programs  are  almost  nonexistent  under   the
        during 1966.  Since  14  municipal  health  boards      current setup.
        filed  no  annual  communicable  disease   report,      While  state  law  mandates  municipal   action
        health  boards  filed   no   annual   communicable
        disease report, the actual  incidence  of  measles      in sewage disposal, many municipalities in  the
                                                                county have failed to even appoint a responsible
        may have been  much  higher.  In  those  parts  of      official. Recent surveys by the Citizens Council
        the nation  where  strong  public  health  leader-      in Delaware  County  have  revealed  widespread
        ship exists, this disease is close to  extinction.      pollution in the county's four small watersheds,
        In addition, there is a soaring  V.D.  rate  among      even though none of the streams  is  more  than
        Delaware  County  teenagers-the,  rate  is   three      a dozen miles long. The county's  streams  gen-
        times  greater  than  the   neighboring   counties      erally flow along the  boundaries  of  numerous
        and almost twice the state average.                     boroughs  and  townships.  This  makes  it  im-
         2. Chi-6nic illness  coizt?-ol:  Other  than  the      possible  for  even   conscientious   municipal
        county's operation of Fair  Acres,  the  field  of      health officials to control pollution.
        chronic disease prevention and control  is  virtu-      In Delaware County, there is no  overall  local
        ally unserved by the official health agencies.          air pollution control service. With the increased
         The  volunteer  agencies  are  active   only   on      popluation of the county, the  problem  of  air
        certain aspects of the problem and  could  be  far      pollution is of great significance.
        more  effective  with  the  aid  which  would   be      In 1965, a study of air pollution  in  Delaware
        provided  by  a  professional  health  department.      Valley by the Drexel  Institute  of  Technology
        Since chronic illness represents  the  major  com-      estimated that nearly 2,500 tons of  pollutants
        munity health problem, this lack  of  any  overall      a day were being  emitted  in  Delaware  County
        official program is a serious gap in health  serv-      alone. Of that, more than one-third was due  to
        ices, In 1966, the mortality rate for  breast  and      pollutants from  transportation  sources.  This
        lung  cancer  in  Delaware  County  exceeded   the      averages out to nearly eight and a half  pounds
        state average. This is highly significant as  edu-      of air pollutant per person per  day.  This  is
        cation and early detection  can  effectively  con-      nearly tivice that of Philadelphia County  pei-
        trol both of these types of malignancies.               person.
         3.  Envii-onmental  health  services:   Virtually      Another  problem  is  that  people   have   the
        all of  the  roughly  100  personnel  employed  by      mistaken notion that air pollution occurs  only
        municipal  boards  of  health  function  primarily      when it is associated with odor.  There  should
        as  sanitation  or   plumbing   inspectors.   This      be available a local service which is constantly
        aspect  of  environmental  sanitation,  therefore,      at work protecting the public against potential
        is  often  carried  out  with  diligence,   though      air  pollution  hazards  and  cooperating  with
        standards vary widely.  There  is  some  question,      surrounding counties on these problems.
        too, whether an untrained  officer  can  bring  to      There  is  no  countywide  program  of   radia-
        this job  the  needed  range  of  knowledge  about      tion protection despite the fact that over  300
        solutions  to  the  sanitation  problems  that  he      county users of  radiation  producing  machines
        finds. Without such knowledge,  the  official  may      or material have registered with the State  De-
        have no choice other  than  to  ignore  the  prob-      partment  of  Health.   Continuous   monitoring
        lem or fine the owner, neither  alternative  being      and enforcement is  necessary  to  protect  the
        good public health practice.                            public against the potential hazards of  radia-
          Also, it is almost impossible to  ascertain  the      tion.
        thoroughness  of  their  inspections.  Municipali-      4.  Maternal  and  child  health  services:  No
        ties are not required to  report  the  results  of      programs  in  maternal  and  child  health  are
        food sanitation inspections  to  the  state.  They      sponsored by local .municipalities.  A   limited
        need  only  state  how  many  establishments  they      program of the State Department  of  Health  is
                                                                                                              59


           available to  a  relatively  small  portion  of  the         The Wee-Care Babysitting  Service
           county's  mothers.  In  a  1966  State   Report   on
           natality  and  mortality  statistics,   the   poorer         Ida  E.  Floyd,   Kathryn   Dunbar,   and
           communities  in   Delaware   County   exceeded   the                 Dorothy S. Federman
           state  average  in  every   category   of   maternal
           and infant  death  rates  including  natal,  infant,      This  project   proposal   describes   our   major
           and  neonatal  and  in  the  percentage   of   imma-    focus   of   the   summer-the    establishment.of   a
           ture  live  births.   Immature   birth@those   under    free babysitting   service   in   Mantua.   However,
           5  pounds-are  usually   premature.   One   of   the    two areas deserve emphasis.
           major reasons  for  premature  births  is  the  lack      1.  Piti-poses:  a.  Parents  in   the   community
           of prenatal care. According  to  the  State's  d@tal    have  a  great  need  for  babysitting  services  at
           the children in our poor neighborhoods          !are    low  cost  or  free.  The  incentive  to  seek  jobs
           little better if they survive birth  and  the  first    and  maintain  them,  keep   appointments,   go   to
           few  months  of  infancy;  while  the  state   aver-    the hospital,  or  take  courses,  is  often  killed
           age mortality rate for  "certain  disease  of  early    because of  the  difficulty  of  affording  babysit-
           infants"  is   24.1,   the   rate   among   Delaware
                                                                   ting services.  This  service  will  provide  mobil-
           County's poor is 52.8.                                  ity f or parents as well as the security that  their
             5.  Health  education:  Presently,  only  a  hand-    children are taken care  of  in  their  absence.  No
           ful  of  county  municipalities   regularly   inform    such  service  exists  now;  all  child  care   pro-
           their  residents  on  health  matters,   and   there    grams  charge  about  $2.50  per   child   per   day
           is little educational use made  of  annual  reports.    and  impose  restrictions  regarding   DPA   status,
           Health education  is  largely  in  the  province  of    income, age, etc.
           voluntary agencies, acting independently-                 b.  It  is  proposed  that  the  service  grow  to
             Most   municipalities,   for   example,   d@   no@    provide  health  services:  (1)  For  the   children
           have  organized  programs  for  the   control   anct    in  the  nature  of   examinations,   immunizations,
           prevention  of  accidents.  The  State  health   de-    etc. (2) For the  parents  in  the  nature  of  pub-
           partment   has   provided   limited   programs    in    licity  concerning  family  planning  services,   or
           Delaware  County,  but   these   have   had   little    programs  involving  such  topics  as  nutrition  or
           community impact.  There  is  no  local  agency  re-    consumer fraud.
           sponsible for poison control.                             c. If  the  service  is  funded,  jobs  will  have
                                                                   been created for community members.
             Health   education   in    Pennsylvania    schools      d.  An  essential  objective  is  to   provide   a
           has  improved   during   the   past   decade.   How-    broad program for preschool children.
           ever, in the  'absence  of  vigorous  public  health      2. Q2testions  to  face  and  problems  to  solve:
           leadership,  the   necessary   parent   and   commu-    a. Question  of  legitimate  use  of  this  service.
           nity  involvement  remains  very  limited.  This  is    What  did  we  consider  good  reasons   for   using
           indicated  by  the  failure   of   school   advisory    the  service,  who   was   to   judge   (if   anyone
           health councils, permitted  under  a  1962  law,  to    should),  how  to.deal  with  the   individual   who
           catch hold in Delaware County.                          had  no  other  commitment  and  would   not   offer
             6.  Labo?,ato?-y  services:  Almost  all  Delaware    time helping  to  babysit,  how  do  you  deal  with
                                                                    arents  whom  we  know  could  afford  to   pay   a
           County  municipalities   contract   separately   and    ip,
                                                                   -abysitter.
           privately for  the  bulk  of  these  services.  This
                                                                        Question  of  whether  to  penalize  the  child
           results in a less  well  coordinated  and  efficient    because   the   parent   took   advantage   of   the
           public health program.                                  service.
             7.  Planning:  Public   health   planning   on   a      Decision: We decided  to  deal  with  the  parents
           county  level  is  now   almost   nonexistent.   The    on  a  case-by-case  basis,  personally   interview-
           situation  will  not  change  until  public   health    ing  each  parent,  seeking  an  honest  answer   as
           programs  are  administered   by   qualified,   full    to  why  they  used  the  service,  explaining   the
           time professionals. In  short,  the  situation  will    reasons for  having  established  the  service,  re-
           not  change  until  Delaware  County  has  a  county    questing help if  they,  could  give  any,  etc.  No
           health department.                                      major  conflicts  have  risen  so   far;   we   have

           60


          limited the age to 5 years old  or  younger,  have      The  project  grew  out  of   prolonged   discus-
                                         d    parents     to      sion  and   personal   contact   throughout   the
          requested donations, have urge                   p      neighborhood,  including  door-to-door   contact,
          send lunch, beverage, and  a  sheet  if  they  can      discussion  with  businessmen,  politicians,  po-
          and we  have  been  able  to  recognize  extenuat-
          ing  circumstances  Nvithout  causing   resentment      lice, schcol coordinators, etc.
          among other parents.                                    Pit)-pose.-a.  To  provide  free  babysitting  to
          c.  Question  of  survival  potential  on  a  vol-      enable parents to seek and  maintain  jobs,  take
          unteer basis. About a  dozen  mothers  have  given      courses, go to the hospital,  keep  appointments,
          some time  this  summer,  some  more  consistently      enter training programs,  etc.,  to  provide  mo-
          than others. What seems  to  be  essential,  given      bility f or parents and the security  of  knowing
          that the interest in helping is  already  present,      that their children are cared for.
          is  frequent   communication   with   all   volun-      b.  To  provide  health  services  (1)  for   the
          teers before and  after  they  work.  The  success      children i.e. immunizations, eye and ear testing,
          of a volunteer organization rests  in  the  mutual      and (2) for the  parents,  i.e.  family  planning
          sense of responsibilit felt by all  workers.  This      services publicity, programs  of  an  educational
                             y
          can only  be  conveyed  through  personal  contact      nature on such topics as consumer  fraud,  nutri-
          and a genuine invitation  that  all  workers  par-      tion, rat control.
          ticipate in policy decisions regarding  the  serv-      c.  To  create  jobs   for   community   members.
          ice. The volunteers are also  aware  of  the  con-      d. To  provide  a  broad  program  for  preschool
          stant efforts  being  made  to  become  funded  in      children, i.e. group activity, arts  and  crafts,
          order to make the transition to a paid staff.           trips, films, music. Many  existing  programs  do
          id. Question of black  or  white  source  of  fund-     not accept the child  younger  than  three  years
          ing. Funding is  the  major  hurdle;  attached  to      old, or they require $2.50 per child per day,  or
          the Proposal  is  a  list  of  contacts  made  and      they  make  some  restriction  regarding  income,
          possibilities still unexplored.                         DPA status, employment status, etc.
          e. Question of  any  funds  leading  to  the  hir-      What has t?-anspired since JulV  I  St.-I.  Prior
          ing of community  people.  This  is  the  stipula-      to Opening on July 15th:
          tion  we  decided  must  be  made   in   accepting      a. Obtained  rent-free  facilities  at  Haverford
          any f  unds-that  the  community  people  involved      Center, Lutheran Social Mission Society  at  39th
          in the service make  decisions  regarding  hiring.      and Wallace Streets.  Room  is  f  urnished  with
          f. Question  of  charging  a  fee.  This  decision      small tables and chairs, refrigerator, toys, etc.
          is being worked out  now  with  the  desire  being      b. Publicized for a meeting  to  arrange  se,hed-
          to maintain  a  free  service,  perhaps  encourag-      ule of volunteers.
          ing steady cash  donations  as  parents  see  fit.      c. Planned  painting  party  with  the  teenagers
          g.   Question   of    organizational    structure,      and cake and hot dog sale to  raise  f  unds  and
          working  within  an  existing  community   organi-      publicize Opening.
          zation with ongoing policies and programs.              d.  Solicited  for  donations   for   babysitting
                                                                  service and  the  sale.  Response  was  uniformly
                        Project Proposal                          generous   from   the   community,   businessmen,
                                                                  police, suburbs, Board of Education.
          Title.-Wee-Care Babysitting      Service.               11. Operating of the Service:
          Brief   description.-Free,   daily    babysitti-ng      a. Publicity.
          for children 5 years  old  or  younger.  Hours  of      b.  Ironing  out  of  details  (1)  programs  and
          operation: 8 a.m. to  3:30  p.m.  Proposed  hours:      routine,  (2)  registration  forms,  (3)   meals.
          8 a.m. to 6 p.m.                                        Parents are asked  to  supply  lunch  and  sheet.
          Geographical   area.-West   Mantua               (1)    III. Present focus:
          Boundaries for publicity  on  door-to-door  basis:      a.  To  stabilize  service  on  volunteer  basis.
          42d Street  to  38th  Street  and  Haverford  Ave_      b. To seek f unds  (see  attached  list  of  pos-
          nue to  Ogden  Street.  (2)  Newspaper  publicity:      sibilities) -
          citywide.  (3)  Boundaries  of  use:  56th  Street      Problems    encountered.-a.    Regulations     of
          to 32d Street  and  Spring  Garden  Street  to'Og-      the  Department  of  Welfare  which  may  be  im-
          den Street.                                             possible to comply with  in  present  facilities.
                                                                                                                  61


                                                                                           Avenue Businessrneii's Associ
                                nature   of   workers,   difficulty   Of      2.   Lancaster
                      b. Volunteer lity of schedule.                     ation;
                      ensuring stabi f  legitimate  use   of   the   Service; 3. PAAC;      delphia  Mental  Health  Con-
                      c. Question 0            on  the   part   of   the      4. West Phila
                      demand of some reciprocity                         sortiUM;
                      parents.                                                5. Public Health Service Research grants.
                      d. Question of  charging  a  fee  to  ensure  some
                      income for  the  Service.  Possibility  of  asking           The Photography Club at St.
                      for regular donations,                                                    Christopher's
                                which an independent ser     .vice     is
                      e. Situation in                             zation
                      set up within another community organi                    Richard Ragg6 and Richard Baines
                      with ongoing Program and policies.                                       Morrison
                      Possible   Budget.-Staffing:   1-   One   individ-                   f   ommurlity   children   is    an    im-
                      ual engaged in  planning  programs  for  children.      Education 0  c                                    Group
                                              nsible    for    schedules      portant concern of the Comprehensive
                      2.  One  individual,respo                                            s   (CGHS).   They   felt    the    estab-
                      and contact with volunteers-               related      Health Service             would    serve    to    edu-
                      3  One individual coordinating health-                  lishment of a camera club
                      -                                                       cate as well as   to   OCCUPY   a   number   of   chil-
                      aspects as stated above. verview;    ie.    mainte-             ing  the   summer.    This    is    what    was
                      4. One  individual  to  0lity   for   registration,     dren dur     orientation  as  a   possibility   for   a
                      nance, finances, responsibi           es:     $7,-      presented at
                      correspondence, etc. Estimated salari                   project.     2 w
                      ooo to $10,000. Maintenance $2,000.                     The   first      eeks    consisted     of     obtaining
                      Space.-Haverford  Center  all   year   round;   if      facilities, financing,  equipment,  a  list  of  poten-
                      expansion  seems  necessary,   possibilities   lie      +.,.al   club   members,   and   advice   from   people
                      with  the  Department   of   Recreation,   Friends      working in programs of this type.
                      Social   Order   Committee,    Mantua    Community      Facilities   consisted   of   a   converted   eye   ex-
                      Planners.                                               amination  room   from   the   health   center   as   a
                      Eqttipraent.-Already   obtained   but   in    fair      temporary   residence   for   the   darkroom   of   the
                      condition: cots, cribs, small tables  and  chairs,      club.
                      toys.  Toilet  and  sink  and  play  yard   adjoin      Financial   support   came   from    the    SHO    pho-
                      main room.                                              tography   allotment   and    from    donations    from
                      Needs.-First   aid   supplies,   disposable    di-      one f oundation, Food   Fair   Stores   and   14    area
                      apers, bathinette, record player, toys, etc.            stores.
                                                            ting    from                               nt   '   Recreation   has    a
                      Estimate of funds required if star                      The city's Departme          of
                      scratch:  (not  including  salaries)   $6,500   to      program   called   PIX   which    helps    to    supply
                      $7000.                                                  photo  clubs  with   film   and   cameras.   We   could
                      Contact   re:   Funding.-I.    Black    Coalition;      not  use  this  because  (1)  we  were  too   late   in
                      2. Philadelphia   Coordinated            Community      applying,  and  (2)   they   were   dealing   generally
                      Services;                                               with a  diff  eront  age  group  (13-19)  and  most  of
                      3.   MIC   (Maternal   and   Infant   Care    Pro-      our  club   members   were   be,tween   10-14;   but    I
                      gram) ;                                                 feel   if   they   were.   approached   early   enough,
                      4.   Episcopal   Diocese;                               something could be worked out.
                      5. Friends Social Order Committee;                       A  list   of   children   (ages   10-15   years)   was
                      6. Redevelopment Authority;                             gathered  from  the  personnel  of  the  health   ce-n-
                      7. Model Cities;                                        ter.   Some   were   recommended   for   special   rea-
                      8. Department of Recreation;                            rons  such  as  difficulty  in  school.   Approximately
                      9. RMP (Regional Medical Program);                      20  children  were  in  the  club's   summer   portion.
                      10.  Smith,  Kline,   and   French,   Merck,   Sharp     The  club  has   offered   a   good   opportunity   to
                      and Dome;                                               get   to   know   the   community,   especially    some
                      11. Philadelphia Foundation;                            of  the  children   from   it;   and   to   work   with
                      12. Department of Welfare.                              these   children   to   make   ourselves   more   aware
                      Unexplored      possibilities.-l.       Presbyterian    of  some  of  the  problems  that  exist  in   a   poor
                      Hospital;                                               community.

                      62


                                                                                      The     reports,      however,
         TNvo  Projects  for  the  children   evolved,   one    during the  summer.                      cooperation
         in  conjunction  with  the   social   services   at    point out the importance of SHO's
         CGHS,  For  this  service  the  Camera  and   Youth    staffing   by   students   and   local   people   in
         Studio  (C&YS)  has   in   three   cases   supplied    Hawthorne.
         pictures of specific  housing  problems  they  were    The  other  articles  in  this  section  describe  a
         dealing  with.  The  other  project  was  supplying    wide range of  activity.  Project  workers  at  Per-
         the  Hartranft   Corporation   with   pictures   of    net   Family   Health   Service,   Houston    Commu-
         various  lots  in  the  community  which  were   in    nity  Corporation  dealt  with  significant   issues
         bad  condition,  also  pictures  of  the  community    for  their  communities.  The  two   project   work-
         crews  that  were  cleaning   them   up.   We   are    ers at  Holmesburg  Prison  report  a  totally  dif-
         also  supplying  several  groups   with   sets   of    ferent experience.
         pictures  of  conditions  in  the  Hartranft  area.    Each  of  these  articles  should  be   read   indi-
         It has been the opinion  of  several  of  the  com-    'dually  for  each  presents  still  another   view-
                                                                vi
         munity  leaders  we  have  met  that  many   people    point on the summer 9s experience.
         in the community  do  not  realize  the  extent  or
         the  degree  of  the  problems  some  people  face.    Hawthorne Viewed by a Staff Member,  a
         These projects  are  only  a  fenv  of  the  things      Student and a Community Worker
         we have done  as  a  club  during  the  summer.  We
         are  -flow  making  arrangements  to  continue  the    Cha)-les  Floyd,  Staff:  The  SHO   personnel   as-
         club on a year-round basis.                            signed  to  this  particular  site  have  been  with
         One  of  the  biggest  hangups  with  "the   estab-    us  now  approximately  four  weeks   as   of   this
         lishmeilt" was a  contact  with  a  local  Business    writing.   The   problems   we   have    encountered
         Association.  Speaking  with  the  past   president
         of the  association  about  support  for  the  pho-    thus far have  been  minimal  and  I  feel  we  have
                                                                solved them  to  each  person's  satisfaction.  How-
         tography  club,  we  found  that  the   association    ever,  of  these  problems,  I  feel  the   greatest
         has  a  means  of  handling   such   requests   for    has been lack of proper  orientation  of  the  stti-
         support.  Community  people  would  have  to   save    dents,  prior  to  their  commitment.  I   recognize
         sales slips  from  participating  stores  and  then
         turn  them  in  to  the  association.  The   people    that this  was  done  on  purpose  to  some  extent,
         would then  receive  2  percent  of  the  total  as    but I personally feel  it  was,  perhaps,  too  gen-
         the contribution.  She  said  that  almost  no  one    eral in scope  and  too  fragmented.  I  think  that
         had availed himself of the plan.  In  our  opinion,    in order for an  orientation  to  be  beneficial  to
                                                                the students, it must be  specific  as  to  the  par-
         the plan  has  worked  well  in  keeping  the  com-    .  I
         munity  from  receiving  anything,  yet  the  Busi-    ticuiar site. I also feel that if this job  is  han-
         ness Association can say that they tried.              dled prior to the  commitment,  it   can   alleviate
          To  end  on  a  positive  note,  our  relationship    other related problems,  e.g.  what  to  work  with,
                                                                where to work, etc.
         with the CGHS  has  been  a  friendly  and  cooper-     An  example  of  the  above  problem  as   it   re-
         Rtive one. The relationship it has  with  the  com-    lates to this particular site is as follows:
         mun@ity  is  a  very  good  one  which  would  make
         the center a good place  to  educate  medical  stu-     SHO   personnel   assigned   here   (Miss    Oster,
         dents on communit                                      Mr.   Sesso   and   Mr.   Williams),   were   handi-
                            y relations.                        capped, so to speak, due  to  lack  of  proper  ori-
               SOME OTHER INTERESTING-                          entation. Although  Mr.  Sesso  is  from  the  adja-
                                                                cent   neighborhood,   it   was   nevertheless,    a
                         EXPERIENCES                            problematic   situation.   They   were   not   given
                          Karen Lynch                           proper  information  as  to  the  age   group   they
                                                                would  work  with,  where  the  base  of   operation
         @@@@A few of the  papers  written  about  the  sum-    would  be,  and  the  resources  they   would   have
                  periences   stand   alone.    These    are    at their disposal. Some may feel that  this  is  the
                   or convenience.                              responsibility  of  the  preceptors  who  are  actu-
                     s  of  the  Hawthorne  experience   are    ally  in  the  programs  and  the  community.   How-
                    Each  highlights  a   different   aspect    ever,  regardless  of   where   the   responsibility
                   gram  and  the  difficulties  encountered    should f all, I feel the  timing  of  this  is  more
                                                                                                                   63


               important.  Whether  it   is   done   by   SHO   or   the upon   the   opening   of   the   Hawthorne   Annex,
               preceptors,   to   me,   is   beside   the   point.   The which I felt  took  too  long  to  open  anyway.  We
               point, as I see  it,  is  to  help  the  students  to  be couldn't  do  many  tangible   things   during   the
               aware   of   the   community   they   will   serve,   and first week. As a  result,  I  felt  that  perhaps  I
               the   mechanics   involved   in    the    serving.    Now was possibly  remiss  in  my  efforts.  In  fact,  I
               if it is decided  this  is  really  a  job  that  belongs didn't  declare  the  compensation   which   I   was
               in  the  realm  of  the  preceptors'  responsibility,  it to  receive  for  an  extra  day's  work,  prior  to
               nevertheless  should  be   executed   before   the   stu- my arrival at Hawthorne.
               dents   are   assigned   and   employed   in   the   com- During  the  first  week,  we   arranged   a   meet-
               munity.  Failure  to  do  so  will  only  add  to   their ing with the teens. Fifty guys  and  girls  partici-
               f rustrating situation  and  it  could  stifle  the  cre- pated.   Many   valuable   ideas   and   suggestions
               ativity  and  imagination   they   bring   as   part   of were given  by  the  teens.  The  kids  were  a  bit
               their offering services.                                leery  or  cautious;  after  all,   we   are   white
               In  this  particular  site,  the  focus   for   the   SHO strangers. Fortunately, we had   Nate   as   a   co-
               personnel   has   been   recreation'    in    the    Haw- worker. Nate commanded  the   respect    of    the
               thorne   Area.   Utilizing   such   activities    on    ateens; "Nate is cool," and so   a    rapport    with
               group  basis  such   as   bus   excursions   to   distant the community began.
               points   (Atlantic    City;    Hershey,    Pa.;    Dorney During the next weeks,   we     attended     staff
               Park;  etc.),  picnics,  Phillies  games,  etc.,   afford and community meetings.  It  is   a    sad    com-
               the   students   the   opportunities   of   beginning   amentary, but we went to  many     sessions      and
               working  relationship   with   the   teens.   Once   this only  a  few  of  them  were  significant,   in   my
               relationship  is  formed,   they   are   then   able   to opinion.
               get  into  the   more   personal   and   often   specific As our  first  outing  we  planned  a  trip  to  the
               problems  which  can   be   worked   upon   on   an   in- Phillies  game.  We  considered  this   a   moderate
               dividual,  but  more   ideally,   on   a   group   basis. success, but since  we  had  to  get  there  on  our
               Most    important    in    this    program,    originated own by public transportation, no    girls     came.
               by   United   Neighbors   Association    is    the    tie It was at the  end  of  the  second  week  that  the
               it  has  to  the  Jeff  erson   Hospital   Children   and Deux  ex  machine,  appeared  in  the  form  of  ex-
               Youth   Services.   Referrals   are   made    here    for cursions   sponsored   by   PAAC.   This   generated
               teen problems.                                          much  interest   and   enthusiasm   from   everyone,
               The   relationship    of    this    program    to    non- and it served  as  a  focal  point  for  our  future
               health    agencies    has    been    most    encouraging. activities. We  went  into  the  community  to  meet
               Collaborating     with     the     PAAC     (Philadelphia and  recruit  the  kids.  According  to  our  commu-
               Anti-Poverty     Action     Committees)     they     were nity  worker,  this  went  over  big,   because   it
               able  to  work  out  bussing  schedules  fof   trips   or showed  we  were  interested  in  associating   with
               excursions.  The  same  is  true  with   the   Board   of everyone. The trips  provided  us  with  the  oppor-
               Education   and   their    Operation    "Green    Grass." tunity to talk seriously  about  health,  education,
               Arrangements  were   made   with   the   staff   at   the or  social  concerns.  We  are  hoping  that   these
               Children   and   Youth   Center   to    have    physicals opportunities  will  increase   in   number   during
               performed.  Work   was   also   done   with   the   Hous- the  future  weeks.  Rapport   takes   time,   espe-
               ing   Authority   as   they   were    made    aware    of cially since we  were  dealing  with  such  a  large
               certain   hazards   in   the   Housing    Projects    and number  of  people,  many   (most)   of   whom   "go
               surrounding   grounds.   The   latter   was    an    out- and  come"  from  day  to  day.   I   must   mention
               growth  of  a  survey  done   by   the   SHO   personnel. the  relationship  that  we've  developed  with  our
                 Don  Sesso,   student:   Much   of   our   first   week ficaptain," Tom  Bradley.  He  is  a  great.guy  who
               was     devoted     to     becoming     oriented      and sets an example for big friends.
               acquainted   with    community    j)eople    and    serv- Much  of  our  time  in  the  passing  weeks   was
               ices.  This  first   week   was   challenging   in   that spent in writing to,  or  contacting,  people  asso-
               we   were   "wetting   our   feet."   I   was    somewhat ciated  with  recreation  or  things   which   would
               disappointed  by  the  lack   of   a   pivot   point   or interest the  community.  We  helped  to  staff  the
                structure"  upon   which   we   could   begin   to   de- Annex,  and  also  aided  in  setting-up  Tot  Lot".
               v'elop  our  projects.  Most  of  our  activities  hinged Tot  Lot  started  nicely,   but   seems   to   have
               64


                              interested       in       recruiting In   conclusion,    urban    development    programs
           ,Waned. I also became           on       coach        aare essential, and  I  hope  that  our  contribution
           youth and helping Jim Washingt                      the at  Hawthorne  was   meaningful.   We   would   like
           track team. Results are OK so far, but                to express our  gratitude   to   our   preceptors   for
           verbal affirmations and support greatly            out-
           weighed the actual number of teens who             par- their guidance.
           ticll)ated.However,    this    is    understandable;     it's Nate   Williams,   Commitnity   Worker:   I    would
           pretty tough to run in 95 degree heat.                like  for  the  recreation  and  education   program
           Also  in   the   past   few   weeks   I've   become   ato continue through the fall,  because  I  think  it
           friend  with  a  group  of  about  10  boys,  who   are is a wonderful  program  for  the  children  of  the
           12  and  13  years  old.   They   had   been   uninter- Hawthorne  community.  As  for  problems,   I   have
           ested in  day  camp,  and  I  guess  felt  young  f  or had  none  except  for  when  we  went  to  Atlantic
           our PAAC excursions. They are nice                    City. The PAAC  staff  were  ignorant  to  the  fact
                                                          guy"   tiTt  we  were  dealing  with   children   and   not
           docile and  willing  to  learn.  We've  gone  on  trips with adults.
           Nvhich  were  planned  to  be  both   educational   and
           fun.  I  knew  I  would   encounter   difficulty   get- Some  of  the  projects  we  worked  with  are   not
           ting them  to  leave  their  boats  at  the  Schuylkill too  good.  And  the  children  are  old  enough  to
           River,  but  was  I  amazed  when  I  had   to   "drag" know in  addition  to  recreation  they  must  learn
           four   boys   from   the   Logan   Library.   We   also other   things,   like   visiting   more   important
           went  to  New  York,  visited  science   centers,   and places  and  doing  more  important  work   at   the
           medical school labs.                                  centers.  In  that  way  it  would  be  much  easier
           Our  efforts  during  the   remainder   of   the   sum- for the ones that are there  to  help  them.  I  en-
           mer  will  be  to  continue  at   the   Hawthorne   An- joyed  working   with   the   children   and   maybe
           nex,,   to   contact   local   business   and   perhaps next summer it will be better.
           news  media  in  reference  to   assistance;   to   set
           up a film series.                                      Teaching Sex Education Classes at
           In  answer  to  the   research   question   of,   "What  Hartranft Community Corporation
           is  your  central  problem?"  I   can   make   supposi- Forest  Lang:  There  was  no  direction  at   Hart-
           tions.  I  must  first  state  that  my   analysis   is ranft. The  first  problem  was  finding  the  right
           meant to  be  constructive,  and  I  hope  it  will  be
           construed as such.                                    bag.  The  anatomy  and  physiology   of   sexuality
                                                                 is one of our  few  areas  of  expertise.  Sexuality
           A.  How  important   was   it   to   have   health   s@ transcends  racial  and  ethnic  groups.  Inadequate
           ence  students  since  the  teens   are   predominately and  erroneous  sex  education  is  the  rule.  V.D.
           interested  in   recreation?   There   was   a   group, control  is  among  the  four  priorities  of  Hart-
           however,   interested   in   more    than    recreation ranft  health  committee.  V.D.  and  prenatal  mor-
           and  we   are   trying   new   ways   to   arouse   the tality are serious medical  problems  in  the  area.
           interest in the others who are the majority.           Our  first  problem  in  planning   was   to   dis-
           B.  There  are  times  when   I   question   the   nec- cover  the   amount   of   sex   information   among
           .essity  of  three  of  us  as  staff  on  a  permanent area youth and  their  interests.  A  teaching  plan
           basis.  Definitely  all  three  were  needed  at  vari- progressing  along  a  course   envisioned   through
           ous  occasions  for   the   proper   relationships   to the  analytical  mind   of   the   medical   student
           occur.                                                would  fail.  We  solved  the  problem  by  allowing
           The    answer    to    this    dilemma    might    come anatomy  and  physiology  to  grow   naturally   out
           about  if  there   were   much   educational   interest of  discussion  on  V.D.,  intercourse,  birth  con-
           from  the  teens,  but  we  were  there  to  help   in- trol, and birth instead of vice versa.
           still this  in  the  first  place.  In  addition  there To  research  and  plan  a   relevant   course.ran
           must  be  added   financial   support   for   equipment us face to  face  with  institutions  entrenched  in
           and   materials   to   implement   any    program    we out-dated  mores.  Building  up  a   birth   control
           attempt.                                              kit  for  educational  purposes  was  a  real  prob-
            Another   answer   might   be   a   surge    of    in- lem.  Planned  Parenthood  decided   to   loan   us,
           creased  creativity  on   my   part;   heaven   kiiow's for one day, their  birth  control  kit.  They  dis-
           I'm trying.                                           pense  thousands  of  I.U.D.  and  diaphragms,   yet
                                                                                                                    65


              to loan one to a medical student for more  than     tions at any time-  The  length  of  each  class
              a day became a serious  problem.  It  was  only     varied depending upon  the  amount  of  material
              through a personal contact at the health center     to be covered and class interest.
              that  we  acquired  these  materials  for   the     We   found   team   teaching   most   effective.
              summer.                                             Forrest Lang and I felt that  we  could  present
              Also, the  films  at  the  Philadelphia  Public     a more honest and accurate picture of  the  top-
              Health  Department   were   often   inadequate.     ics together than separately.  My  presence  may
              They were poorly described  in  their  catalog.     have  helped  the  boys  learn  to   communicate
              We had to personally screen out the  moralistic     better with a  woman,  Forrest's  helped  accus-
              and threatening movies related to sex and  V.D.     tom the girls to deal  with  male  doctors  more
              The "Innocent Party" is an example  of  such  a     easily.
              movie. Other  movies  (Boy  to  Man)  were  in-     We also felt it important  that  we  were  young
              adequate for the white community  and  inappro-     and not authority figures.  We  think  that  the
              priate for the black. Most  characteristic  was     classes found it easier to  ask  questions  they
              the attitude of the Narcotics Addiction Center.     might be reluctant to ask their teachers, clergy,
              They would not lend us a film  on  dope  addic-     parents, etc.
              tion for fear of putting ideas in  the  "little     Good  visual  aids  are  of   paramount   impor-
              minds"  (our  boys  have  been  on  grass   for     tance.  Films  should  be  previewed  beforehand
              years).                                             since catalog descriptions can be misleading  to
              The  same  problem  occurred  with   films   on     say the least. If material presented in the film
              childbirth. Jefferson Hospital would not lend us    is new it must be discussed before the  film  is
              its film  because  the  boys  were  too  young.     shown.  Otherwise  the  best   presented   movie
              Hahnemann  allowed  its  birth  film  out  only     makes little sense. Many of  the  films  require
              with a  physician.  Childbirth.Education  Asso-     discussion afterwards, especially those  dealing
              ciation has a great film. But the rental is $10     with sexual attitudes.
              because they are a private institution.             Clay models  of  the  female  reproductive  sys-
              Finally Hartranft would  not  financially  back     tem-simple  to  make-are   invaluable.   Concep-
              the necessary  expenditures  because  they  did     tualizing  the  uterus,  vagina,  ovaries   from
              not approve  of  our  sex  education  on  their     drawings  is  practically  impossible  even  for
              facilities.                                         the medical student. Models were made Ito  scale.
              These  problems  exemplify  the  need  for  SHO     A female pelvis  was  brought  in  to  show  how
              and all future doctors to push for realistic re-    the organs were situated in the  body.  A  model
              sources in youth education.                         pelvis was also useful in describing childbirth.
              Yvonne Butte?,field: Members of  the  sex  edu-     Whenever   possible   examples    of    tampons,
              cation classes were recruited from  preexistent     napkins,  deodorants,'  and  powders  should  be
              groups-clubs, gangs, baseball  teams.  We  felt     used  when  explaining  menstruation  to  either
              that in this way classes would feel  more  com-     boys or girls. Classes should  be  directly  in-
              fortable if all were already friends, that infor-   volved by allowing them to open  the  boxes,  us.e
              mation would b                                                                  a
                           e more  efficiently  retained  and     the powder and sprays, talp  part  the  napkins,
              passed from one  to  another,  that  attendance     place the  tampons.  in  water.  This  same  ap-
              would be better if a leader of a group could be     proach is necessary when discussing  birth  con-
              interested in  coming  himself,  This  recruit-     trol. We purchased examples of  foams,  jellies,
              ment tactic seemed  to  work  well.  Attendance     suppositories and  borrowed  diaphragms,  IUD'S,
              remained a problem  as  gang  fights,  baseball     and pills. We inserted IUD's into the clay model
              games,  and  trips  conflicted  with  scheduled     of the uterus to show how it is done by the doc-
              classes. We tried to remain as flexible as pos-     tor, squirted foams into the clay vagina. Every-
              sible in scheduling to allow for  these  occur-     one was allowed to handle  everything.  If  pos-
              rences. If possible, community  recruitment  is     sible, material was presented  by  question  and
              best. We Used this whenever possible.               answer to encourage  class  participation.  This
              Classes were kept @ small (less  than  six)  to     was particularly effective  with  birth  control
              encourage questions and discussion. All , mate-     since classes usually had some idea of  a  meth-
              rial was presented informally,  allowing  ques-     od. The idea of "corking" the  vagina  to  sepa-

              66


                                                                     covered   by   United    Health    Services
        rate sperm  and  egg  leads  easily  to  the  idea  of paper was
        foams  and  jellies.  A  rubber  for  a  woman  is   a(an  agency  of  United  Fund),  and  the   cover's
        diaphragm.                                           cost was paid by SHO.
        With  each   subject,   particularly   venereal   dis- We  distributed   the   booklet   ourselves   going
        ease  and  birth  control,  classes   must   be   told door-to-door  to  1,500  households.  The  people's
        ,,vhere to go for advice and treatment.              response was in the  main,  positive;  people  were
        In  summary,   classes   were   encouraged   to   par- glad  to  have  a  convenient   source   explaining
        ticipate themselves  as  much  as  possible,  by  ask- what  things  are  and  how  to  get   them.   Some
        ing   questions,   handling    materials,    selecting people  accepted  them   passively.   Others   said
        movies, and making models.                           they couldn't read.
                                                             Southern  Philadelphia  will   hopefully   have   a
        Preparing  a  Community  Health   Booklet   at       Community   Health   Center   Service   within    5
             Houston Community Center                        years. Such centers act  as  a  central  point  for
                                                             health information and referrals  as  well  as  for
        Zack   Pinkney,   Mike   Rutberg,    Lynn    Sullivan, health care. Booklets  such  as  ours,  written  on
                  and Pat Witherspoon                        a  community  format,  can   act   as   a   central
                                                             source  of  information  until  the   centers   are
        Our  project  was   the   writing   of   a   community formed  and  active.  It  is  our   recommendation,
        health  booklet.  The  booklet  contains  articles  on therefore, that booklets be written for  all  areas
        health  services  available  and  how  to   go   about of  Philadelphia.  They  can  be  informative   and
        getting  them.  Included  topics  are:   Medical   So- convenient   based   on   a   community   or   geo-
                                                             graphic  basis.  Booklets  could  be  sponsored  by
        cial   Service;   Community   Information   and    Re- city   agencies   interested    in    health-United
        ferral Service; finanical helpIthrough          Public
        Assistance,   Medical   Assistance,   health    insur- Health  Services,  Health  and   Welfare   Council.
        ance   Blue   Cross   and   Blue   Shield,   Medicare; These  agencies  could  be  approached  to   organ-
        Health  Center  District  2;  Chest   X-Ray   Service; ize and write  the  booklets  themselves,  or  per-
                                                             haps  health  students  could  be  employed  on   a
        Venereal  Disease;  Help   for   the   Alcoholic   and part-time job basis  to  write  them.  Distribution
        Drug   Addict;   Poison   Information    Center;    or could  be  handled  by  (political)   Committeemen,
        Ambulance  Service,   Police   Red   Car,   Cabulance, working on a Ward basis.
        Wheels   for   Welfare;   Dental    Care;    Community
        Mental   Health   Center;    Rehabilitation    Center; Working With Pernet Family Health  Service
        Planned   Parenthood;   Senior    Citizen's    Center;
        and  a  health  director   of   area   hospitals   and
        practicing    physicians,    dentists,    optometrists                Joan Gomeg
        and chiropodists in the area.                         I would like  to  begin  this  paper  by  a  brief
         We  decided   on   writing   the   booklet   on   our description  of  the  Pernet  Family  Health  Serv-
        own.  We  wanted   to   do   something   tangible   so ice  with  which   I   have   been   working   this
        that  people  would  be  able  to  see  that  we   had summer.
        done   something.   Our    work    group    was    two The  Family  Health  Service   is   a   voluntary
        health  science  students  and  two   youth   interns. nonprofit home  health  agency,  staffed  conjoint-
        We  were  responsible  to  our  preceptor,   a   corn- ly by the Little  Sisters  of  the  Assumption  and
        munity     organizer     at     Houston      Community lay personnel. Their work  with  the  families,  in
        Center.                                              either a crisis  intervention  situation,  or  with
         We  got  information  for  the  booklet   by   inter- the   more   long-term    multi-problem    complex,
        viewing  people  in  the  areas   previously   listed. seeks the  overall  aim  of  the  agency  which  is
        We   started   with   Public    Assistance,    Medical the preservation of  the  values  of  family  life.
        Assistance,   Public   Health,   the   Community   In- The 'Optimum  level  -of  the  family's  physical
        formation and Referral Agency,      and        Medical and  emotional  health  is   encouraged   and   fos
        Social  Service.   We   were   further   referred   by tered through  the  rendering  of  direct  services
        these  people.  We  then  wrote   the   articles   and which seek to identify  and  alleviate  the  health
        typed,   stenciled   and   mimeographed   the    book- and  social  problems  that  threaten  the   family
        let  ourselves  at  Houston  Center.   The   cost   of structure. These services are:
                                                                                                               67


                                                                         difficult as  the  community  has  no  provision  for
                              Nursing    Care;     2.     Maternal     and             o  requires  custodial  care.  I   also
                    Skilled     Care;       3.       Homemaker        Home the patient wh             the  Sisters  to   limit
                    Child Health          ; 4.     -Referral      Service; believe it is important for                    West
                    Health and Aid  Service and Instruction.             the dimension of the area of service to            nt
                    and 5. Health Promotion                 r        serv- Philadelphia; otherwise too much time is spe
                    Everyone  who  applies  is  evaluated  fo limited    travelling.
                    ice. Admission criteria  are  necessarily                In  my  interpersonal   relationship   with   the
                                            ographical      area       and
                    to: acuteness of need, ge               rred        to Sisters  and   other   people   involved   with   the
                    availability Of staff. Families are  refe            gency   there    was    good    communication    with
                                                            ional      anda
                    the  agency  through   numerous   profess            coworkers  as  well  as  with  the  patients  I  have
                    nonprofessional sour,-es.                                          The   only   problem   encountered   in
                                                            satellite    tried to help                nal  limitation.   Being
                    The  Sisters  have  recently   opened   a            MY  work  was   my   professio nt had  to  be  limited
                    office  in  our  Mot-her  of   Sorrows   Social   Cen- only a student, my assignme
                    ter-where   l,loo   children   from    the    neighbor to  patients  who  did   not   require   professional
                    hood  are  registered  for  day   camp.   The   office skilled  nursing.  But,  by  Penerating   the   hones
                              a  first  aid  station   where   the   chil- of several  patients,  I  feel  that  I  have  had  a
                    has become or   minor   injuries   or    are    brought unique  experience  arid  an  occasion   to   observe
                    dren come f                             jous     prob-                            rty  creates  and   that
                    there by their  counselor  for  more  ser            many   problems   that    pove
                    lems,   including   infected   wounds,   ring   worms- create poverty.
                    or   suspected   battered    child    syndrome.    The
                                            many    of     these     cases
                    problem there  is  that                                        Holmesburg Prison Project
                    should  be  closely  followed  up  but  the  lack   of
                    personnel  does  not  permit  them  to   'do   so   at
                    the  present  time.  The  Sisters  hope  to  be   able      Lawrence Krony Alan Cohler, and
                                                            nter  is   10-          N. Joblon, M.D., Preceptor
                    to  penetrate  the  area  where  the   ce
                    cated,  an  underprivileged  area  with   a   predomi-
                    nantly   Negro   populatiion.   They   have    pledged   We  have  been  involved   this   summer   with   the
                                             their     individual      and   State   Maximum    Security    Forensic    Diagnostic
                    themselves   to   combine           -ngths   to    re-   Hospital  at   Holmesburg   Prison.   This   hospital
                    group efforts with community stre       e   in   soci-   deals  primarily  with  court  committed   offenders.
                    store families  to  their  rightful  plac                                                         P       chi-
                    ety,  and  to  do  something  about   the   conditions   The bosi)ital serves to give a complete  sy
                    which  create  poverty.                                  atric Evaluation of  its  inmates,  which  is  subse-
                                                             with      the   quently  reported  to  the  court.  Our  function  at
                    A  problem  I  have  noted   in   working                                                                Work-
                    Sisters is  the  geriatric  patient.  Many  times  re-   this institution is that of Mental Health
                    ferrals  are  made  for  elderly  patients   who   re-   ets. in this  capacity,  we  deal  with  the  compil-
                    quire  custodial  care  in  their  home.   The   aging   ing  of  social  history  and  character  evaluations
                        n  is                               s  of  spouse,   of the  patients.  In  addition,  we  have  been  in-
                    perso     surrounded   with   loss:   los
                                                                             volved   in   numerous    Fact    Finding    research
                    family,   health,   independence,   mental   capacity,
                    This  sense  of  loss  is  a  profound  human  experi-   projects   concerned   with   both    followup    and
                                             reness   of   isolation,   of   therapeutic studies.
                    ence. It causes an
                    not  belonging,  of  uselessness.  In  trying  to  re-    S,ince.the  hospital  deals  with  an   incarcerated
                    spond  to  their  needs  the  Sisters  have   burdened   population there  is  little  room  for  flexibility,
                    themselves  with  a  heavy  cage  load  of   geriatric   i.e.,  the  regimented  structure  is  necessary  for
                                               that til
                    atients. it seems to me            ey   should    con-   functional  utility.  It  is  this  highly  organized
                    p
                    centrate  their  efforts  in  working  with  families,   environment  that  we   found   ourselves   in,   and
                    especially   with   multiproblem    families,    where   within  which  we  must  function   effectively   and
                    the  underlying  cause   of   their   problems   could   educationally.  It.is  apparent  that   our   primary
                                                                             problem  was  learning  to  deal  with  the   strict-
                    be   explored   in   an   intimate   in-depth   family
                    contact.                                                 ness of the environm.ent.
                      I  have  discussed  this  problem  with   the   Sis-     There.ig  no  typical  character  type  here,   but
                                                            ave -tried  to   a general  appraisal  of  the  people  we  work  with
                                       w      of  it  and   h
                    ters  who  were   a   are
                    disebar  e   some   'geriatric   patients   in   order to is in order.  The  majority  of  these  patients  are
                            9
                               o  work  with  families.but  it   is   very   poor,  deprived,  and  considerably   socially   dis-
                    be free t

                    68


                             roducts   of   broken   homes,      work  he  chooses.  One's   daily   work   experience
      turbed. They are the p                                              the    most    profound    molding    influ-
      little  education,  and  even  less  motivation.  The      is probably
      main  problem  in  our   dealing   with   these   men      ence that is allowed   to   operate   on   an   individu-
      has been the  difficulty  in  establishing  interper-      al's psyche. Therefore,   in   "The   Disaster    Drill,"
      son@l  communications   of   a   meaningful   nature.      a short, one act play, I wished to  not  only  intro-
        We  presented  ourselves   to   the   patients   as      duce people  to  and  impress  them  with  the  gross
      both  confidant   and   therapist.   Therefore,   to-      inadequacies  of  the  existing  health-care   deliv-
      together   with   the   administrative    and    psy-      ery  system,  but  to  confront  health   profession-
      chiatric  staff,  we  endeavored   to   provide   the      als with  a  situation  that  they  themselves  might
      courts  with  concrete   detailed   information,   as      be  in  someday,  and  to  depict   characters   that
      well  as  beginning  therapeutic   and   motivational      could  very  well  be  themselves.  My  primary   aim
      programing.                                                is  to  make  health  professionals  begin  to  ques-
        In  summary,   the   vastness   of   the   problems      tion  their  educational   experience,   their   work
      which  give  rise  to  the  personalities   we   have      environment,  their  attitudes  toward   those   they
      seen  is  incalculable.  Therefore  we  have  striven      treat,  and  their  feelings  about  the  very   type
      to work within  the  structure  of  this  institution      of life they are leading.
      to provide a  service  to  both  the  prevailing  ju-      Of  all  the  groups  to  whom  I   would   like   to
      dicial system and, in a  limited  capacity,  the  in-      present  the  play,  medical,  dental,  and   nursing
      mates  and  their  families.  Obviously,  there   are      students,  and  beginning  students,  are  first   on
      sufficient problems to deal with  for  a  long  time.      my  list.  These  young  people  must  be  forced  to
      We, theref ore, feel this to be a continuing  f  unc-      question  their  most  basic  assumptions   and   am-
      tional project for the  Student  Health  0  rgarliza-      bitions, as well as to see  as  lucidly  as  possible
      tion.  Both  the  insight  one  derives   from   this      the  huge  problems  now  existing  in   the   health
      experience,  and  the  opportunity  to   be   produc-      care  system.  In  addition,  I  definitely  do   see
      tive, more than  justify  this  project's  existence.      possibilities  for  presenting  it   to   any   group
                                                                 which  is  either  directly  medically  oriented   or
         Drama as a Means of Changing Health                     peripherally related.
                  Professionals' Attitudes                       The  best  chances  for   the   play   being   widely
                                                                 circulated  would  come  from  the   Student   Health
                         Lucia    Siegel                         Organization's  sponsorship  of  it  as  a   packaged
                                                                 program,  the  play  being  followed  by  small  dis-
                                                                 cussion groups  led  by  people  trained  in  "sensi-
         I came to my experience       with      the       Student
                                                                 tivity"  techniques.  A  permanent  cast  is  yet  to
        Health Organization having     a   f   airly   well   con- be  assembled  and  the  possibilities  of  obtaining
        ceived idea of the kind of     project      in       which a director have  not  yet  been  explored.  The  play
        I    wanted    to    work.    Coming     from     graduate shall  have  its  first  rehearsed  reading  on   Au-
        school   of   Social   Work   and   having   spent    sev- gust  28,   1968,   at   the   Philadelphia   Student
        eral   summers   working    with    residents    of    the Health Orgariization's final conf erence.
        ghetto   in   various   capacities,   I   recently    have
        made  a  decision   to   devote   an   increasing   amount
        Of   my    time    to    understanding    and    exploring           Misericordia Hospital
        what  I  consider   the   white   economic   and   politi-
        cal   Power   structure,   responsible   for   the   major At the  beginning  of  the  summer  of  1968,  rep-
        decisionmaking   in   this    country.    It    is    only resentatives  of  the  Philadelphia  Student   Health
        through influencing
                               this     power     structure     by Organizations   and   Misericordia   Hospital   Divi-
        Many     methods-"educational'@      efforts,      protest sion  of  the  Mercy  Catholic  Medical  Center  dis-
        movements,   and   mass    civil    disobedience,    ete.- cussed the desirability  and  feasibility  of  devel-
        that  individuals   can-   work   for   creative   change, oping  and  carrying  out  a  10-week   program   de-
        @id  the  issues  that  are  best   suited   as   rallying signed to  expose  health  science  students  to  the
                for   initiating   change    are    those    which patient as a social  being.  It  was  proposed  that,
               -the    individuals    personally.    Nothing    is the  health  science  student  -who  may   eventually
              personal   to   an   individual   than   what   hap- serve  lower  class   patients   lacked   an   under-
                  him  as  a  result  of   the   type   of   life- standing of the  problems  that  beset  them'.  @  It
                                                                                                                     69


                                                                            The Cei'vical Caacer Detection Pha-se
                 was also proposed that patients      of      the       lower
                 class  (ghetto)  usually do      not       receive       health operating  with  a   grant   from   the   cancer   con-
                                urate     with     their     needs.     After trol  division  of  the  Department  of  Health,   Edu-
                 services commens             nd with the                   cation,  and  Welfare   of   the   Federal   Government
                 weighing the pros and cons a                            con-
                 sent   of   the   hospital   administrator    and    medical and   under   the   direction   of   Dr.   J.    Edward
                                ram was begun.                                               r   of   the   Department    of    Ob@
                 director the prog                                          Lynch, the directo
                                                                            stetrics   and   Gynecology,   the   hospital    estab-
                        Pui-pose of the Prog?,am                            lished  a  cervical  cancer   detection   program   for
                                                                            women,  which  is  designed   to   detect   cancer   of
                 The   purposes    of    the    program    were    as    fol- the cervix in its earliest stages.
                 lows -                                                      steff  orts  to  recruit  and  involve   lower   class
                 1.    To    make    known    to    the     community     the Pa
                 health   service   programs   offered   by   the   hospital. community    people    in    programs    designed    to
                 2.   To   reduce   the    gap    of    communications    and make   available   and   improve   the   health    care
                 understanding     between     community      people      and services  they  receive   revealed   that   this   par-
                 hospital staff.                                            ticular  segment  of  the   community   did   not   re-
                 3.   To   pin-point   problem   areas    and    make    rec- spond  readily  to   traditional   methods   of   corn-
                 ommendation for their resolution.                         mu-nication,  i.e.  the  news  media.   Therefore,   it
                 4.    To    demonstrate    how    health    services     may was   decided   that   new   methods   of   recruitment
                 be   improved   and   made   more    available    to    the' should  be   developed   for   the   Pap   smear   pro-
                 entire community.                                          gram.
                 5.  And  finally,  to   give   the   health   science   stu-
                 dent   the   opportunity    to    develop    an    awareness App?,oaches and Results
                 of  the  problems  of  those   individuals   living   in   aThe   community   health   aides   decided   that   the
                 lower class area.                                          best  way  to  augment  the  recruitment   effort   was
                                                                            through  direct  and  personal   contact   and   estab-
                             Structu?-al Design                             lished the following objectives:
                 The    program    was    composed    of    the     following 1.  To  recruit  women  who   had   not   had   a   Pap
                 components:                                                smear test within the past 6 months.
                 1. A cervical cancer detection phase;                      2.  To  inform  all  women   in   the   area   serviced
                                                                            by the  hospital  of  the  existence  and  availability
                 2.   A   recruitment   phase    f    or    the    hospital's of the test.
                 Neighborhood Health Center;
                 3.     An     emergency     room     out-patient     depart- The    program    was    initiated    by     conducting
                 ment survey phase;                                         interviews   with   the   mothers   of   children   who
                 4.    A    cultural    enrichment    phase    for     neigh- were  selected  to  attend  the   cultural   enrichment
                 borhood children  (Operation Create).                      program   Operation   Create   (see   section   below).
                                                                            Having   completed   the   initial    interview,    the
                                   Personnel                                interviewer  discussed  the   Pap   smear   test   with
                                                                            the  child's  mother;  due  to   the   rapport   estab-
                 The   program   was   carried    out    by    the    follow- lished  through  the  interview   pertaining   to   the
                 'n
                 i g individuals-                                           child, the reception to  the  idea  of  the  Pap  smear
                 1. Three health science students;                          test  was  favorable.  Moreover,  through   this   con-
                 2. Three community health aides;
                                                                            tact the interviewer  was  able  to  get  referrals  of
                 3.   One   art   education    major    (teacher)    ;    and                                                    a.
                 4.    Two    Sisters    of    Mercy    of    the    teaching families, friends and neighbors in the are
                                                                             The  use  of  a   familiar   name   for   introductory
                 vocation.                                                                                sibility   of   favorable
                                                                            purposes increased the pos
                                                                            reception.    The    interviewers    continued    using
                                  Preceptorship                                            y  referrals  until  they  were  finally
                                                                            these secondar
                 in   order   to   develop   a   smoothly    operated    pro- scheduled   for   appointments   or    "disposed    of"
                 gram and to    .handle    problems     as     they     arose, (i  e.  some  referrals  were  outside  of   the   hos-
                                                              ho          met pital, s  service  area   and   therefore   referred   to
                 the aides were assigned to preceptors w
                                                                            closer places for treatment)
                 with them periodically.

                 70


         Extending  the  concept  of  direct  contact,  the     "At (blank)  church  we  were  told  by  the  sec-
        interviewers  canvassed   door-to-door   and   con-   retary  that  their  members  were  not   the   type
        dlicted interviews in the hospital's  clinics.  Be-   we were  looking  for.  First  she  said,  that  her
        cause  of  the  high  percentage  of  working  wom-   congregation  was  too  old,  and  when   this   was
        en  in  the  area,  contact  was  made  with  about   'answered by  the  fact  that  cervical  cancer  has
        only  one-fourth  of  the  women  in   the   blocks   a   higher   incidence   among   older   women   and
        canvassed.                                            that this indeed  would  be  a  substantially  bene-
         The   door-to-door   technique    provided    very   ficial  program  for  these  women,  the   secretary
        interesting insight as to  the  attitudes  of  some   abruptly  said  that  most  of  their   women   were
        of  the  neighborhood  residents.   The   following   from the suburbs and that  she  would  not  see  us.
        statements  were  taken  from   reports   submitted     "In   another   incident   Reverend   (blank)   of
        by the interviewers:                                  (blank)  Baptist   Church,   who   is   an   elderly
         "A  few   women,   mostly   elderly,   would   not   cleric,  said  he  would  be  embarrassed  to   make
        listen at all. Others  listened  but  were  totally   the  announcement.  He  did  refer  us  to  a  woman
        disinterested.  Some  reacted   with   a   negative   who  was  very  active  in  the  parish   activities
        attitude and a fear of cancer. 'If I  have  cancer,   and  who  handled  our  program  as  well  as  could
        I don't want to  know  it'  was  one  of  the  com-   be expected."
        ments recorded.                                         Avoiding  the  impulse  to  hurry   the   ten-week
          "Most  of  the  superstition  and   misconception   period of operation to a close,  the  aides,  throug
        about  cervical  cancer  was   deeply   entrenched.   cerebral  gymnastics,  decided  to   recruit   block
        This  convinced  us  of  the  need  and  importance   chairmen and to  encourage  them  to  solicit  their
        of a program such as  this.  An  attitude  held  by   block  members.   They   reported   the   following:
        a  woman  on  the  5300  block  of  Larchwood  Ave-     "Astonishing  returns   resulted.   For   example,
        nue,  concerned  her  seeming   immunity,   because   in  one  block,  45   women   responded   and   have
        she was white  and  middle  class.  This  lady  sai   made  appointments   for   Pap   smears.   The   rea
                                                              sons  are  that  these  block  chairmen  know   when
        that neither  she  nor  the  other  women  on  that   to contact their  neighbors  and  they  do  not  run
        street  would  be  interested,  and  that  what  we   into  the  obstacle  of  suspicion.  We  fully  edu-
        really wanted were the 'black streets.' "             cated  these  women   to   our   program   and   an-
          The  door-to-door  contacts  were  effective  but   swered any of  their  questions  so  that  they,  in
        they consumed a great  deal  of  the  interviewers'   turn, could act as  health  educators  to  the  rest
        time;  therefore,  efforts  were  concentrated   o@   of the block.  It  must  be  emphasized  that  these
        working  through   community   organizations   anci   block  chairmen   must   be   fully   educated   and
        churches.
                                                              understand  their  task  so  that   they   may   not
          Almost   immediately   the    community    health   only  carry  out  their  tasks  and   convince   the
        aides discovered that  the  vast  majority  of  the-  women in their block to take preventive     .   meas-
        community  organizations   in   the   West   Phila-   ures  against  cervical   cancer,   but   to   guard
        delpbia-Misericordia  Hospital   area   were   dis-   against   any   misrepresentation    and    perpetu-
        organized, that they  existed  only  on  paper  and   ation of misinformation."
        in name,  and  had  registers  of  nonparticipating      The aides found out  as  a  result  of  following
        members'   However,   those   organizations    that   up   unkept   appointments,   that    people    were
        were contacted promised  to  publicize  the  cancer   often   scheduled   for   appointments   without   a
        detection program.                                    realistic  assessment  of  the  time   factor.   For
          Moving  on  to  the  area  churches,  the   aides   example,  some  were  scheduled   for   appointments
        were able to  get  several  priests  and  ministers
        to anno unce the  existence  of  the  program  dur-   only a day or two  after  they  received  their  an-
        ing  Church  services,  in  fact,  at   one   Roman   nouncements  and  after  they  had   already.   made
        Catholic Church  the  aides,  with  the  assistance   other  commitments.  In  addition,   some   received
        of a church group, solicited  registrants  for  the   their appointment cards  4  or  5  days  after  they
        test at the end of each Mass  on  a  given  Sunday.   had  been scheduled (via Pony Express).
           While  most  of  the  clergymen  were   coopera-   Recommendations
        tive the aides recorded  the  following  incidences      1.  That  appointment  be  confirmed   by   tele-
        which are worth relating:                             phone  call   before   assuming   that   the   woman
                                                                                                                 71


          has  received  information  about  the   appoint-   diate area of the clinic to a dinner at  the  hos-
          ment.                                               pital for the  purpose  of  seeking  their  advice
            2. That the postcards be sent  out  after  con-   and ideas.
          firming the  appointment  and  about  a  week  in      The director of the council, furnished  a  list
          advance  of.the  appointment  time.                 of the neighborhood organizations  for  the  invi-
            3. That  consideration  be  taken  of  the  pa-   tation list. Also, invited were: chairman  of  the
          tient, i.e. certain arrangements may have  to  be   West  Philadelphia  Chamber  of   Commerce,   rep-
          made  in  order  to  keep  an  appointment,  i.e.   resentatives  of  the  American  Cancer   Society,
          babysitter, transportation, etc.                    head of the local school district,  and  the  area
            4.  That  the  backlog  of   women'which   were   representative  of  PAAC.   Representing   Miseri-
          recruited  be  scheduled  for   appointments   as   cordia  were:  Alisericordia  Hogpital's  adminis-
          early as possible, even if  it  would  entail  an   trator, director of the clinic,  director  of  the
          extra day a week for appointments.                  social service  department  and  the  director  of
            5. That a community health aide     be   hired.   the public relations department.
          This health aide, as a member of  the  indigenous
          area, be  assigned  certain  tasks.  Among  them:   Appi-oaches and Results
            (1)  Continue  the  program   which   has   al-      In spite of a logical and  sequential  approach
          ready proved successful.                            to establishing and publicizing  the  clinic,  re-
            (2) Since the  regular  secretary  canno  maiKe   turns f rom  client  appointment  files  were  not
          evening calls to  schedule  the  women  for  eve-   favorable.
          ning clinics, the  community  health  aide  would      i
          assume the task. Considering                  hat      As  mentioned  above,  it  became  obvious   to
                                            the fact t        the  Health  Aides   that   the   community   (for
          there are many women  iTi  this  area  that  work
                                                              wnich the clinic  was  established)  did  not  re-
          during the  day  (as  has  been  proven  by  can-
                                                              spond to  traditional  methods  of  communication,
          vassing and mentioned earlier  in  this  report),   i.e., the mass  media.  Therefore,  the  following
          the evening service  is  essential.                 obpectives were established:
            (3)  Consider  that  this  health aide  may   in-    1. To visit  meetings  of  community  organiza-
          deed be  an  essential  feature  of instituting  a
                                                              tions for the  purpose  of  explaining  the  fune-
          program  of   preventive   medicine in this  corn-
                                                              tion of the clinic.
          munity with its base  at  Misericordia  Hospital.
                                                                 2. To make door-to-door contacts  in  order  to
          Rec?-uitment fo?-  the  Hospital's  Neighbo?,hood   explain  how  community  women   could   use   the
              Health Center                                   clinic.
                                                                 The  health  aides  made  numerous  visits   to
            The site of the Neighborhood  Clinic  (52d  and   Community  meetings   and   churches.   They   no-
          Thompson Streets, some  2  miles  from  the  hos-   ticed  that  those  in  attendance  represented  a
          pital) was chosen because  no  hospital  actually   segment of  the  community  which  was  articulate
          serves the  area  and  because  hospital  records   and knowledgeable of existing  health  care  serv-
          showed that a  relatively  small  number  of  pa-   ices. Moreover, this particular  group  of  people
          tients from this area had seen a doctor prior  to   maintained very little  contact  with  the  "grass
          admission.  Since  the  majority  of  cases  from   roots"  people  and  had  personal  physicians  at
          this area  were  maternity  patients,  the  pilot   hospitals  other  than   Migericordia   (primarily
          program, under  the  department  of  obstretrics/   Mercy Douglas Hospital).
          gynecology, offered  prenatal  and  gynecological      Ijuring the month  of  July  1968,  the  health
          care and free cervical cancer detection tests.      aides  made  door-to-dbor  recruitment   contacts.
            Working  closely  with  the  West  Area  Health   According to Mr.  James  McGee,  director  of  the
          and Welfare Council,  the  Public  Relations  De-   out-patient  department,  the  clinic  served  the
          partment discovered that  merely  establishing  a   greatest  number  of  patients   for   any   given
          clinic in a giv3n community  does  not  guarantee   month  since  its  opening  (see  July  statistics         a
                                                                                                                         a
          its acceptance, no matter what services  are  of-   below).
          fered or for how little. Therefore,  it  was  de-      As a result of the door-to-door  contactg,  the         a.
          cided to  invite  the  chairmen  and  leaders  of   health  aides  discovered  that  the   "community"
          various  community  organizations  in  the  imme-   was not aware of the existence      of the  clinic

          72


        and its purpose. In  addition,  racial  and  relig-         ing hospital-community relations,   a   health   sci-
        ious misconceptions  were  evident.  "Most  of  the         ence  student  was  assigned  to   the   department.
        black people that I contacted felt that the  clinic         Appi@oacit and Obse?-vatioits
        was  for  Catholics.only  and  they  thought   that
        you had to be white to  receive  service.  Most  of         The  health  science  student  first  oriented  him-
        the whites living in  the  area  were  Italian  and         self  (through  consultation  with  staff)  to   the
        they thought the clinic was  for  blacks  and  that         function and  operation  of  the  E.R.  after  which
        it was  degrading  f  or  them  to  go  there"  was         he  attempted  to  define  existing   problems   and
        the comment of one health aide.                             to  relate  them  to  the  developing   concept   of
                                                                    hospital-community   relations.   The    orientation
        Neiglibo?,hood Clinic, July 1968 Statistics                 included  direct  observation  of  the  E.R.'s  per-
                                                                    sonnel  and  procedures  as  well  as   interviewing
        I.  Health services rendered:         Nui)iber pe)-,gons    patients  to  determine  their  general  background,
           Gynecology ...............................  ...................... 14 i.e. economic status  and  health  service  orienta-
           Pap           Smear   ........ .............. ......  ........... l  6tion.
           Pediatrics ........................................ ........4Of  the  two  hundred   (200)   respondents   inter-
           Prenatal          .......... ..................................5viewed,  the  following  percentages   were   calcu-
                                                                    late: *
                                                      39            (A)   80   percent   were   employed    7    percent
                                                                                                        p
        II. Information contacts:                                   retired, 8 percent  on  public  assistance,  2  per-
           By  telephone     ...... ...... ......  .................. 21 cent on social  security  benefits  related  to  the
           In  person  --- ................................. ............ 12 death of husbands,  and  3  percent  received  their
                                                      33            support from the divorce courts.
                                                                    (B)   60   percent   had   family   physicians,   23
            Total    I     and     II ....... ................................ ... 72 percent  relied   on   Misericordia   Hospital   for
                                                                    health  care,  5  percent  relied  on   Philadelphia
        Recommendations                                             General  Hospital  and  Hospital  of   the   Univer-
           In an effort to increase  the  utilization  of  the      sity  of  Pennsylvania,  the  remaining  12  percent
        clinic,  the  health  aides   recommended   the   fol-      represented    Mercy    Douglass    Hospital,    St.
        lowing.                                                     Christopher's Hospital, Police Welfare       clinics
           1.  That  a  black  and  a  white  receptionist  be      and union clinics.
        on duty on alternate days.                                  (C) 2 percent had periodic physical           exami-
                                                                    nation  every  6  months,  29  percent  every  year,
           2. That a full-time health aide be hired       to        12  percent  every  2  years,  and   the   remainder
        promote  the  clinic  and  other  hospital   projects.      (57 percent) only when they were' ill.
        Emei               -Out Patient
             -gencli    Room                                        (D)  Less  than  5  percent  had  'chronic   illness
        Department Su?,vey                                          in their family.
           The    Emergency    Room    Out-Patient     Depart-      (E)  56  percent   of   the   patients   had   never
        ment  represents  the  point  at   which   most   com-      used the clinics  at  Misericordia,  while  the  re-
        munity  people  have  their  first  contact  with  the      maining  44  percent  had  used  the  clinics   once
        hospital.  In  instances  where   there   are   racial      or more.
        and   cultural   differences,   the   community   per-      The   student   observed   the   following    situa-
        son  often  gets  a  negative  impression  of   hospi-      tions  and  occurrences  which  are   submitted   as
        tal's staff  and  its  policy;  racial  prej.udice   and    possible  areas  of  concern  as  they  may   affect
        bigotry are often claimed.                                  patient and hospital staff relationships:
                                                                    First,  situations  which   usually   created   con-
           if a hospital is  to  serve  effectively  the  com-
                                                                    fiict between the patient and  hospital  staff  were
        @unity  in  which  it  is  located,  there   must   be
                                                                    those in which that patient felt  that  he  suffered
        a   reasonable   amount   of   mutual    understanding
        and tolerance  of  differences  by  both  the  patient      from a f  atal  disease  or  a  grave  physical  in-
        and hospital staff.
                 .   .                                              * 'No'ice is here given to the  fact  that  this  survey  is,  skewed
           In  an  effort  to  pin-point  problem  areas   and      and therefore v.lid only insofar as  it  helped  the  Health  Science
                                                                    student to get some very general  in4ight  into  the  background  c-f
        to   recommend   changes   directed   toward   improv-      the E. R. patient).
                                                                                                                       73


                                              case        the         patient sie-jans either do  not  hear  their  page  or  ignore
                 jury. As a  result  of  either                         ition it.,,
                 was emotionally upset.  To him, his cond
                 appeared    critical    and    immediate    attention    was Reco)li))ieiidations
                 required.    To    compound    the    situation    he    may 1.  An   extensive   effort   be   made   to   acquire
                 have    been    accompanied    by     members     of     his re black and white American physicians.
                              ds     who      were      also      emotionally MO                      .    ity    over     confer-
                 family or frien                                            2. That patients have prior
                 involved.                    in   the    E.R.    is    often ences  which  require  the   presence   of   on   duty
                 In  addition,  this  situation at     the     hospital      is residents.      be     developed     which     ex-
                 compounded  by  the  fact   th unity     as      a      "white 3. That a booklet f  the  F,.R.  and  that   it   ex-
                 known  throughout   the   Comm                             plains the function 0
                 Catholic     hospital".     Consequently,     the      NegroIlain the need for delays.
                 patient   becomes   concerned    about    the    possibilityp
                                        .     t      him      because      he Opei,atiolt Create (Citititi'al En?,ichment for
                 of    discrimination    agains vironmp,-nt             (credi- Ne-igliborhood Ciiildi-en)
                 doesn't trust  this  alien  en
                 bility gap).                                               The   short-range    objective    of    the    program
                                                                                           a     rewarding     and      meaningful
                 Secondly,  as  is   the   case   in   E.R.'s   in   general, was to  provide                 for        neighbor-
                 patients  are  treated  on  the  basis   of   the   serious- 49cultural enrichment" experience
                 riess  of  their  conditions  and  often   those   who   are hood  children,   through   stressing   the   creative
                 less  ill  are  required  to   wait   several   hours.   The aspects  of  learning  rather  than,  the  mechanical.
                                                                            The  long-range  objectives  of  the   i3rogram   were
                                              ften       interpreted       by                                           d      the
                 priority  of  service  was   0            y.           Also, to develop community interest, rapport an
                 the black patient as being discriminator                                                                 hospital
                 itconflict    occurred    when    patient    sought    emer- expertise with the hope of making the            the
                 gency    treatment    for    a     nonemergency     problem. a more meaningful institution sensitive to
                                              wait       while       patients needs  of  the  community  in  which  it  is  located.
                 As  a  result  of  having   to re     were     served,     the "Operation   Create')   consisted    of    7    weeks,
                 who   needed   immediate    Ca                                                         Forty    children     par-
                 black   patient   seemingly   felt   that   he   was   being divided into two sessions. conducted          Mondays
                 discriminated against."                                    ticipated. The program was
                 Next,   "situations    which    did    not    produce    im- through Fridays.         the    following    activi-
                 mediate   conflict,   but   which   were    not    conducive The program included
                                              the    hospital    staff    and ties:   Choral   singing,   physical   education    On
                 to   good   rapport    between ped     when     the     doctor records,  reading  book   corner,   finger   painting,
                 community    People    devel.0 te     with     the     patient murals,  collages,  interpretive   Painting,   sewing,
                 was   unable   to   comrnunica                                           ed   Cross   volunteer    worker    gave
                 because   of   a   lack   of   command   of   the    English etc. Also, a  R          rnplete   with   films   of
                 language   to   say   nothing   of   the    vernacular    of 5 hours of instruction, co  e   home,   child   care
                 the black patient."                                        instruction,'On safety in th  dition,   the   children
                                              s    involved    in     improv- and personal hygiene. In ad              how      to
                  In  addition,   the   problem elations      are       greatly were given practical suggestions on
                 ing    hospital-community    rlong      waiting       periods handle fires  and  burns  by  the  local  fire  chief.
                 increased  as  the  result  of                                           n were  taken  on  field  trips  to  the
                 before   the   patients    received    medical    attention. The    childre            Hood   Dell   (the   chil-
                                                               to         the following pla'es- Robin
                 "In one case a patient was admitted                                      c                 H.ospital  to  see   the
                                              s   and   40   minutes    later dren's concert), Lankenau
                 accident  ward  and   8   hour                             Health  Museum   Exhibits,   St.   Joseph's   College-
                 he  was  admitted  to  the   hospital   to   have   a   for- moliere's    comedy     "The     Patient     Pretends"
                 eign object removed from his ear."                                    r   juvenile   audiences,   the   Art   Mu-
                   Finally,   several   cases   which   required   the    at- adapted fo
                 tention   of   a    resident    physician    were    delayed seum, Abbotts Dairy,  the    Philadelphia    Evening
                 because   either   "the   residents   on   duty   were    in Bulletin  And  other  sites  of  interest.  Recreation
                                                                                                           rough  trips   to   the
                 conference  or  because   the   residents   had   left   the was provided for them th
                 hospital    without    informing    the    telephone     op- Westtown   camps   and   the    Sherwood    Recreation
                 erator   or   a   responsible   person   in   the    depart- Center.
                                                                                                          ied   and    interesting
                 rnent    which    they    were    covering;    where    they As a    result, of the var
                                                                      navail- activities  provided   for   the   children,   tremen-
                 were going, thus making themselves u
                                                                            dous  community  interest   was   generated   by   the
                 able."   Also,   "it   was   observed   that    some    phy-

                  74


                                         the center      mp-ncement exercises for the group. A program
     program,   Many parents visited                                                           was pre-
                         their children be included      entitled "A Message Through Song"
     and requested that    am war, continued.            sented after which certificates of merit were
     next year if the progr                              given by the hospital administrator.
       "Operation Create'3  was concluded with cOm-

                                                                                                          7


                                                Section III
                           PROJECT WORKER PERSONAL CONTACTS
                                                 ion    Snodgrass

                                                    introduction
                                                                      discussion   among   the   researchers,   the
          From   the   outset   the   research   phase   f   aced siderable       Ith   professionals,   the   idea
          two  major  questions:  (a)   how   to   evaluate   the staff and a f ew hea th   delivery   system   as    a
          effect  of  student  activities  on  the   institutions of viewing the heal
          and  organizations   with   which   they   dealt,   and process within which  there  were  presently  vari-
                                                       p-       ous points of  friction  came  to  mind.  The  idea
          (b) how to collect  relevant  information  hel                           ashington     Conference      of
          ful  to  concerned  agencies  of   the   Federal   gov- was taken to the W
                                                                June 8-            as   favorably    received    by
          ernment  who  -might   realistically   begin   to   re-    9 where it w
          form the health system in the future.                 several of the social science  consultants.  Later,
                                                                their  recommendations  as  to  how  the   projects
          The   very   diversity   and   complexity    of    PSHO                 included  the'notion   of   peri-
              ted  easy   answers   to   these   questions.   For might be evaluated s   which   would   reflect   the
          preven               planned    to     introduce     80 odic contact report health   care    process    was
          example, PSHO had                unity          workers points at which the
          health science students, 20 comm                      poor or inoperative.
          and  20  youth  interns   to   40   different   project Basically,  the  idea  was   to   view   the   con-
          sites.  The  number  of  persons  at  each  site  would sumer  at  one  end  of  a  dimension   of   health
          vary,  the  function  of  each  at  the   sites   would service and the institutions  of  delivery  at  the
          vary and,  of  course,  the  nature  of  each  individ- other. Theoretically@ it was thought that  at  cer-
          ual  would  vary.  At  first  and  for  a  considerable tain  points  along  this  dimension,  health  care
          period  of  time,  the  project  appeared  to  be   too was quite highly developed  or  at  least  adequate
          diverse   and   complex   for   any   evaluative    re- in  comparison  to  other  points  in  the  process
                to  be  c,onducted.   It   was   impossible,    for              extremely   poor   or   completely
          search                                                at which care is
          example,   to   develop   a   standardized    reporting absent. Student placements    in    PSHO     would
          procedure   for   feedback   because    the    pro3ects be  involved  with   community   organizations   or
          were  so  diverse  that  no  common  questions   perti- official institutions which dealt directly  or  re-
          nent  to  all  participants  could   be   asked-   Pre- latedly with the health  status  of  the  consumer.
          vious  research   bad   asked   students   to   prepare In this capacity we felt that it  was  possible  to
          a  log  r  diary  to  be  reported  periodically   from consider  students  as  participant  observers   of
               0
          which  data  could   be   collected.   However,   these                                                 to
                                                                the  health  delivery   system,   in   a   position
          researchers  had  learned  that  students   soon   lost report  on  which  aspects  seemed  adequately  de-
          interest  in  maintaining   a   personal   account   of veloped,  inadequately  developed   or   completely
          their  activities  so  that  by  the   close   of   the overlooked. In  an  effort  to  systematically  un-
                               ority    had    made    consistent                   n this  area,  the  researchers
          project only a min                                    cover information i
          and valuable reports.                                 reasoned  that  if  students  were  able  to   make
             An   answer   tIo the first question was        never brief reports on the nature  and  purpose  of  each
                                                       oten_    individual  with  whom  they  came  into   contact,
          found by the present research, but     one   p
          tial  answer  to  the  second  came  to  light   during a picture of  the  points  of  consumer  grievances
          the  presummer  research   planning.   After   con-   Iand  satisfactions  would  come  to  light.  ;:   @
                                                                                                                  77


             The  research,  however,  did  not  have   the   re-   below is  a  description  of  the  variety,  nature
             sources or the personnel  to  carry  out  this  plan   and  outcome  of  contact  made  by  these  project
             at  every  site.  Consequently  it  was  decided  to   workers.  The  report  is  organized  according  to
             experiment  with   the   idea   of   personal   con-   the type of contact  made  by  each  project  work-
             tacts revealing the health  system  deficiencies  at   er, such  as  city  official,  community  resident,
             two sites for a  2-week  period.  If  this  approach   and medical professional.
             to the  investigation  of  medical  services  proved   The   reader   can   judge   how   valuable   these
             successful,  then  it  might  be  improved  and  em-   descriptions are in the collection  of  information
             ployed in future SHO research.                         helpful  to  the  Federal  Government  in   improv-
             Appendix  5  is   a   copy   of   the   Philadelphia   ing  the  health  care  system.  However,  in   the
             Student   Health   Organization    "Personal    Con-   final  section  the  researcher  has  commented  on
             tact  Sheet,"  It  contains  a  checklist  by  which   the value of the  "Personal  Contact  Sheet"  as  a
             the  respondent  can  quickly  give  the  biographi-   research instrument  in  collecting  such  informa-
             cal characteristics of  the  person  contacted,  how   tion, and its potential as a  research  device  for
             the contact was  established,  the  purpose  of  the   future SHO research.
             contact  and  a  means  for  reporting  the   conse-      St. Christopher's Child and Youth
             quences  of  the   contact.   The   reporting   form          Comprehensive Care Center
             was  designed  to  be  brief  enough  so  that  Stu-
             dents  would  not  be  reluctant  to   complete   it   Fii-st Healtit Science Stttdent
             following  each  personal  contact,   yet   substan-    1.  City  Officials:  During  the  2-week  period,
             tial enough  to  indicate  whether  the  outcome  of
             a  contact  revealed  a  complaint  or   a   compli-   there  were  15  contacts  with  Philadelphia  city
             ment for the health care system.                       officials, a total of eight different  Philadelphia
                                                                    governmental officials.
              Two  sites  for  the   exploratory   use   of   the    The  contacts  were  all  associated  with   cases
             personal  contact  sheet  were   chosen,   the   St.   of  lead  poisoning  in  renovated  public  housing
             Chn'stopher's   Child   and   Youth    Comprehensive   units. The health science  student  stated  that  a
             Care  Center  and  the   Spring   Garden   Community   specific accomplishment as a result of  these  con-
             Center, both  located  in  North  Philadelphia,  St.   tacts was: "The  presence  of  lead  poisoning  and
             Christopher's  C  &  Y  Center  employed  all  three   the need for  immediate  relocation  of  f  amilies
             types  of  PSHO  participants,  three  health   sci-   with lead  poisoning  was  brought  to  the  atten-
             ence  students,  one  community   worker   and   one   tion  of  the  health  department."  Also  an   ap-
             youth intern. This  site  was  chosen  in  the  hope   pointment to meet  personally  with  a  responsible
             that  by  multireporting,  the  three  varieties  of   city official to examine the issue of lead  poison-
             project  worker  would  shed  light   on   the   de-   ing  was  made.  There  was  no   indication   that
             livery  system  at  this  institution.  Unfortunate-   the student was successful  in  relocating  a  spe-
             ly, the youth intern at this site  was  not  respon-   cific family which  was  the  victim  of  the  lead
             sive to  our  request  and  did  -not  file  contact   poisoning within the two-week period.
             reports.                                                 2.  Community  Leaders:  One   contact   with   a
               The  Spring  Garden  site  also  had   a   variety   community leader in  person  in  effort  to  obtain
             of  project  workers;  one  male  and   one   female   information and  advice  on  how  to  approach  the
             health  science  student  and  two  youth   interns.   health   and   housing    departments    concerning
             Here again, however, we  did  not  receive  the  co-   the cases of lead poisoning.
             operation -of  the  youth  interns  and  their  con-     3.  Health  Professionals:  Three  contacts  with
             tacts  and  perspectives  of  the  health   delivery   health  professionals  were  established  in  order
             system remain unknown.                                 to obtain inf ormation on  the  relocation  of  the
               The  project  workers  at  these  two  sites  were   cases of lead poisoning.
             asked to complete  a  contact  sheet  for  a  2-week     4.  Community  Residents:  The   health   science
             block  of  time,  (August  12-16  and   August   19-   student   bad   contact   with   three    community
             23)  on  each  person  contacted  either  by   phone   residents  during  the  2-week  period.  One   con-
             or in. person. The  results  were  collected  during   tact was  with  the  woman  involved  in  the  lead
             the  final  conference  and  subsequently   analyzed   poisoning  mentioned  above.  In  a   second   con-
             and  collated.  The  analysis  which  is   presented   tact,  the  worker  collected  information  for   a

             78


         ,,voman's  Public   housing   application   and   in   the with  other  PSHO  project  workers   on   a   number
         third,   discussed   the    career    opportunities    and of issues.                       health        sci-
         further   education   of   a   14-year-old   Negro    male 1. He established contact with a
         on   the   verge   of   quitting   school.   The    health ence  student  at  another  site  and   pursued   the
         science   student   remarked   that   he   was    success- possibility of developing  a  sex  education  course.
                                             in            investi- Several films were  later  reviewed  for  their  pos-
         ful in getting the contact interested
              Lances     for     further      education      before sible incorporation into the course.
         gating c
         dropping out of junior high school.                      2.  He  was  in  contact  with  a  variety  of  other
         5.    State    Government    Officials:     A     personal PSHO  workers  at  his  site  placement,   a   neigh-
         contact   was   initiated   with   the    Department    of boring  site,  and  Nvith  PSHO  staff  in  order  to
         Public   Assistance   which   was   successful   in   hav- discuss  the  admission  policies  of  various  Phil-
         ing   the   allotment   of   a   welfare   recipient   in- adelphia  medical  schools  and   to   discuss   what
         creased to include a dependent child.                    action  and  contributions  they  might  collectively
         6.    Community     Groups:     The     health     science make toward improving these policies.
         student   met   with   one   high   school   drill    team 3.  The  health  science   student   called   several
         composed   of   both   male   and   f   emale    teenagers meetings  of  other  members   of   the   child   and
         and   one   Puerto   Rican   boy's   social   organization youth  site  to  discuss,  outline  and  write  their
         to  show  and  discuss  a   film   on   venereal   disease site problem paper.
         and sex education.                                       4.   The   health   science   student   initiated   a
         Adult    community    workers     of     two     different meeting   with   three   other   members   of    PSHO
         community    organizations    were    shown    the    film who  were  also  enrolled   in   the   same   medical
         which  was   also   followed   by   discussion   sessions. school to  discuss  the  possibility  of  creating  a
         Health     Pi-ofessionals:     There     were      several "humanitarian    program"    for    their     medical
         contacts    with    health    professionals    for    num_ school in the  fall  and  to  investigate  this  par-
         erous reasons.                                           ticular school's black admissions policy.
                                                                  5.  He  attended  a  sensitivity   training   session
         Second Health Science Student                            with  other   student   participants   and   institu-
         1.   The   director   of   St.   Christopher's    Children tional residents at Eagleville Hospital.
         and  Youth  Center  was   seen   personally   to   discuss NonHealth  Pi-of  essionals:   A   personal   contact
         and  revise   the   informal   review   clause   practiced with the  head  of  social  work  department  at  St.
         by the Patient Care Review Board.                        Christopher's   Children   and   Youth   Center   was
         2.  Later  in   the   week,   a   personal   contact   was made  and  a  time  arranged  for  the  social  work-
         made   with   a    professor    at    Hahnemann    Medical ers to view the childbirth films.
         College   from   whom   two   films,   "Labor   and    De- A  going-away   party   for   a   nonhealth   profes-
         livery"    and    "Natural    Childbirth"    were     bor- sional  was  held  one  after-noon   at   which   the
         rowed.                                                   health  science  student  had  contact   with   'num-
          In a  third instance, the health science                stu- erous  doctors,  social  workers  and  other  person-
         dent  personall,y   contacted   a   female    official    of nel of  the  St.  Christopher's  Children  and  Youth
         St.  Christopher's  Children   and   Youth   to   set   up Health Center.
         an  on-going   sex   education   course   in   the   fall. Medical  Technicians:  The   health   science   stu-
         He offered to her   a   resum6   of   our   class    mate- dent  met  in  person  with  one  medical  technician
         rials  and  resources."   The   student   indicated   that of  St.  Christopher's  Children  and  Youth   Center
         the.   official   was   very   interested   and   coopera- after  having   shown   the   childbirth   film   and
         tive,   but   he   personally   had   some    reservations discussed  her   attitude   toward   childbirth   and
         about  the  complete   success   of   the   contact.   The toward sex in general.
         same    individual    was    contacted    several     days Comraunity   Youth:   The   health   science   stu-
         later    and,    through    her,     arrangements     were visited  the  home  of  a  female   community   resi-
         made  to  show  a  film   on   childbirth   to   a   group dent in an eff ort to find her son, the leader  of  a
         of nurses.                                               teenage  gang.  The  son  was  in  St.  Christopher's
           Other      PSHO      Project      Workers:      Over.the Hospital  recovering  from  a   gunshot   wound   re-
         course   of   the   20-week   period,   this    particular ceived  from  another   gang   member.   The   health
         health   science    student    made    several    contacts science  student  visited  the  gang  leader  at  the
                                                                                                                      79


               hospital and had him  select  the  sex  education   of  the  Hartranft  Community  Corporation   after
               movies to be shown to  his  gang.  The  following   an in-person contact and request were made.
               week the gang leader was  seen  in  his  home  to   The  health   science   student   telephoned   the
               discuss a date f or the films.  At  this  meeting   Childbirth  Education  Association  requesting   A
               the health science  student  reported  that  they   film on childbirth and  asking  that  the  central
               talked about  retribution  against  another  gang   fee  be  waived.  The  contactee  responded   that
               that shot him 2 weeks ago.                          the film committee  would  look  into  the  possi-
               Several  days  later,  a  group   of   about   10   bility of using the film.  There  is  no  notation
               gang members met at  the  branch  of  the  Public   by the student as to  whether  he  was  eventually
               Library for 3 hours with several  health  science   Successful or unsuccessful in this request.
               students   and   a   physician   from   Hahnemann   Another  community  leader,   the   organizer   of
               Medical College in which the films on  childbirth   a drill team, was contacted in person  to  arrange
               were shown,  models  of  the  uterus  and  pelvis   for a meeting with the  team  to  show  films  and
               were discussed and questions answered.              discuss sex  education.  As  described  below  the
               This  same  format  was   followed   with   three   meeting of the team was held  a  few  days  later.
               other local gangs during the  cours6  of  the  2-   The  health   science   student   had   previously
               week period,  a  total  of  about  35  gang  mem-   established a relationship  with  the  members  of
               bers. On the whole, the health  science  studefit   a local teenage baseball  team,  so  that  at  the
               reported that  the  members  of  the  gangs  felt   outset  of  the  2-week  reporting   period,   sex
               the experience to be interesting  and  sucessful.   education  classes  were  held  with  this  group.
               At the outset of  the  2-week  reporting  period,   He played a f ew  innings  of  baseball  with  the
               the Health Science  Student  conducted  sex  edu-   team  after  which  the  players  participated  in
               cation classes  with  a  local  teenage  baseball   sex education classes.  Over  the  2-week  period,
               team.  There  was  more  extensive  contact  with   four classes were held at which a  total  of  five
               this particular group than with the  others.  The   films were viewed,  each  of  which  was  followed
               health  science  student  had  previously  estab-   by a discussion session.
               lisbed a relationship  with  the  local  baseball    The  sex  education  films  and  discussion  ses-
               team.                                               sions  were  also  conducted  with  other   groups
               Cominit?zity Leade)-s: The  health  science  stu-   and associations. On one day, the  film  was  seen
               dent  was  contacted  over  the  telephone  by  a   by  three  different  groups,  Negro,  and  Puerto
               community  leader  who  was   the   chairman   Of   Rican females,  and  on  another  day  six  family
               the  St.   Christopher's   Children   and   Youth   health  workers  from  St.   Christopher'g   Chil-
               Health  Center  Advisory   Board.   They   agreed   dren  and  Youth  Health  Center  saw   and   dis-
               that a suggestion box was needed for  the  griev-   cussed the films.  The  film  was  also  shown  to
               ance committee in  the  health  center.  Approxi-   eight members of a local girl's club.'On    another
               mately a week  later,  the  health  science  stu-   occasion, the student took the film to  a  biology
               dent  contacted  the  leader  and  together  they   class  at  Gwynedd  Mercy  College  and  presented
               sawed the pieces  of  wood  neessary  to  make  a   it to a group of 25 students and faculty.
               complaint  box.  Later,  the  box  was   actually   Third Health Science Student
               built and sanded by the health  science  student.     The  third  health  science  student   was   in-
               On several  occasions  between  these  two  meet-   volved mainly in the  establishment  of  a  camera
               ings, the committee leader was seen twice per-  -   club  at  St.  Christopher's  Children  and  Youth
               sonally; once  to  investigate  the  bylaws  con-   Center. During  the  2-week  period,  he  reported
               cerning  the  Patient  Care  Review  Board   and,   repeated contacts  with  young  high  school  stu-
               secondly, to invite  him  to  attend  an  evening   dents interested  in  learning  about  photography
               meeting   of   PSHO's   Committee    for    Black   and establishing  a  permanent  camera  club.  His
               Admissions.                                         activities were in  association  with  four  Negro
                The  health  science  student  personally   con-   male and two  Negro  female  teenagers  and  three
               tacted  the  pastor  of  Holy,   Cross   Lutheran   Puerto  Rican  male  teenagers.   Also:   involved
               Church who "refused  to  lend  his  take-up  reel   were  an  11-year-old  Puerto  Rican  girl  and  a
               for our  films  on  sex  education."  The'take-up   10-year-old  Puerto   Rican   male.   The   health
               reel was borrowed later that day  from  a  leader   science student  carried  out  a  number  of  dif-

               80


                                           all       of       which phone  number  or  address  at  which  the   priiei-
           ferent projects with each of them)
                             ound      the      instruction      Of pal could be reached.
           seemed to center ar    they     designed     a      pho- The  health  science  student  was  also   in   cOn-
           photography. In addition)                                  h   the   director   of   educational   services
           tographic  display  for  the   waiting   room   of   the tact wit          nd       Montgomery       County
           community   health   center,    and    worked    on    aof the Philadelphia a            s intere
           picture   story   of    PSHO.    Equipment    for    the TB and Health Commission who wa         '     sted
           permanent  club  was  sought  and   a   name   for   the in  obtaining  prints  of  housing  and  lot  condi-
           club,   "Camera   &   Youth    Studio"    was    decided tions  to  be  used  to  display  to  persons   with
           upon.                                                  whom he officially comes into contact.
           The   student   was   in   contact   with   two    adult Other   PSHO   Students:    The    health    science
           members  of   the   community   who   he   hoped   would student  met  with  two  PSHO   workers   from   an-
           like to  take  charge  of  the  club  and  see  that  it other site  and  discussed  in  general  PSHO  plans
           continued after the close of the summer.               for the f all  of  the  year.  He  later  talked  to
           Another     community     resident     was     contacted different area  coordinators  about  the  plans  for
           in  her  home   in   order   to   take   pictures.   The the  final  conference.  Another  telephone  contact
                                                                  involved  one  of  the  PSHO   directors   and   the
           health  science   student   reported-that,   "The   pic- pians  to  show  the  Children  and   Youth   Center
           tures  would  be   used   in   an   approach   to   city to out_of-town visitors. This  health  science  stu-
           agencies to have the house fixed."                     dent  was  also  in  frequent   contact   with   the
           Preceptors:   The    health    science    student    had youth  intern  at  the  site  and  numerous  conver-
           several  personal  contacts  with   his   preceptor   in sations  covering  a  wide  range  of  subject  mat-
           an  effort  to  obtain  the  -names   of   persons   who ter. Finally, on one occasion,  the  health  science
           might   be   interested   in   continuing   the   camera student  along  with   the   PSHO   committee   went
           club in the f all. One  other  preceptor  was  brief  ed into  the  neighborhood  to  take   photographs   of
           on  two  occasions  about  the  nature  of   the   final the housing conditions.
           conference  at   which   his   attendance   was   urged. Coramunity    Worker:    The    community     worker
           Healtib   Professionals:    Three    different    health                   f   contact   sheets;   however,
                                          I                       completed a series  o
           professionals  at  St.  Christopher   s   Children   and some of them  were  incomplete  or  else  too  vague
           Youth  Center   were   contacted   in   an   effort   to to give  a  complete  picture  of  her  2-week  con-
           provide  for  the  continuity  of   the   camera   club. tae-ts. She was  primarily  in  contact  with  Corn-
           During  the   2-week   period   no   solution   to   the munity   residents   and   community   leaders    in
           problem was obtained.                                  reference to a  number  of  issues  centered  around
           The  health   science   student   also   came   into   ahousing conditions and welf are rights.
           wide  variety  of  health   science   personnel   at   aCommunity  Residents:   On   one   case   she   took
           farewell  party  conducted  at   the   institution   one a  Puerto  Rican  female   to   a   welfare   agency
           afternoon.  Approximately  40  people   of   all   races where she  was  successful  in  having  the  welfare
           and  from  a  wide  variety   of   occupational   status grant  increased  to  include  a  dependent   child.
           were present.                                          In  two  other  instances  she  obtained  permission
            City  Government   Officials:   A   group   of   teach- from  two  community  residents   to   take   photo-
                                           tour    of    the    St. graphs  of  urifit  housing  conditions.  She   con-
           ers were contacted while on
                                            th     Center.      The tacted                          dents   by   tele-
                                                                         several community resi
           Christopher's Children and You
           health  science  student  discussed   with   the   prin- phone  to  give  information   concerning   hearings
           cipal   of   Hartranft   School   about   the    further which  the  residents  were  unable  to  attend.  In
           development  and  continuity   of   the   camera   club. two other cases, she  went  to  the  homes  of  com-
                                          e                       the munity  residents  to  learn  the  status   of   the
           In  an  effort   to   f   ollow   up   th   possibility,
           health  science  student  attempted   twice   by   tele- residents'  applications  for  public  housing.  She
           phone  to  contact  the  '  incipal  of  the   Hartranft also  attended  several  'local  meetings   as   re-
                                Pr
           School in order to   describe    the     camera     club sources  to  further  her  work  with  housing  con-
           activities and status and to  possibly     work      out ditions.
           a solution of its continuity." In   both    cases,    he Community   Leaders:    The    community    worker
           was  not  able  to  get  beyond  the  principal's   sec- also  met  with  several  community  leaders,   par-
           retary,  who  twice   refused   to   provide   a   tele- ticularly ministers,  to  arrange  meetings  to  or7
                                                                                                                     81


             ganize  community  members  to   obtain   improved    and  then  would  have  to  open  it   to   someone
             housing conditions.                                   else."
               Com,mit??ity 07-ganiza,tio,@is:  During  the  2-      The next contact  with  Mrs.  R.  by  the  health
             week   period,   the   community   worker   became    science student was  the  following  day  in  which
             -an  associate  member  of  the   Welfare   Rights    they  had  discussion  about  selling   Mrs.   R.'s
             Organization and  worked  with  them  to  organize    radio-record player. The  contact  sheet  does  not
             for the improvement of housing conditions.            disclose whether the  radio-record  player  was  in
               Health  P?-ofessionals:  The  community   worker    connection with  the  funds  needed  to  visit  the
             came into contact with a  number  of  health  pro-    public  housing  or  not.  The   student   reported
             fessionals in  the  2-weeIk period;  in  some  cases  that "I have the feeling  that  Mrs.  R.  will  not
             made  arrangements  via   telephone   for   dental    find anyone to  buy  her  record  player  and  will
             services  for  community   residents;   in   other    continue  making  the  payments  on  it  which  she
             cases she made contacts  in  person  or  by  phone    really does  not  want  to,  because  of  being  on
             with officials responsible for public  health  and    welfare."
             public housing. She also  attended  a  lecture  on      Approximately  1  week  later,  Mr.  R.  came  to
             environmental health delivered by  a  health  pro-    the center and informed  the  health  science  stu-
             fessional,  and  a  lecture  on  housing  at   the    dent that she  could  not  attend  a  clinic  at  a
             University of Pennsylvania.                           nearby hospital by  herself  because  of  the  many
                                                                   other  problems  she  has.  "She  asked  me  to  go
                  Spring Garden Community Center                   along -  I  explained  the  value  of  going  alone
                                                                   and  reporting  back  to  me  how  she   feels   it
               This  female  health   science   student   noted    went." At that time  the  student  did  riot  think
             that  the  contacts  which  are  summarized  below    Mrs. R. would attend the clinic.
             "ivere made at the end  of  oLir  project  period,      After Mrs. R.  left,  the  student  telephoned  a
             when the  clinic  had  closed  for  the  month  of    nurse at the clinic and informed her  of  Mrs.  R's
             August;  they  are  not  necessarily  typical   of    reluctance to come to  clinic  and  clarified  that
             those  contacts  with  community  people  we   had    since she is in the maternal and infant  care  pro-
             been making in the beginning."                        gram, she  need  not  be  there  until  12:30,  al-
               In reporting the results of this student's  con-    though  the  appointment  card  reads  11:15.   The
             tacts, the material has been  organized  in  terms    student also  asked  that  the  interpreter  be  on
             of the person contacted rather than  the  type  of    the lookout for Mrs. R.  The  health  science  stu-
             person. Most of the contacts were  of  a  patient-    dent also noted that the  clinic  had  become  more
             advocate nature.                                      cooperative with  her  and  had  followed  some  of
               Mrs.  R:  Mrs.  R.  is  a   36-year-old   Puerto    her suggestions oii  specific  patients  since  the
             Rican living in the  neighborhood  of  the  Spring    time  the  student   had   personally   accompanied
             Garden  Community  Center,   who   came   to   the    them to  the  clinic  earlier  in  the  summer.  In
             center  with  a  letter  from   the   Philadelphia    spite of this, the student believed  that  the  ob-
             Housing  Authority.  The  health  science  student    stetrics clinic process needs a total revision  for
             translated the  letter  into  Spanish,  which  ap-    all patients.
             parently  stated  that  housing   was   available.      An hour or so later,  the  student  again  called
             From the contact reports  it  is  unclear;  either    the nurse at the  clinic  concerning  Mrs.  R.  and
             the housing required a  $25  deposit  or  Mrs.  R.    learned that she had just been  seen  by  the  phy-
             felt that she needed this sum  in  order  to  make    sician. The  student  noted  "this  was  the  first
             arrangements to inspect  the  housing  and  secure    time to my knowledge  that  Mrs.  R.  was  seen  so
             it. The  health  science  student  telephoned  the    quickly in the clinic."
             city official who had written the  letter to  Mrs.      Mrs. R.  stopped  by  the  community  center  af-
             R. and found that the  official  was  away  for  a    ter her visit to  the  clinic  and  talked  to  the
             week.  The  health  science  student  then   spoke    health  science  student.  The  student   suggested
             to another official and  "explained  to  her  that    that "Mrs.  R.  had  proved  to  herself  that  she
             Mrs. R. did not have  the  $25  to  cornIe  and  see  could go to the  clinic  alone  regardless  of  the
             the house now.  The  official  replied  that  they    language  and  cultural  -barriers  she  might  en-
             could only hold the apartment  for  a  short  time    counter there and on the way."

             82


                              contacts       reports        witll The  following  day  the  health   science   student
         There are no further ek     period.      Whether      she visited the L.'s home  to  discuss  the  results  of
         lvlrs. R. during the 2-we         housing             is the  appointment  with  the  mental  health  clinic.
         was successful in obtaining Public                                                              possibility
         unknown.                                               At that time they also discussed the pital.
                                           dent            called of having his wife admitted to the hos
         Officer S.: The health science stu                     The  health  science  student  later  spoke   to   a
         the  community  relations  ofFicer  of   the   Philadel- medical secretary to learn  how  Mrs.  L.  might  be
         phia   Police   Department   and   learned   that   they admitted to the hospital  for  surgery.  The  secre-
         had  no  record  of  a  letter  written  by  the.student tary offered to  contact  a  doctor  who  could  ex-
         asking  for  an  officer  to  speak  about  the   police plain  admission  procedures.  A  doctor  from   the
         and  community  relations,  to  a   meeting   of   P'SHO hospital  called  later  and  "suggested  that  Mrs.
         students.                                              L.'s  other  medical  problems  be  handled   before
         An   officer   of   the   community   relations   office her  oral  surgery."  The  health  science   student
         -returned  her  call  later  that  day  to  let  it   be explained Dr. R.'s deferral  of  her  oral  surgery.
         known  that  he  could  not  speak  on   the   day   re- Her possible admission  was  to  be  discussed  with
         quested. A  health  science  student  told  the  officer another   doctor.   The   health   science   student
         she  would  find  out   what   other   date   might   be stated that she had arranged  to  page  Dr.  S.  the
         scheduled for the SHO students.                        following  day  to  find  out  what   doctor   would
         The  following  day,  Officer  S.  called   the   health perform  Mrs.  L.'s  surgery  and  when  she   might
         science  student  to  ask  whether   a   definite   date be admitted, but  there  is  no  indication  whether
         had  been  arranged.  It  had  not,   so   the   student this was  done  or  whether  Mrs.  L.  received  the
         promised  to  call  back  as  soon  as  the   date   was surgery.
         established.   After   discussing   the   problem   with Several  days  later  the  health  science   student
         the  area  coordinator,  a  date  was  established   and received a telephone call from  the  doctor  at  the
         Officer S. was informed.                               mental  health  clinic  with  whom   she   discussed
         Several   days   later   the   student    again    tele- Mr. L.'s case.
         phoned  Officer  S.  to  confirm  the   date   and   the On  the  same  day  Mr.  L.  came  by   the   Spring
         topic  and  2  days  following,  the  officer  spoke  at Garden  Community   !Center   "to   thank   me   for
         the   Hahnemann   Medical   School   Auditorium   to   ahaving helped him and  his  family.  The  fact  that
         group of SHO students.                                 iNh-. L. sought me out to say  goodbye  I  feel  was
         Mr.  and   Mrs.   L.:   The   health   science   student significant-apparently   he   feels   our    contact
         had   been   in   continuous   contact   with   the   L. with him  this  summer  has  been  on  @  person-to-
         family   during   the   summer.   During   the    2-week person  basis  and  that  he  has  made  some  prog-
         reporting  period,  she  was   involved   in   obtaining ress."
                                    -year-old    Negro    at    aMrs.   M.:   "Mrs.   M.   (a   30-year-old   Puerto
         treatment for Mr. L  a 30
         mental  health  clinic  and  oral   surgery   for   Mrs. Pican)  called  me  over  when   she   was   waiting
                                          -week     period     in                    clinic. She  asked  me  to  in-
         L. The first contact during the 2                      with.her son at the
         regard  to  the  L.  family  was  to  telephone  a  pub- quire when her son would  be  seen,  since  she  had
         lic health nurse to  brief  her  on  the  L.  family  in been waiting 2 hours  already  (she  did  not  speak
         order  to  provide   continuity   of   care   once   the English).  When  I  explained  this  to  the  nurse,
         health   science   student    completed    her    summer she and  her  son  were  seen  immediately  so  that
         assigrunent.                                           she co.uld get  home  to  her  other  children  before
          She  next  went  to  the   L.'s   home   and   informed it got too late. Actually this is  not  much  of  an
         Mr.  L.  personally  of  an  appointment  she  had   set accomplishment  (the  intervention   of   a   health
         up   with   the   Community   Mental   Health    Clinic. science student) because it  is  not  remedying  the
         She   also   discussed   his   progress   in   obtaining situation of long waits  that  almost  all  patients
         public   housing   and    informed    him    that    she at the clinic must endure."
         woulld   be   leaving   soon   and   that   the   public Mrs.  C.:  A   28-year-old   Puerto   Rican   came
         health nurse would take over his case.                 to  the  Spring  Garden   Community   Center   seek-
           She   then   called   the   mental   health    clinic, ing health care for  her  son.  The  community  cen-
                                                                                     'de ',,he care
         thanked  the  nurse  for   setting   up   the   appoint- ter could not provi             ,  so  the  health
         ment for Mr. L.                                        science student called the  pediatric  clinic  at  a
                                                                                                                   83


             nearby   hospital   and   obtained   information   on   science  student  were  done  in  a  perfunctory  and
             how  Mrs.  C.'s  son  might  receive  treatment.  The   cursory fashion so that it is difficult to  establish
             student  informed  Mrs.  C.  of  the  procedure   and   the  purpose  and   accomplishments   of   his   work
             referred her to the hospital clinic.                    activities. During  the  first  week,  he  apparently
               This   health   science   student   had    numerous   worked  closely  with  health  professionals   of   a
             other  contacts  durn-ig  the  2-week  period   aside   mobile  X-ray  unit,  although  the  specific   tasks
             from  those   associated   with   patient   advocacy.   remain  vague.   He   also   had   frequent   contact
             She worked  with  a  mobile  X-ray  unit  working  in   with  a  female  Puerto   Rican   over   the   2-week
             the  Spring  Garden  area,  attended  a  sex   educa-   period  who   was   a   community   worker   although
             tion  seminar  with   other   PSHO   students   which   the reasons for  contact  are  not  spelled  out.  He
             explained how one hospital  is  teaching  this  topic   was  in  continuous  contact  with  two  other  P'SHO
             in the Philadelphia public  schools,  toured  a  hos-
             pital  museum   and   worked   with   several   other   students of  another  project  to  discuss  and  help
             PSHO  members  to  develop  a   schedule   of   meet-   carry  out  a  project  survey.  Other   than   these
             ings and speakers for the final convocation.            issues, the  other  contact  reports  filed  by  this
             Second Health Science Student                           particular student are  not  especially  valuable  in
                                                                     understanding  points  of  grievance  in  the  health
               The contact reports filled in     by  this   health   care delivery system.

             84


                                              Section  IV
                     SHO'S SHOW: AN EVALUATION OF THE 1968
                   PHILADELPHIA STUDENT HEALTH ORGANIZATION
                                              SUMMER PROJECT

                                                 ion Snodgrass

                                                   introduction

                                                                                      a  grand  success   or   dis-
        The  title,  ,SHOIS  Show,"  @rnay  imply  that  the    whether the attempt is
        1968  Philadelphia   Student   Health   Organization    mal failure. pSHO's  relevance   to   larger   socie-
                            a'ludicrous  carnival,   or   it    in locating              ost    outstanding     and
        Summer project was                                      tal trends, one of the m
        may imply that  it  was  a  remarkable  deriionstra-    curious features of  the  project  was  the  nature
        tion in social rP-f Orm- Possibly it  implies  both,       financial  support  and  the  character  of  its
        perhaps neither. In any  case,  the  title  is  left    of its                inistrators
        sufficiently  ambiguous  to  allow  the  reader   of    participants. The adm              and     partici-
        this report  to  come  to  his  own  conclusions  by    pants  were  almost  entirely  youth,  While  those
        critically examining the data in this section.          funding the project were primarily  adults.  It  is
        The report can be  read  on  two  different  levels.    this fact,  it  seems  to  the  researchers,  which
        The reader can view it  as  factual,  empirical  ma-    contains  PSHO's  relevance  to  the  broader   so-
        terial  about  the  1968  PSHO   project.   Or   the    ciety. It struck  the  researchers  time  and  time
        reader can view it as a specific example  of  larger    again throughout  the  summer  that  the  relation-
        historical trends in society.                           ship between the  adults  and  youth  in  PSHO  was
        On  an  empirical  level  PSHO   was   composed   of    somehow only a reflection  of  a  larger  trend  in
        74 health  science  students,  five  area  coordina-    society. A trend in  which  it  seems  that  adults
        tors, three  directors,  21  community  workers  and    not  only  identify  strongly  with  youthful  life
        20 youth interns who  worked  with  a  total  of  34    styles, dress and ideology, but  place  great  hope
        community  .organizations   and   health   and   wel-   in the present generation  to  attain  a  conflict-
        fare institutions within the city  of  Philadelphia.    free society and secure the basic  rights  of  men.
         On  a  general  level  PSHO  was  composed   of   a    This is  not  the  "generation  gap."  The  genera-
        group  of  individuals  in  an  attempt  to  improve    tion gap  is  an  old  phenomenon,  widely  covered
        the social  conditions  of  relatively  few  victims    (but never bridged)  by  the  media  and  generally
        of the 20th century.                                    acknowledged  by  the  public.  Even   170   -years
         On  an  empirical  level  the  evaluation  reflects    ago  de  Toequeville,  the  French   scholar,   was
        that   PSHO   had   mixed   results-successful   and    aware  of  the  generation  gap  when   he   stated
        unsuccessful.                                           that in the United States,  "The  tie  that  unites
          On a  general  level  the  actual  results  appear    one generation to another is  relaxed  or  broken',
        insignificant in  comparison  to  the  attempt.  The    every man there readily  loses  all  trace  of  the
        importance of  PSHO  lies  in  the  attempt  to  mi-    ideas of his forefathers or  takes  no  account  of
        prove  the  conditions  of   less   privileged   men    them."  But  the  contemporary   relation   between
        caught  up  in  the  human   race,   regardless   of    the  generations  as  reflected  by   PSHO   seemed
                                                                                                                  85


                                                                               by  adults.  This  means  that  the  burden  of  social
                    to indicate that we have moved beyond the gen              reformation  rests  heavily   on   the   shoulders   of
                    eration  gap  to  what  we  can   only   describe   as   the         Within   the    field    of    medicine    it
                               invers@ion."       De       Tocqueville       saw youth alone. he    passing    generation    of     medical
                    "generational sical      relationship       between       adults eanS that tremain inactive observer
                    that the clas                                              in                                          s        as
                    and  youth  would  be   fractured,   but   not   that   they professionals can         tempt      to       improve
                    might   be   totally    inverted_he    did    not    foresee their youthful successors at
                    the   possibility   that   the   forefathers   might    imi- the field of medicine.
                    tate  the  traditions  and   ideas   of   their   offspring. if   PSHO   is   a   representation   of   a    general
                    There    presently    is    much     debate     over     the societal  trend  in  which  adults   rely   on   Youth,
                    meaning   of   active   and    protective    movements    of then one has in this  report,  on  the  general  level,
                    youth.   On   the   one   hand   the   vast   majority    of material  which  would  indicate  -,vhether   the   so-
                    people   overtly   claim   that   this   is   the   undisci- cial  reforms  so  urgently  needed  have   been   dis-
                    plined    response    of    the    permissive     generation covered  by  Youth.  If  the   generational   inversion
                    constrained   to   act   out   of   the   boredom   of   its pen-nits acquiescence  by  adults,  we  fear  that  the
                                                            eath            this                          mented,    but    held    in
                    affluence. On the other hand, but ben                      reforms will not  be  inlple
                    general   assessment,   there   seems   to    be    a    mi- abeyance   awaiting   the    initiative    of    youth.
                    nority,   but   growiny   number   of    individuals,    who Whether all  youth  will  take  up  the  initiative  is
                                                        of       hope;       the                          h    youth     alone     can
                    claim that this is the generation        ent           solu- doubtful;   whether    enoug     its  is   at   least
                    generation which can achieve perrnan                       match the expectations of the adu
                                             mplex        problems         which           t  eff  '  ts  by  both  either   independ-
                    tions to the many ind co                                   uncertain. Bu   or
                    increasingly    plague    modern     civilization.     There ent or in  unison,  seem  far  more  prornasing.  With-
                    appears   to   be   a   subtle   and   gradually    emerging out  broader,  transgenerational  efforts   in   social
                    belief  @that  youth   are   prodigies   who   can   ingeni- refon-n,  the   generations   may   not   continue   to
                    ously   resolve   the   social   Pathologies   of   co'ntem- invert,  but  both  dissolve  amidst  the   crises   in
                    porary society.                                            society.
                    The   generation   inversion   is   seen,    for    example,           ments   are   not   restricted    to    the
                                                ret     Mead,     the      well- These com                search  but  apply  to   the
                    in a statement by Marga              ,What's            hap- empirical aspect of  the  re
                    known anthropologist, who said,                            total   evaluation-the   qualitative    portion    're-
                    pening  now   is   an   immigration   in   time   with   the ported  by  Miss  'Karen  Lynch  in  section   11   and
                    people   over   40-the   migrants    into    -the    present .'the  qualitative  portion  in  the  present  section.
                    age,   and   the   children   born   in   it-the   natives."
                                               e    comment    by    an    OfF'- As  to  the  empirical  aspect  of  the  research,   it
                    It is also evidenced in th                                                                             social-bio-
                    e-ial  of   the   U.S.   Department   of   State   who   re- has been directed toward, first, a
                               "Th,ese  kids   are   all   trying   to   tell   us graphical   description   of   student    participants,
                    marked,                                                                                             or     project
                    something-a'nd   we   better   damn    well    figure    out and second,--the impact PSHO summ
                    what it  is  Similarly,    an    eminent     fashion     de- has  on  student  attitudes,  student   education   and
                                                    "It   used   to   be    that                careers.   of   these    three,    the
                    signer recently quipped that,                              student f uture                 has    received     the
                    the  son   Who   sneaked   in   to   borrow   his   father's change in student attitude            more       than
                    tie,  now  the  father  is  sneaking  in   to   borrow   his greatest study,  out of 'necessity
                    son's   turtleneck."   And   also   by   a    housewife    w.ho choice.  The  impact  of   PSHO   on   student   future
                    reflected,   "I   believe   this   whole    generation    of careers  was  beyond  the  individual  ability  of  the
                    young  people  is  saying  to  us,  in   eff   ect,   'Look, researchers,  beyond   the   financial   resources   of
                                                            -ly          things;                          beyond   the   capacity   of
                    you use beautiful words and do U.        uty     out      of the  project   and   perhaps          its     present
                    we'll take ugly words and make bea                         social   science   research, at least in
                    them.'                                                     stage  of  development.  To   learn   whether   a   10-
                                                                                                          altered   students'   career
                     Should   the   exchange   be   simply   one   of   clothes, week     work     experience
                                                 as    new    virtues,    state- direction  would  rniiiimally  require  a  longitudinal
                    or but old vulgarities seen
                    ments   of   precaution    would    be    improper.    How-. study  with  a   carefully   matched   control   group-
                    ever,   the   inversion   permits   the   older   generation a   very   ambitious   undertaking.   The   most    the
                    to  resign  its  responsibility  for   building   a   better researchers    have     been.able  to  doin  this  regard
                    society.   The   reliance   and   expectation   placed    on is ask students  to  project  the  direction  of  their
                    youth   imply   a   resignation,   if    not    acquiescence future   careers   and   to    subjectively    estimate
                    86


       what  influence  PSHO   has   had   in   shaping   that    tude from  pre-test  to  post-test  occurred  on  only
       direction.                                                 a  limited  number  of  questions.'  The  present  re-
       To  know  what  effect   the   project   has   had   in    search  has  attempted  to  rely  on  this  past   re-
       increasing    student    knowledge    and    broadening    search, using  their  experience  as  a  guide  as  to
       their  education  assumes   that   one   knows   before    what  pitfalls  to  avoid  and  what  errors  to  cor-
       hand  what  will  be  learned  and  can  devise   meth-    rect.  Both  limitations  of   the   California   1966
       ods  to   measure   the   quantity   and   quality   of    project  have  been  improved  upon   but   not   com-
       learning.  Since   PSHO   has   been   organized   pre-    pletely resolved.
       dominantly  by  students   of   medicine,   there   has    In  the  following  pages  then   is   the   empirical
       been  a  great  interest  is   discerning   what   stu-    portion  of  the  evaluation  of  the  1968  Philadel-
       dents   have   learned   with   regard   to    subjects    phia    Student     Health     Organization     Summer
       within  the  field  of  medicine.  Unfortunately,  pre-    Project. It is composed of several parts:
       vious  research   has   not   been   able   to   devise    The   background    characteristics    of    the    74
       means   of   measuring   the   quality   and   quantity    health  science  participants  and  the  eight   staff
       of  knonvledge  gained  and  thus  has  had   to   rely    members.
       primarIily   on   students'   subjective   estimate    of  The  influence  that   PSHO   has   had   on   student
       the  amount  learned;  as,  for  example,   by   askin-    education and careers.
       "how  much  did  you  learn  about   health   care   in    The  results  of   the   administration   of   several
       an   urban   setting,"   "health   problems   of    the    attitudinal tests to  the  participants,  both  before
       poor,"  "politics  and  health   care"   and   so   on.    and after the summer-work experience.
       While  certainly  students'  judgments   are   reliable    A  few  of  the  accomplishments   of   the   students
       indications  of  learning  these  estimates   are   not    over  the  course  of  the  summer  and  their   reac-
       conclusive   in    themselves.    Unfortunately    how-    tion to PSHO as an organization.
       ever,  the  present  research  has.not  been  able   to    A  comparison  of  the   attitudes   of   39   medical
       avoid  this  dilemma  and   students   have   therefore    students  in  PSHO  with  38  medical   students   not
       been  asked  to  judge   the   amount   and   type   of    participating  in  PSHO,   as   they   were   measured
       learning provided by PSHO.                                 both  at  the  beginning   and   conclusion   of   the
        Out  of  default  then,   rather   than   enthusiastic    project.
       disposition,  the  present   research   has   attempted
       to  evaluate  the  impact  of   the   PSHO   experience    Background    Characteristics    of     the     Health
       on  student  attitudes.  The   measurement   of   atti-                  Science Students
       tudes  has  also  been  attempted   by   previous   SHO
       research  largely  without  success.  The  1966   Cali-    Introduction
       fornia  SHO  research,  the   most   highly   developed     Presented    here  is  a  description  of  the  back-
       in  this  regard,  attempted  to  measure  the   change    ground   characteristics    of    PSHO    participants
       in  student  attitude  toward  a  variety  of   @edical    along  with   a   modest   comparison   of   what   is
       and social issues."                                        known  about   the   background   characteristics   of
         The  two  major   limitations   of   that   research,    members   in   other   students'    movements.    Also
       (a)  the  absence  of  a  control  group   with   which    'a  few  notes  of  comparison  on   the   composition
       to  compare  attitude  change,  and  (b)  the   absence    of  the  Philadelphia  168   project   with   previous
       of a technique by which to  control  for  or  at  least    SHO projects in other cities.
       account  for   student   selection   procedures   which
       tend  to  choose  students   already   favorably   pre-    Methodology
       disposed  toward  the  attitude   in   question,   have      During  the  initial  orientation  held   June   21-
       both been partially  corrected  in  this  research.  In    23,  1968,  at  Eagleville  State  Hospital  and   Re-
       the  following  year,  1967,  the  California   evalua-    habilitation   Center   near   Norristown,   Pa.,    a
       tion  also  concerned  itself  with  attitude   change.    questionnaire   consisting   of   biographical   items
       No  conclusions  could  be  drawn  in  this  case   be-    and a  battery  of  five  attitudinal  tests  contain-
                    g  keys  were  not  available.  Item   an-    ing 185  questions  were  given  to  the  majority  of
                    ver, indicated  that  a  change  in  atti-    students on  the  first  day  immediately  after  reg-
                    Health Project, USC-SMC Stude"nt Health  Project 'Evaluation of the California 1967 Student  Health  Project,
                    unknown, December 1966.                       mimeo., n.d., p. 24.
                                                                                                                       87


                                                                                class and  whose  f  ather  is  a  medical  prof  es-
                                       1    and     3).     For     those     who                       arning    on    the     aver-
                        istration (see app.                                     sional or a businessman e
                        arrived   at   orientation   late,   the    questionnaire age over $15@000 yearly. describe     the      charac-
                        was  given  to  them  to  a,,snver  as   soon   as   pos- The data which      follow
                                                       .  tation,              62                       and    staffs    and    their
                        sible. By the conclusion  of  the   orle'nly       to        par- teristics of the      students tail.
                        of the 74 students who Nvere eventual                   background ii   greater   de
                        ticipate  in  the  projects  had  completed   the   ques-           a7@ticipation
                                             ts    who     were     not     sarn- Reason fo"P                         ing        Ori-
                        tionnaire. The 12 studen         or       were        not       were asked both at the open
                        pled are those who did not arrive,                      Students at   the   closing   conference   to    rank
                        hired  until  after  orientation,  or  were   either   un entation and          participation    in     PSHO.
                        willing   or   neglectful   in   completing   the   ques- three major reasons for
                        tionnaire   during   orientation.    A    decision    was In all,  there  were  four  dominant  interests:  (1)
                        made  not  to  follow  up   the   unsarnpled   12   since to learn about corflrnunity medicine; (2)        to
                        the   orientation   period   contained   a   great   deal learn  about   urban   slurn   conditions;   (3)   to
                        of   activity   and   discussion   which    might    Pro- bring about  social  change;  and  (4)  to  help  the
                        rnote  attitudinal  change.  it  was   felt   that   any- poor. In the  beginning,.  almost  one-half  selected
                        one  not  present  at  orientation  would  not   be   ex- either  the  opportunity  to  learn  about   cornrnu-
                        posed  to  the  complete  range  nor  the   f   ull   in- nity medicine  or  the  opportunity  to  learn  about
                        tensity  of  the   summer   project   and   might   e-on- urban  sitirn  conditions  as  their  major   reasons
                        sequently  tend   to   neutralize   attitudinal   changes for participation. These were  also  the  first  and.
                        should   their   responses   be   compiled   along   with second choices  respectively  of  over  one-third  of
                        those exposed to the orientation.                       the  students.  This  would  indicate  that  students
                                            data      on      the      background perceived   the   summer   project   mainly   as    a
                        On the other hands                                                                                  one-third
                        of  all  74  student   participants   is   available.   Alearning experience. Approximately
                        word   of   explanation,   however,   is   needed    con- also  selected  two  altruistic   reasons,   creating
                        cerning  the  total   'number   of   students:   of   the social  change  and  helping  the  poor,   as   among
                        original  74  students   to   begin   work   at   project the  three   primary   reasons   for   participation.
                        sites,  four  dropped  out  during  the  course  of   the These  two  were  among  the   'highest   first   and
                        summer   for   various   personal    reasons    or    be- second  individual  choices-  initially  then,   stu-
                                                                                                        joined  primarily   for   the
                        cause  of  illness.  Below  are  described  73   of   the dents seemed  to  have  ,                 humanita-
                        original  74  project  fellows,   Plus   One   individual educational value, and secondly for
                        who  was   employed   as   a   replacement   very   early rian  interest   in   community   welfare.   Personal
                        in   the   summer.   Also   described   Separately    are reward  such  as   earning   $900   and   living   in
                                                                                                         priority         originally-
                        the  background  attributes  of   the   five   area   co- Philadelphia  took  lower
                                                              s      who      are The  response  to  the   reason   for   participation
                        ordinators and three student director
                        jointly  reported   under   the   heading   of   "staff." changed  somewhat,  however,  by  the  time  of   the
                                                                                -closing  conference.   The   emphasis   on   learning
                        The   term   "health    science    student"    is    some
                        what  of  a  misnomer  in   describing   the   field   of and  creating  social  change   remained   relatively
                        study   of   the   participants.   Roughly   65   percent constant  but  the  interest  in  helping  the   poor
                                           d    medical    students,    and    an dropped  from  the  fourth   most   frequently   men-
                        are osteopathic an                                                                                          t
                        additional   12    percent    encompass    nursing    and tioned to  the  ninth  position.  This  shift  is  no
                                             there    are    also     representa- readily  explicable.  It  may,  perhaps,  indicate  a
                        dentistry. However             academi.c        disciplines change in  the  expectations  of  what  realistically
                        tives of a wide variety of                                                                  'ks.    Moreover,
                        only indirectly related to  Physical     health      such can be accomplished in ten wee
                        as    communications,    counseling,    Psychology    and twice  as  many  students  in  the  closing   session
                        anthro   ology.   The   term   "health    science    Stu- indicated  an  interest  in  income  as  being  among
                              p                                the         under-                             r  participation   than
                        dent" is used for convenience with                      the three major reasons fo  -    s f a is  that  cOn-
                                                            context    to     all did originally. Another curiou     et
                        standing that  it  refers  in  this                                                          s   was    amonP
                        students participating in the project.                  cern With advancing civil right
                                                                                -the lowest justifications  for  participation  origi-
                          The  model   response   of   health   science   partici nally, and while this  increased  slightly  over  tb(
                        pants  indicates  that  they   have   their   origin   in                   .   ed a  minor  reason  for  Stu
                        the    Philadelphia    area    from    Jewish    families summer,     it     remain n the whole.
                        which    are    predominantly    middle     and     upper dent   participation    0


                The      data       concerning       reason       for       participation constant      over      the      summer      with      the      exception
        both      before      and      after      the      summer       project       are of    interest     in     helping     the     poor     which     declined
        shown     in     table      1.      In      general,      students      initially and                    personal interests          which increased
        gave      educational      and      altruistic       reasons       for       par- slightly.
        ticipation;       for       the       most       part,       this        remained
                                               Table l.-Student's Reasons for Participation, Before and
                                                                                        After.

                                     R,@son
                                                                                 Percent Percent          Percent Percent            Percent Percent Percent Percent
              The opportunity to:
                Learn   about   community   medicine   ...    ............              34.4     27.6     21.3        19.0                   9.8 17.5 21.9   21.4
                Learn about urban slum conditions .             ......  ....            19.7     19.0     36.1        15.5                   13.1 15.8 23.0  16.8
                Help bring about social change ...          ...  ....  .....            14.6     20.7     16.4        15.5                   18.0 10.5 16.4  15.6
                Help  the   poor   .-. ..................... .........  .......         11.5     1.7      11.5        8.6                    24.6 3.5 15.8      4.6
                Associate with health science students            ......                3.3      5.2      4.9         6.9                    8.2 14.0        5.5 8.7
                Earn      $900 .................. .......................  ......       1.6      6.9      6.6         10.3                   8.2 15.8        5.5 11.0
                Help advance Civil Rights movement ....                ....             3.3      1.7      ....        8.6                    8.2 8.6         3.8 6.4
                Live and work in Philadelphia             ......................        3.3      10.3     1.6         5.2                    4.9 7.0         3.3 7.5
                Work with a practicing health science
                  professional     ..... ..........................  ..............     3.3      1.7      ...       6.9                      3.3 5.3         2.2 4.6
                Other     ......  ........ .............. ......... ........  ............... 4.9 5.2     1.6         3.4                    1.6 1.8         2.7 3.5
                  Total    ... ...  .......     ....................................    99.9     100.0    100.0       99.9                   99.9 99.8 100.1 100.1
                     efore=   .
                O),igin     of     the     Students:     The     majority     of      the                 Table                    2.-Students and Administrators.
                student          participants          considered           Pennsylvania,        ge                                          tudents
                particularly        Philadelphia        or        its         surrounding                                                    NP.,e@i
                suburbs,     to     be     their     home.      Most      attended      a        Up   to    19    years .........            45.4            ....    ....
                university     or     medical     school     in     the      city      of        19 to 20 years       ....... ............   68.1            ....    ....
                Philadelphia.      There      were,       however,       some       whose        20 to 21 years       ....................   22.7            1  12.5
                home     and     school     of     attendance     were     quite     dis-        21 to 22 years       ....................   15 20.3         ....    ....
                tant.     For     example,      four      nursing      students      came        22 to 23 years       ...... .............   17 23.0         2  '25.0
                                                                                                 23 to 24 years       .............                ..... 16 21.6337.5
                from    San    Jose,     Calif.,     one     medical     student     from        24 to 25 years       ....................   19.4            ...     ....
                Milwaukee,     Wis.,     and      one      nursing      student      from        25 to  26  years  .... ..............       45.4            1  12.5
                Rochester,     N.Y.      In      a      few      instances,      students        26 to 27 years       ..... ..............   22.7            ....    ....I
                who     considered      Philadelphia      to      be      their      home        27 years and     older ............         11.4            1  12.6
                  ie      a      universities      outside      the       State       and        ISex     and     Race:     The     student      participants      were
                had    returned     to     the     city     for     the     summer     to        predominantly     white     males.     The     sex      and      race
                Participate in the project.                                                      of   the   staff   and   students   are   shown    in    the    table
                                                                                                 below.
                Age:    The     age     of     the     great     majority     of     stu-
                dents     was     concentrated     in     a     very     narrow     range          Table   3.-Sex   and   Race    of    Students    and    Staff.
                of     3     years.     Almost     65      percent      were      between
                the    ages    of    21    and    24     years.     The     most     fre-                                                    11
                quently     reported     age     was     22      years      and      when
                this      is      broken      down      categorically      into       mon        Male     ............. ...................  51 68.9         6       76.0
                                                                                        thSt     Female   ................................   23 31.1         2       25.0
                               mmon    age    is    closer    to    23     years.     The                 Total       ........................4100.1
                                ject       administrators       too       were        ap-
                                  the     same      age      as      fellow      partici-                                                    -Percent        N  Percent
                                e  2      following      reflects      the      distribu-        White ... ............ ...................  70 94.6         7       87.5
                                                                                                                                             4    5.4        1       12.5
                     Of ages      of     the     74     health      science      students        Negro    .................................
                     the eight members of the staff.                                                      Total       ........................4100-C
                                                                                                                                                                     89


                                                                                                   30      percent      have      a      background      in      studies      other
                             Religion:      Students      were      asked      to      provide      in-                 ir-al     and     -natural      sciences.      Table      6
                                                              religion.       Table       4       de- than     the      phys                 of       study       as        under-
                     formation       on       their        family                       is,       the displays        the        major        area
                     picts    the     religion     of     their     family,     that    they       gradua@es.
                     type       of       religious        background        in        which
                     were       reared       rather        than        their        own        personal Table     6,-Undergraduate      Major      of      Students      and      Staff.
                     belief                                                                                                                                       Staff
                             Table   4.-Family   Religion   of    Students    and    Staff.                                                  17
                                                                                                   Natural      sciences,
                                        Religion                                 -                                                           28      37.8         3  47.5
                                                                      ereen             Percent            Biology      .......................
                                                                                 5      62.5               Pre-med      ........................3       4.0       1  12.5
                                                                                                   ....    other (chemistry,                         10.8         2  25.0
                                                                                 3      37.5               zoology)     ..................
                                                                                                           Total        ........................

                             orrnon     ----- ............ ........
                                                              1       1.4        ....              ---- Physical       sciences:
                      Quaker            ------  ----------------------11.4                         ...     Engineering  .-@       -------------1        1.4       ....          ....
                      Russian           Orthodox  --------------1     1.4        ....                      Total        ........................
                      Eastern           Orthodox @---  ---------1     1.4        ....
                      Atheist           ...................... ......                              social       sciences:
                                                              1       1.4        ....                      psychology    ......       .........5        6.8
                      Unknown           ............................                                                                         3          4.0       1          12.5
                                Total       ........  .........                                            Philosophy    ................    4          5.4       ....          ....
                                                                                                           Sociology    .......      ..............1    1.4       1          12.5
                             Educational           Experiences:           Eighty-one            percent    History      ------------------------2       2.7       ....          ...
                                                              nrolled         in         professional      Political    scieice -----
                             of    the    students     were     e                                                   Total ........................I
                             schools,        either        medicine,        osteopathic,        dental,
                             law     or      nursing.      Approximately      10      percent      were           Humanities:                1          1.4.
                                                                                                           German       ........................                  ...
                             in      various      graduate      schools      and       10       percent    English      ------------------------3       4.0       ....          ....
                             were     undergraduates.     Table     5      below      reflects      the    French      .@ ...........     ............1 1.4       ....          ....
                             variety       of       professional       and       graduate       schools    Art          --------------------------------11.4      ....          ....
                             which the students attended.                                                           Total ------------------------6     8.2       ...           ----
                                                                              and              Staff. Other:                                 7          9.5
                             Table     5.-Field     of      Study of      Students                         Nursing      ------------------------
                                                                                                           Pharmacy      ....................3          4.0       ....          ....
                                        Field -f rldy                                   NPercen            Physical therapy            --------3        4.0       ....          ....
                                                                                        8          100.0            Total ---------------     -------- 13 i7.6    ....          ----
                             Medicine   ------------------------------ 39     52.7                                  Total ........................7     100-0     8
                             Nursing    --------------------------------7 9.6           ....       ....
                             Osteopathy   ..........................9     12.2          ----       ....
                             Dentistry  ----------------------------2     2.7           ....               F(&mily        Background:        A         well-known         technique
                                                                          2.7           ....       ....
                             Law       .. .....................  ............2          ....               for    determining    social    class    3     reveals     that     most
                             Social work    ------------------------2     2.7
                             Anthropology     ----------------------1     1.4           ....       ....    of     the     PSHO     participants     are     from     either     the
                             Communications       ................ 1      1.4           ...        ....    upper     or     middle     class.     This     technique      estimates
                             Counseling   .......  ..................1    1.4           ....       ....
                                                                          1.4           ....       ...     an     individual's     social     class     position      based      on
                             Education    ............................1
                             psychology  .., ------------------- - -1     1.4           ....       ...     the     amount     of     esteem     accorded     by     the     general
                             Undergraduate       ---------------   7      9.5                              public    to    the     father's     occupation.     Tablo     7     re-
                                                              ---  74     99-0                     100-0   flects      the      distributions      of      students       according
                                        Total  -----------------
                                                                                                           to social class.
                                Over      75      percent       of       the       students were      en-
                                                                                 d      to     health                                                             its the prestige
                             rolled     in     disciplines      directly      relate                       3The North-Hatt occupational Prestige Scale
                                                                                        and      den-      accorded by the g@ner 1 public to some  90  cecup
                             care-medicine,               Osteopathy,               nursing                                    a
                                                                                                           Hatt   scale   was   divided   into four equal parts eac
                             tistry.                                                                       upper        iddle,   working   and low classes. A stude
                                                                                                           a  par@iemular   class   based   on his father's occupat
                                The     undergraduate          majors,          however,           show                                      provided  on.the
                                                                                                           ,ious   equivalent    occ    pation is
                             a      much      wider      variety      of       scholarship.       Here,    an    estimate    was    made    on the basis of the amount of skill  an
                                                                                                           education required. see  Delbert  C.  Miller,  HaAdbook  of  Resea?,ch
                             there    is     a     greater     representation     of     the     social    Design and  Social  Measurement  (David  McKay  Co.:  New  York,  1964
                             sciences      and      humanities       indicating       that       almost    pp.  106-110.)

                             90


                   Table     7.-Social      Class of      Students      and      Staff.                 Table IO.-Occupation of Mothers of Students                   and          Staff.
                                                                                                                                              Stu e
                                                                                                                                                      rcent                     P.,-cet
        Upper      ---------------------------------- 23    31.1                    225.0               Professional medical    ..........    3         4.1           2              25.0
                                                   30       40.5                    460.0               Professional    nonmedical    -.      11       14.9           1              12.5
        Middle     --------------------------------                                                                                           1         1.4           ....     ....
        Working  .@      ............................ 17    23.0                    225.0               Proprietors     and     managers
                                                                  2.7                  ....             Businesswomen     ..................  1         1.4           ....     ....
        Lower      .......................  ............    2                                           Clerks and kindred     ............   9        12.2           3              37.5
        Unknown        ....  ........................       2     2.7               .... ....           Manual .........  ......................1       1.4           ....     ....
                                                                                    8100-0
                   Total     ..................... 74       100                                         Protective and service      ......    4         5.4           ....     ....
                                                                                                        House@-if e ............................ 44    59.5           2              25.0
                   Family        Income:        Combined        parental            income                Total     ----------  ............. 74     100.3            8           100-0
           of       students       averaged       $15,195,        while             that            of
           staff      was      $9,312.      These      figures       indicate       that                Pi-eviotis      Expeiience:      Students       were                      asked
                                                                     me          from           the     whether     they     previously     had     any     ex      erience
           the   students   for   the    most    part    co                                                                                                           @ p
           more     affluent     sectors      of      the      economy.                                 with    sccial     action     programs.     Only     39     percent
                                                                                                        of   the   students,   but   75   percent   of   the   staff,   had
                   Table  8.-Family  Income  of  Students   and   Staff.                                previously    participated    in     at     least     some     form
                                                                                                        of community work.
                                                                                                        Students     were     also     questioned     as     to     whether
           Up to 2,999      ...........  ..........         3     4.1               1  12.5             they      had      taken      coursework      in      comprehensive
           3,000 to 5,999       .........  .......... 1.    3     4.1               1  12.@             medical    care     or     community     medicine.     Here     ap-
           6,000 to 8,999       ....  .................     16    20.3              2  25.u             proximately    15    percent    of    the    students    and     25
           9,000 to 14.999         .....  ............      17    23.0              3  37.5
           15,000 to 19,999            ........ .......     8     10.8              1  12.5             percent   of   the   staff   had   had   this    sort    of    aca-
           20,000 to 24,999           ................      13    17.5              ....                .... demic preparation.
           25,000 and over           ..................     13    17.5              ...                 ....
           Unknown          .... .................... I.,   2     2.7               ....                .... Combining     these     two      as      indicators      of      an
                    Total       ........................    74    10                                    0.0 interest    in    social    activism    reveals     that,     alto-
                                                                                                        gether,    approximately     50     percent     of     the     stu-
                   Father's       Occupation:       Classifying       father's        oc-               dents    had    either     practical     experience     or     aca-
                   cupation    into     several     broad     cateLyories     shows     a               demic     coursework     that     might     prepare     them     to
                   wide     range     of     occupational     types     as      indicated               carry    out    their    summer    work    projects.
                   in table 9 below:                                                                    Pi-evious    SHO    Compc&rison:     It     is     difficult     to
                                                                                                        compare     the     members     of     PSHO      with      previous
                   Table   9.-Occupation   of   Fathers   of    Students            and         Staff.  SHO    projects    since    the    past    method    of     report-
                                                                                                        ing   is    considerably    different    or    in    many    cases,
                                                                                    N  ereen            severely   limited.   This   is   possible    in    a    few    in-
                   Professional     medical     ........    17    23.0              1                   12.5 stances;     however,     the     composition     of      Philadel-
                   Professional     nonmedical     ..       9     12.2              1                   12.5 phia    1968    in    terms    of     percentage     of     medical
                   Proprietors     and     managers-.       2        2.7            ....                ....
                                                                                                        students   is   identical   to   that    of    Bronx    1967    and
                   Businessmen      ......................  15    20.3              1                   12.i)
                   Clerks  and  kindred  ..     ........    11    14.7              2                   25.0 Chicago    1967;    all    three    had    65    percent    medical
                   Manual   ................................ 12   16.2              1                   12.6 student     participation..     The     students     of      Phila-
                   Protective  and  service     ......      3        4.1            ....                .... delphia     1968     also      reported      fewer      Protestants
                   Deceased  ...........  ..................4        5.4            2                   25.0 and    Atheists    and    more    Catholics    and    Jews     than
                   Unknown   ... ......    ...... .............1     1.4            ....                .... previous     projects.     However,     this     may     be     ac-
                       Total      ....  ................... 74    100.2             8                   100-0 counted    for    by    the    fact    that    Philadelphia    1968
                                                                                                        students     noted      their      family      religious      back-
                   Mother's      Occupation:      Most       of                     the      students'  ground    rather    than    their     personal     faith.     Addi-
                   mothers     were     occupied     as     housewives,     very      few               tionally,     Philadelphia      1968      had      fewer      black
                   were    professionals     in     the     health     science     field,               health    science    students    than    any     previous     proj-
                   and      only      about      40      percent      worked      outside               the ect    (5.4    percent)    except    possibly     Chicago     1967,
                   home.                                                                                which   made   -no    report    on    its    racial    composition.
                                                                                                                                                                                        91


                                          d       Characteristics:   a  heterogeneous  group  whose  level   of   Social
               Disciission of Backgroun                                                       .  ce  in  social   recon-
               Using  the  most  frequently  reported   character-   awareness, previous experien   widely.     Certain-
               istics as an indication of the typical health  sci-   struction and background vary
               ence  student,  one  finds  a  22-year-old,  white,   ly  some  members  of   PSHO   were   deeply   com-
               Jewish, male,  student  of  medicine,  who  minored   mitted to the  improvement  of  social  conditions,
               in  biology  as  an  undergraduate.  He   has   his   others were as  unseeing  and  indifferent  as  the
               origin in the upper middle  class  and  his  father   career-bound  normal  student,   and   others   yet
               is  a  medical  professional.  On  the  average  he   began  to  emerge  as  among  the   concerned.   It
               has had no previous  experience  in  social  action   seems  reasonable  to  state   that   students   in
               programs  nor  substantial   academic   preparation   PSHO   had   many   characteristics    in    common
               for medical work in the community.                    with students  in  dissent  groups  with  one  not-
               There  is  a  growing  body   of   research   being   able  exception.  The  major  fields  of  study  of
               conducted  concerning   student   social   activism   most  activists  are   the   humanities   or   more
               and  the  student  protest  movement.  One  of  the   commonly  the  social  sciences.6   PSHO   partici-
               most f  requently  reported  observations  is  that   pants are  mainly  medical  students  and  even  in
               the vast  majority  of  college  students  are  not   their  undergraduate   careers   majored   in   the
               activists.  Most  students   across   the   country   natural sciences. Also, student activists  tend  to
               seem to uncritically accept society as it is  pres-   be more  intellectually  or  esthetically  oriented
               ently established, see college as an  extension  of   and not concerned with specialization  in  a  tech-
               high school and  as  a  vehicle  to  a  comfortable   nical  field  which  more  or  less  guarantees   a
               career. Rarely  are  they  apparently  deeply  con-   secure  and  durable  position  in  society.   PSHO
               cerned with political and  social  issues  or  per-   students   are   overwhelmingly   oriented   toward
               ceptive of disturbing  social  conditions  in  this   a professional  career  particularly  in  medicine.
               country  or  abroad.  Student  dis@ent   seems   to   As  mentioned,  over  80  percent  of  PSHO  health
                                                                                                           SC
               occur  predominantly  among  a  minority  of   Stu-   science students were enrolled in       hools    of
               dents in large, urban universities  either  in  the   professionalization, either law,  dentistry,  nurs-
               North  or  Far  West  which  are   well-known   for   ing,  medicine  or  osteopathy.  The   moderateness
               their academic standing.4 Two  recent   studies   by  of the students  of  professions,  including  those
               one social scientist  investigated  the  background   of medicine in the United States,  is  not  typical
               of 50 activists in Chicago  area  colleges  and  65   in other parts of the world.  Lipset  reports  that
               students   who   sat-in   at   the   Administration   medical  students  in  Latin  America  and   south-
               Building  of  one  university  in  protest  against   ern Europe are historically more  leftist  in  ori-
               the administration's cooperation  with  the  Selec-   entation,  while  in  northern   Europe   and   the
               tive Service System. The  findings  disclosed  that   "Anglophonic"  world  they  have  a   traditionally
               studentsIinvolved  in  protest  activity   generally  conservative orientation .7 In  Holland   and   Ger-
               are from  upper  status  families  which  are  Jew-   many, for  example,  medical  students'  participa-
               ish or irreligious and whose  head  of  the  house-   tion  in  reformative  groups  is  a  rarity.8  The
               hold is an affluent professionals                     comparison   of   PSHO   students   with   -protest
                One  would  like  to  be  able  to   compare   the   groups  is  basically  a  comparison  between   two
               attributes  of  PSHO  students  with  the   members   student  groups  and  not  a   comparison   between
               of  activist  groups  to  discover  whether   there   two protest groups. The  activities  of  PSHO  stu-
               are  similarities  and  dissimilarities.   Unfortu-   dents over  the  summer  were  more  in  the.tradi-
               nately, no  tabulation  of  the  biographical  fea-   tion  of  moderate  casework-like  improvement   of
               tures of Student activists  is  available.  Impres-   social conditions rather than  strong  dissent  and
               sionistically  it  seems  that  PSHO  and   members   demand for radical change in  the  existing  social
               of  student  movements  generally  may  have   com-   structure.
               parable  traits  in  some  cases   and   remarkably
               different traits  in  others.  PSHO  students  were
                                                                      6 Trent, op. cit., p. 42. And Seymour Martin Lipset, "Student  and
                                                                     Politic6  in  Comparative  Perspective";  Daedalus   (Winter   1968)
                'J.  W.  Trene  and  J.  L.  Craise,  "Commitment  and  Conformity pp. 1-20.
               in the American College," Journal of Social Issues 23  (July  1967)
                                                                      7Lipset, op. cit., P. 17.

               P. 35.
                "Richard Flacks, "The  Liberated  Generation:  An  Exploration  of 8 Frank E. Pinner, "Tradition  and  Transgression.  Western  Euro-
               the Roots of Student Protest", Ibid., P. 66.          Pean Students in the Postwar Period", Daedalu3,  op.  cit.  p.  144.

               92


                                                                      There were of course vague  goals  that  vari-
                      Student Education                               ous staff members held such as  reforming  the
                                                                      health   care   system)    improving    conditions    Of
                                                                                                                             e
                                                                      the poor) effecting social change.    But          thes.
           Tite Goals of PSHO                                                tract,   almost   bordering   on    the    trans-
                              Ith Project     Proposal              for were abs
           The   Student    Hea              sized       the       edu- cendental,and    not    intended    for    actual    imple
           Philadelphia Summer 1968 empha                             -mentation   unless   a   tinited   movement   in    this
           cational   importance    of    the    project.    The    pro direction  naturally   developed   out   of   the   sum-
                              e       Summer       Health       Project      periences.   Staff   and   students    did    not
           posal stated that th               from              various mer's ex          ajor   goals    of    PSHO,    aside
           ,,will provide 80 health students  ew       and        vital f ully agree on the in ation,    and    on     particular
           sectors of the country with a n      would             hope- f rom the goal of educ
           educational experience." ") Students                      in issues, opinion Was fragmented.
           f ully learn about Problems of health care                 If  one  had  to  define   the   goals   of   the   PSHO
                               entive     solutions      to      health      project,  its  goals  were   what   each   i-ndi-
           indigent areas, prev               approach               to summer
           problems,  a  multidisciplinary                                   rticipant  defined  as  his  goal   on   a   per-
           health   care,   the   economics    of    health    delivery vidual pa
           systems    and    community     medicine     among     other sonal  basis.  If   individual   goals   coincided   and
           issues.                                                    they  desired  to  join  together,  initiate  a  reform-
                                                                      ative   movement    within    the    organization    and
           Aside   from   education,   the   goals    of    the    Stu- draw  in  other  members,  then  the   structure   -%vas
           dent    Health    Organization    summer    projects     are flexible enough to permit this to occur.
           a   complicated    mattter.    Primarily,    the    philoso- Education,    then,    was    the     primary     empha-
           phy  of  the  staff  was  to   allow   students   to   expe- sis-betterment of the poor and social     ref      orm
           rience   the   multifaceted   problems   of    health    and were  incidental,  if  not  serendipitous.   In   regard
           the   urban    poor    on    an    individualistic    level, to  education,  it  was  believed  that   should   there
           through    a     decentralized     organizational     struc- be  no  reformative   movement   as   an   outcome,   at
           ture   with    nondirective    leadership.    There    were, least  students  had  personally   witnessed   the   im-
           then,   no   ubiquitous,   definitive   goals.    The    or- poverished  conditions  of  the   urban   lower   class;
           ganization   did   not   establish   goals    for    student and   students   could   learn   how   the   educational
           participants  to   achieve   other   than   self   -edifica- institutions  might  be  altered   in   order   to   ad-
           tion    through    firsthand    experience,     PSHO     was dress  themselves  to   the   medically   indigent   and
           designed   to   allow   students   to   Witness   alone   or how    students    themselves,     once     they     had
           in  small  teams  the  social  conditions   of   the   poor, achieved  positions  of  influence   in the       medical
           particularly   health   conditions   in    industrial    so- or  professional  field,   might   from that     statiire
           ciety,  and   from   this   experience   create   and   ini- be  successful   in   bringing   about,      constructive
           tiate   new   and   hopefully   practical    reforms.    The change.
           staff  itself  and  the   office   materials   were   avail- The  research  collected  some  data   on   the   heur-
           able as resources to the students.    The          directors istic  effects  of   PSHO   which   are   presented   in
           could   be   contacted   for    advice    and    recommenda- detail in the following paragraphs.
           tio-ns   on   how   students   might   approach   the    re-
           form   of   particular   problems,   but    the    directors PSHO as an Educational Expe?,ience
           did not  feel  it  their  task  to  select  specific  goals,
           make  strategy   decisions   and   outliiie   the   aim   of As  mentioned   in   the   section   concerning   stu-
           all   project   members   for   the   total   summer.    The dent  characteristics,  roughly  50   percent   of   the
           leadership  did  not   conceive   of   itself   as   leaders students  joined  the   summer   projects   in   antici-
           but   as   coordinators.   The   organization    did    -not pation   of   a   learning   experience.   When    asked
           have   formal   organization,   but   was    flexibly    or- specifically   during   the   introductory   orientation
           ganized  so   that   students   could   follow   their   own "how   much   do   you   think    your    summer    work
           individually   conceived   courses   of   action   and    it experience  will  add  to   your   professional   educa-
                                                                      tion,"  over  40   percent   thought   it   would   con-
           did   not   designate   major   purposes   for   the   total tribute  a   "great   deal"   and   an   additional   42
           project.                                                   percent  thought  it   would   make   a   "considerable"
                                                                      contribution.  However,  by  the  close  of   the   sum-
             9 Student Health  Project  Proposal  for  Ph@elphia,  Surnmer  1968, mer,  10  percent  fewer  students  in  each  of   these
           n.d., Tnimeo, p. 2.
                                                                                                                             93


                                                                                  atched        staff     thought     general     knowledge      was      acquired.
                    categories felt that the summer had m                                                                           roups        (80        percent
                    their     expectations.     Moreover,      almost      twice      as        A  lesser  percentage   of   both   g
                    many     (30.5     percent     vs.     17.7     percent)     thought        and   87.5   percent)   felt   that   specific    skills    helpful
                                                                                                                were     gained.     In     both     the     cases,
                    the     summer     provided     only     a     moderate     learning        to their career
                    experience   in    the    end    as    they    expected    in    the        the    experience    was    judged    to    be    more     valuable
                    beginning.    Also,    while    no    one    thought    the    proj-        in    the    acquisition    of    knowledge     than     in     the
                    ect    would    have    "little    or    no"    educational    value        acquisition  of   skills.   In   f   act,   20   percent   of   the
                    prior    to    the    actual    work    experience,    10    percent        students    thought    the    summer    was    not     helpf     ul
                    felt this way at the closing conference.                                    at   all   in   terms   of   skills   as   contrasted   with   only
                         As   for   the   staff,   all   but   one    member    expected        5   percent   who   felt   this   way   in    terms    of    knowl-
                    the   summer   to    have    a    great    deal    of    educational        edge.    The    distribution    of    student     responses     are
                    value    before    the    project    began,    but     only     five        presented   below   in   table    12.
                    felt   this   way   after   the    project    closed.    Table    11
                    reveals    students'    and     staff's     before     and     after        Table   12.-Judgment   by   Students   and   Staff   of   Knowledge
                                                                                                           and Specific Skills Acquired.
                    responses     to     the      question, How     much     do      you
                    think     your     summer     work     experience      will      add                                          nts
                    (has     added)      to      your      professional      education?"
                                                                                                                         percent    percent    percent       percent
                    Table   II.-Judgment   of   Students    and    Staff    on    PSHO's        Very helpful  ...............    35.6 18.6       75.0      25.0
                                          Educational       Value.                              Moderately helpful   ....    44.1   32.2         12.5      50.0
                                                                                                Slightly helpful  ..........    13.6 28.8        12.6      12.5
                                                                                                Not helpful at all  ......   5.1    18.6           ....    12.5
                                                 Ye f o-r,                                      Detrimental   ................   1.7  1.7
                                                  ))e7,cert I)erce7it   percent     pment           Total     ................    100.1
                    A great deal      .............. 40.3   28.8          87.5      62.5        'N Stud.,,tl-59-
                    Considerably        ...... .... 41.9    30.@          12.5      12.5        N Staff=8.
                                                                                    25.0
                    Moderately     .................. 17.7  30.5           ....
                    Very little   .......... ........   .... 10.2           ....       ....     "Rcnald  Miller,  "The   Project   Evaluated:,   The   Student   Health
                    Nothing     ................ .......   ....  ....       ....       ....     Project of the South Bronx Suntrier  1967.  ed.  S.  Fisch  &  J.  Wil-
                            Total  ..@ ............. 99.9   100.0                               liams, publisher unk., n.d. p. 188.
                         N Students before=62.                                                  Estimating    the    value     of     the     PSHO     in     terms
                         N Students after=69.                                                   of   student    education    is    a    difficult    matter,    and
                         N Staff before and after@g.
                         Students  X2=10.6,   df=4,   p=0.05.                                   the   above   figures   should    be    used    only    as    rough
                         In    general,     both     staff and          students           reported indicators.    It    may    be    that     the     projects     had
                         a     decline     in     education      enrichment      in      compari- more     educational     impact      than      students      recog-
                         son      to      their      original      expectations.       Chi.Square nize   or   were   willing   to    report    during    the    imme-
                         calculated     for     students     indicates     that     this      de- diacy   of   the   closing   conference.   It    is    also    pos-
                         crease    is    probably    not     a     chance     occurrence,     but sible    that    educational    value    may     only     material-
                         rather     a     significant     decrease     in      judged      educa- ize   over   a   more   extended   period   of   time.    In    any
                         tio-nal    value.    The    only     source     of     comparison     is case,   it   can   be   fairly   stated   that   on    the    whole
                         the     Bronx     1968     project     which     asked     the      same a   great   majority   of   students    and    staff    did    sub-
                         question.     In     that     project,      53      percent      thought jectively      estimate      that      the      summer      program
                         that     the     work      experience      contributed      a      great was    helpful    to    a    varying    extent     in     acquiring
                         deal     to     their      professional      education      as      con- knowledge    relevant    to    their     future     careers.
                         trasted     with     29     percent     for     Philadelphia     1968.10 Students     were     also     questioned     as     to      what
                         One    should    bear     in     mind,     however,     that     follow- they    saw    as    the    "major    benefits"    of    participa-
                         ing     the     summer     experience,     90     percent     of     the tion     in     PSHO.-The     major     benefit     agreed     upon
                         students   and   all   of   the   staff   believed   it   to    be    of by   20    percent    of    the    students    was    the    oppor-
                         some educational enhancement.                                          tunity     to     learn     about     urban     slum     conditions
                          As     to     what     was     learned,     students     and      staff firsthand.     Here     again,      self-education      is      the
                         both     were     asked     to     what      extent      the      summer point      most      heavily      emphasized      by      students.
                         experience       contributed        knowledge        and        specific Approximately      the      same      percentage,      one      may
                         skills    helpful    to    their    future     careers.     Over     '93 recall,   stated    that    they    joined    the    program    for
                         percent    of    the    students    and    100    percent     of     the this    specific    learning    opportunity    (see     p.     88).

                         94,-


                                         ous    facts    stand     out-over                                 Students'   Ideology
           However,      several      curi
           20     percent     of     the      students      joined      for      the      oppor- A      major      question       in       previous       SHO       evalua-
           tunity       to       learn        about        community        medicine,        but        ch      reports      has      been      the       degree       to
                                         listed        this        among         the         top tive  resear               tudents      has      a      bias       built
           less     than     4     percent ticipation.               Likewise,                some which the selection of s                ts         with          views
           three    benefits    of     par                    tunity           to           help in    which    naturally    selects    studen  S.               Students
           16     percent     joined     for     the      oppor idered           this           an already favoring particular attitude
           the    poor,    but    only    5    percent     cons                                     cted     on     the     basis     of     their      interest      in-
           advantage       to       participation.       On        the        other        hand, are  sele
           20       percent       joined       to       learn       about       urban       slum gaining       insights       into       community       health       prob-
           conditions         and         approximately         the          same          nuin- lems     and      their      previous      participation      in      com-
           ber    agreed     that     this     was     a     ma or                      advantage. munity     involvement     projects.      As      a      result,      pre-
           Similarly,         creating         social         change         was         equally vious      research      has      been       unable       to       discern
           considered      to      be      a       major       reason       for       participa- whether     students     are     converted      to      liberal      views
           tion        and        a        major        benefit.        Other         advantages as    a     result     of     project     participation     or     whether
           most         frequently         mentioned         were:         earning         $900, the     summer     simply     reinf      orces      liberal      attitudes
           working        with         a         practicing         health         professional, previously established.
           and       associating       with       fellow       health        science        stu- Consequently         before         measuring         student          at-
           dents.         Data         concerning         the          major          advantages titudes    on     more     specific     issues     such     as     compre-
           of      participation      are       shown       in       table       13       below. hensive      medical       care       and       socialized       medicine,
                                                                                               a     technique     for     learning      an      individual's      degree
                                                                                               of       liberalism       and       conservatism       was       employed.
           Table     13.-Rank     Judgments     of     Students      on      Major      Benefits Milton       Rokeach       has        devoted        a        considerable
                        Resulting From  PSHO  Partid'ipation.                                  amount     of     his     career      to      the      measurement      of
                                                                                               belief      systems.      This      research      utilized       Rokeach's
                                                  It          2,                               Opinio-nation     Scale,     40      item      test,      designed      to
           The       opportunity       to:                                                     uncover     an     i-ndividual's     degree     of     left      opiniona-
                Learn     about      urban                                                     tion,      right      opinionation,      total      opinionation       and
                   slum         conditions ...... 30.9        14.8    13.0                     19.0 conservatism/liberalism."          Rokeach           claims           that
                Help      bring      about                                                     the      Opinionation      Scale      is      meant       to       measure
                   social    change    ... ....... 16.4       10.7    14.8                     16' lu it                                        of    a     series     of
                Earn $900     .....................    9.1    1.11    22.2                     14.1 general intolerance". It consists                  in          orien-
                Work    with     a     practicing                                              20 statements prejudged to be leftist .
                   health          professional.. 12.7        11.1    13.0                     12.3 tation      politically      and      20       statements       indicating
                Associate       with       health                                              a     rightist      political      position.      Within      each      of
                   science        students ......   5.5       14.8    14.8                     11.7 these     two     positions     are      10      questions      indicating
                Live    and    work     in
                   Philadelphia          ............   3.6   13.0        5.6                  7.4 either    an    acceptance    or    a    rejection     of     the     par-
                HEID    the     poor     ............   1.8   7.4         5.6                  4.9 ticular      political      stance.      The       Rokeach       Opiniona-
                Hel-P    advance     civil                    3.7         5.6                  4.3 tion Scale appears in appendix 2.
                   rights    -. ......................   3.6                                    Total      opinionation       indicates       how       strongly       an
                Learn     about     commu-      -                                                                                                         0             OYIS
                                                              5.6         3.7                  3.7 individual      responds      to      both      Political      P      siti
                   Tilty          medicine ..........  1.8
                Other         -----------------------   14.5  1.9         1.9                  6.1 combined.      Left      opinionation      is      the      degree      to
                          Total ....  ............  9.9       10                               0.1 which       an       individual       accepts       those       statements
                                                                                               indicating      a      left      orientation.       Right       @opiniona-
                                                                                               tion     is     the     strength     of     agreement     with      state-
                   Any       conclusions       concerning        the        total        heuris- ments      associated      with      rightist       political       views.
                tic     effect      of      PSHO      must      remain      tentative.      Stu- Liberalism/Conservatism        is        the        difference         be-
                dents      joined      mainly       for       the       educational       advan-                           nation      and      left       opinio-nation;
                tages       offered.       The       outcome,       however,       did       not tween right opinio                           conservatism,             a
                fulfill       their       complete       expectations        and        students a       positive       score       indicating
                in     Philadelphia     SHO      felt      they      learned      less      than negative score indicating liberalism.
                students     in     the     Bronx     1967     projects     In     spite      of  Although         Rokeach's         scale         is         undoubtedly
                this     it      bears      reiterating      that      over      90      percent filled    with    flaws,    and    dated,     if     not     questionable,
                                                              ely     to      greatly      help@-                        e open and The Closed Mi,,d.  (New  York,
                felt     the     project      was      ?noderat                                  la Rokeach, milton, Th
                f     ul     in     educating     them     for     their     future     careers. Basic Bocks, Inc., 1960.) PP. 80-97.
                                                                                                                                                                        95


                                                                             atti-        score    for     all     student     participants.     The     sub-
                    content, it is the most highly researched                                                   verage      left      opinionation      score
                    tudinal    scale    of    this    nature    available,    and    by   sample had an a
                    all    indications     the     most     accurate.     There     has   of    84.2,    while    all    students    scored     84.7.     The
                    been   a   great   body   of   research   to   test   its    valid-   Penn   medical   students    were    not    as    far    left    in
                    .ity    and    reliability.    For    these    reasons    it    was   opinionation,     scoring     72.81.     Rokeach      has      also
                    selected   in   this   research.   (For    a    f    urther    dis-   administered    this    scale    to.    groups     of     students:
                    cussion   of   this    scale    see    pp.    105-106    of    this   in    1955,    186     Michigan     State     University     under-
                    report.)                                                              graduates      had      an      average      left      opinionation
                    In     the     experimental     study     (pp.     106-108)     one   score of 61.2     .12 The     comparison     of      PSHO      par-
                    can    compare    the    political    stance    of    PSHO    medi-   ticipants      with      the      Michigan      sample      reveals
                    cal     students     with     Penn     medical     students     who   that    PSHO    was    considerably    more    left     in     ori-
                    attended     school     during     the     summer.     As     noted   entation.    Also,    however,    the     Penn     medical     stu-
                    there,     PSHO     medical     students     are      significantly   dents    had    a    more    leftist    opinionation    than    the
                    more    left    in    orientation    than    are    medical    stu-   Michigan    students.     Table     14     below,     shows     the
                    dents who attended school.
                    The    mean     score     for     the     subsample     of     PSHO   various    sample    scores    on    left     opinionation.     The
                    medical   students   is    almost    identical    to    the    mean   higher the score, the more left opinionation.
                                                        Table 14.-Left and Right Opinionation of Students.
                                                                                                                                                            p
                    PSHO students    ...      ............. 60     84.7      20.031                                  63.8    10.01
                    Michigan State   ......   ............. 186    61.2      11.9     5      8.4    0.0005          180.8    II.
                    Difference ................................... 23.5
                    i                    udents .......
                    Penn Medical students     .. . . ....... 36    72.8      10.1     5                              68.8    1 Of
                    Difference -. ........................ ......... 11.4                                             6.0
                     In     terms     of     right     opinionation,     PSHO      stu-      students    are    significantly    more    liberal    than     the
                    dents    in    general    during    the     initial     orientation      Penn      medical      students       who       were       sampled.
                    were    less    right    oriented    than     Rokeach's     sample,      Since     PSHO     students     average      liberalism      scores
                    and     the     subsample     of     SHO      medical      students      are   very    similar    to    that    of    the    PSHO    medical
                    less    right     than     Penn     medical     students.     Table      student    subsample,    one    would    be    led    to    believe
                    14    above    shows     the     sample     scores     on     right      that    PSHO    students    on    the    whole    came    to    the
                    opinionation.     The     higher     the     score     the     more      project      with      a      tendency      toward       liberalism
                    right the opinionation.                                                  greater   than   that    of    students    in    general.    There-
                      In    general,    the    PSHO    students     have     a     sig-      fore,    it    would    seem    likely     that     PSHO     health
                    nificantly    greater    left     orientation     than     students      science   students   would   tend   to   come    to    the    proj-
                    sampled    by    Rokeach    and     a     sample     of     medical      ects    predisposed    to    favor    certain     liberal     atti-
                    students attending school.                                               tudes.
                      The  difference between             the    right     and     left
                    opinionation  results.is  a          measure      of       liberal-                          Attitude Change
                    ism-conservatism.          PSHO          students           average
                    score   on    this    index    placed    them    in    a    liberal        The    data    above    tends    to    indicate     that     PSHO
                    position.     There     are     no     Rokeach     scores      with      participants     in     general     have     liberal     attitudes.
                    which    to    compare    PSHO     students     on     this     di-      Thus,    the    PSHO    project,    rather    than     an     agent
                    mension.    However,    the    reader     is     again     referred      to     convert     conservative     students      to      liberals,
                    to     the     section     concerning     a      comparison      of      would     appear     to     be     geared     toward.      carrying
                    PSHO    medical     students     with     Penn     medical     stu-      liberal    attitudes    to    more    liberal     positions,     or
                    dents.    There    it    is     shown     that     PSHO     medical      at     least     reaffirming     liberal     positions      already
                                                                                             held.   At    the    beginning    of    the    summer    only    11
                      @Rokeach, op. cit., p. 95.                                             students    (18    percent)    held     a     conservative     view

                    96


                                                         very         mildly     and    this    change    was    sufficiently    large    to    affect
          and the majority of these were
          conservative.   At   the    close    of    the    summer,    seven     liberalism     scores;     therefore,     staff      members      ap-
          or   11.6   percent   still    held    conservative    views    so     parently    became     less     right     in     opinionation     and
          that,    at    most,    only    four    students    moved     from     also     moderately     more      @liberal.      Total      opiniona-
          a   conservative   to   a   liberal    position.                       tion,    that    is,     how     emphatically     students     reject
           Tables    15,    16,    17,    and    18    compare     students'     one   political   stand    and    accept    the    other,    or    in
          and    staff's    scores    both    before    and    after     the     this    case    the    degree    of    leftism,     remained     con-
          summer     experience     on     left     opinionation,      right     stant from pre-test to post-test.
          opinionation,      total      opinionation      and       liberal-       In    terms    of    liberalism    there    was     no     signifi-
          ism/conservatism.    In    each    case,    a     higher     score     cant      change      in      attitude;      students      maintained
          means    a    greater    acceptance    of    the    attitude    in     approximately      the      same      degree      of       liberalism
          question.    On    the     left     and     right     opinionation     from    pre-test    to    post-test.     The     staff     on     the
          scales   scores   can   range   from   20   to   140;   on   total     whole     moved     considerably     more      to      the      left;
          opinionation,     from      40-200;      and      on      liberal-     in     fact,     their     average     liberalism     score      more
          ism/conservatism,     from     @l     to     @140.     As      can     than    doubled    over    the    course    of    the    summer.
          be   seen   from   a   glance   at   all   tables,    there    was       On     the     whole,      however,      there      was      little
          apparently     a     change     only     in     right      opinion     change     in     the     ideological     position     among      the
          among    the    students.    That    is,    students    did    not     student      participants      in      PSHO.       This       finding
          become    more    left     in     opinionation     (table     15),     would    tend    to     support     the     assertion     that     th'e
          but    less    right    (table    16).    This,    however,    did     experiences     operate      to      reinforce      opinions      and
          not    significantly    affect    their    general    scores    on     beliefs   already   held   and    does    not    result    in    sig-
          liberalism.   The   staff    as    well    became    less    right     nificant attitudinal shifts.

                                                Table 15.-Left Opinionation of Students and Staff.

                                                                                                                                    t           p
          Before ....    .......................................... 84.67 20.031  0.66         N.S.       86.38      16.531         0.59        N.S.
          After .......    ............      ........... 87.00      18.34                                 191.88     18.04 5
          Difference ................  .............................3-1.69

                                                Table 16.-Right Opinionation of Students and Staff.

          Before  .....  ............................................. 63.83 10.021 3.19    0.005         5   70.13  0.0251         2.25        0.025
          Af ter .... ................ ................  ........ 57.83 10.44                             154.12       9.20 5
          'Difference ......... .................................I...   .00    .42                        -16.01     -7.27

                                                Table    17.-T(>tal Opinionation of Students and          Staff.  -
                                                                                                                  Staff
                                                                                      t                                                t             p
          Before   ................ ........  ........... ........ 143.83 17.761                          i  155.25    23.581
          After   ............................................... ..... 144.08 17.67 0.08       N.S.      1  146.00    17.46        0.84        N.S.
          Difference   .......... .............  ................... .25 -.09                                 -9.25   -6.lz
                                                     Table   18.-Liberalism   of   Students   and    Staff.

                                                                                                                  staff
                                                                                                                                       t             p
          Before   .......  .......................................... 23.33 24.8.4                       5   16.38   16.921
          After  ...    ......... ...........  ....................... 24.51 24.51 0.26         N.S.      137.75      22.12 S        2.03       0.025
          Difference ..  .................................. ......... .18 -.33                                21.67     6.ZU
                                                                                                                                                     97


                                                              majority       of        the    proach     in     medical     treatment,     it     was     an     exce     -
                  Medical Attitudes: Since the                                                         odel     for      the      present      research.      Three      of
                  students    were    pursuing     careers     in     the     field     of    lent in
                  health     science,     the     research     was      interested      in    the     five     scales     in      Boswell      and      Newman      instru-
                  learning     whether     there      were      changes      in      medi-    ment      were      used:       (a)       Attitude       toward       compre-
                  cal     attitudes     over     the     course     of     the     summer.    hensive      medical      care;      (b)      attitude       toward       the
                  Considerable       research       was       conducted       by       the    team      approach      in       medicine;       and       (c)       attitude
                  University     of     Colorado      School      of      Medicine      in    toward       preventive       medicine.        The        three        scales
                  the     1950's     when     they      introduced      a      physician's    in     combination     are      compiled      as      a      total      medi-
                  educational        program         which         emphasized         com-    cal     attitude     scale.     A     brief     description      of      each
                  prehensive      medical       care.       That       research       com-    of    the    scales    is    given    below    along     with     the     re-
                  pared    two    groups,     one     exposed     to     a     traditional    sults      of      the      pre-      and      post-test       administration
                  educational     program     and      the      other      exposed      to    to      the      PSHO      students.
                  the innovative comprehensive care program                           .13
                  In     an     attempt      to      evaluate      the      newer      and       Comp2-ehensive       Care:       This       scale        measures        a
                  broader      program's      effect      on       medical       students'    subject's      attitude      as      a      physician      toward      taking
                      'ng,  the  researchers                                                  responsibility     for     the     patie-nt's     total      health,      the
                  traini                                  used         Boswell         and
                  Newman's      "Medical       Attitudes       Test.       Since       the    general      health      of       other       family       members,       and
                  purpose       of       the       comprehensive       coursework       at    the        environmental        and        social        factors        which
                  Colorado     was     much     like     the     purpose     of      PSHO,    enter      into      an      individual's      health       status.       The
                  that    is,    cultivating    a    broader    approach     to     treat-    before    and    after    results    on    this    scale    f     or     both
                  ment     rather     than     concern     with     the     narrow     or-    the     staff     and     student      workers      is      presented      in
                  ganic     disorder,     interest     in      the      prevention      of    table    19    below.    Scores    can    range     from     1     to     50;
                  disease     rather     than     the     curative      process      only,    the     higher     the      score,      the      more      favorable      the
                  and     the     development     of     a      multidisciplinary      ap-    attitude  toward  comprehensive  care.

                                                            Table 19.-Attitude of Students and Staff Toward
                                                                         Comprehensive Medical Care.

                  Before ....................................................   36.97    3.621  0.09          N.S.      5    40.38      2.74                           N.S.
                  After ........ ........ ............................ ......   37.03     3.56                              141.75      2.16
                  Diff erence ...........................................  .06  -      .06                                      37     -.68
                   The    table    shows    that    students'    and    Staff    is    at-      suiting        and         working  xith          other          nonmedical
                  titudes     did     not     become     more      favorably      disposed      professionals      and      such      as      social      worker,      psy-
                  toward       comprehensive       medical       care       but        re-      chologists,     and     the     benefit     of     a     team     consulta-
                  mained      remarkably       constant       from       pre-test       to      tion      among      all      treatment       personnel       such       as
                  post-test.                                                                    technician,      therapist      and      nurse.      Table      20      re-
                    Team       Approach:       This       scale        measures        the      flects     the     test     results     on     this     attitude     scale.
                  subject's     opinion     concerning     the     value      of      con-
                                                          Table    20.-Attitude    of    Students    and    Staff    Toward    the
                                                                          Team Approach in  Medicine.

                                                                          x                                                                                               p
                  Before ... .......................... ...................... 37.30    @    4    29                        40.13        2.93
                                                                                                  1.10          N.S.                                    2.01          0.025
                  After .  .................................................... 36.50    3.56                               36.25         4.18
                  Difference   .............................................. 80       -.73                                               1.25
                       Is Kenneth R. Hammond and Fred Kern, Teaching Co))tprehensive Medical Care (Cambridge, Mass.: Harvard Univ. Press 1959.)

                  98


                                                         Table       2i.-Attitude Of Students and Staff Toward
                                                                              Preventive  Medicine.

                                                                                                                                                               0.72               N.S.

                                                                                                                                                4.

                This      table      shows      that      the      staff      became      sig-      Table 21  contains the results on this scale.
            nificantly      less       in       favor       of       a       multidisciplinary           There      was      no      attitude      change      for      the       stu-
            approach       to       medical       treatment       over       the        course      dents       on       this       measure;        however,        the        average
            of     the     summer.     If     this     finding      is      not      spurious,      staff    score    was    less     in     the     post-test     than     in     the
            one     would     be     led      to      interpret      that      the      inter-      pre-test.      The      difference      between      the      two      is      not
            action     of     staff      with      persons      of      other      disciplines      sufficiently        large        to         indicate         anything         more
            and    in     many     diff     erent     roles,     resulted     in     a     de-      than  random  variation,  however.
            c,line      in      proteam      approach      in      medicine.      As       for
            students       in       general,        there        was        no        attitude           Total      Medical      Attitude:      This      is       a       combination
            change       on       this        scale        whatsoever.                              of     all     three     scales     and     is     an     indication     of     an
                Preventive          Medicine:          This           scale           measures      individual's        overall         opinion         on         these         three
            opinion       concerning       the        need        for        and        impor-      medical      issues      in      general.      There      is      no      signifi-
            tance      of      preventive      medicine      as       opposed       to       a      cant      change      either      for      students       or       for       staff
            concentration           on           curative           medicine            alone.      as the following table  summarizes.

                                                        Table 22.-Total  Medical Attitude of Students and Staff.

                                                                                dents
            Before     ....     ........    ........................... 114.17            8.60           0.45         N.S.          121.88           4.311       1.13                  N.S.
            After     ....... ......... .....................  ---   113.42           9.                                            117.13
            Difference      ................... .....................                        4                                                      6.15
                 In      summary,       the       findings       in       regard       to       atti-    Scales f or the Measurement of Attitudes.                              14  In
                tude      toward      various      medical      issues      f       or       students    the      original      scale      Mahler      used      the      terms       "com-
                indicate       that       there       was       no       change       over        the    pulsory           health            program"            and            "compulsory
                length      of      the      summer.      As      for      staff,       the       one    health      insurance"      to      refer      to       a       medical       sys-
                change      was      a      shift      from      a      more       favorable       to    tem       supervised       by       the       Federal        government.        In
                a      less      favorable      view      of      the      team      approach      in    this      research      these      terms      were      replaced      by       the
                medicine.       To       be       noted       too       was       the        downward    phrase        "socialized        medicine"        to        avoid        confusion
                shift,        although        not        statistically        significant         the    and  ambiguity.
                attitude         toward         preventive          medicine          and          in      Both        among        the        staff        members         and         the
                total medical attitude for the staff.                                                    PSHO        students        there        was        a        more        favorable
                   Socialized               Medicine:               Another               attitudinal    view       of       socialized       medicine       after        the        summer
                scale        administered         to         students         concerned         their    work           experience,           although           the           significance
                opinion       on        the        issue        of        socialized        medicine.    level     in     both      cases      leaves      open      to      doubt      the
                The      scale      was      developed      by      R.       A.       Mahler       in    possibility      that      this       change       occurred       by       chance.
                1953       and       is       reproduced       in       Shaw       and       Wright's    The  findings  for  socialized                     medicine        are         re-
                                                                                                         flected      in      the      Table       below.       Here       the       higher
                  "Marvin   E.   Shaw   and   Jack   M.   Wright.    Scates    jor    the    Hea5ure-    the      score      the      more      favorable      the       attitude       to-
                raent of Attitudes. (New York- McGraw-Hill Book  Co.,  1967)  PP.                        ward  socialized medicine.
                152-154.
                                                                                                                                                                                          99


                                                                      Table 23.-Attitude of Students and Staff Toward
                                                                                           Socialized Medicine.

                                                                                           nts
                                                                                  x           SD                   t           p
                          Before ............... -------- ------------------ -------- 50.17  17.93              1.55        0.10            49.25           8.50             1.39            0.10
                          After --------------------------------------------  ........ 54.83 14.53                                          55.38           7.97
                          Difference        -------------------------------------- 4.66    -3.39                                             6.13         -.53
                          Attt'tude      Toiviw)-d      the      Pooi-:       A       great       number      the      assertions      made      by       the       two       authors       after
                          of     the     site     assignments     were      to      indigenous      com-      having      been      exposed      to      the      poor.      It      was      as-
                          munity . organizations       or       to       health       and        welfare                                                                                    amil-
                                                                                                              sumed that students would become more f
                          institutions      which      serve      the      citizens      of       impov-      iar       with       this       group's        qualities        and,        thereby
                          erished         neighborhoods.          Consequently,          it          was      gain      sufficient       firsthand       knowledge       to       reject       or
                          felt       appropriate        to        discover        whether        student      accept         the         statements         more          decidedly.          Any
                          opinions      about      the      poor      Nvere       altered       signifi-      change       in       attitude        assumedly        would        be        based
                          cantly     as     a     result     of     their     contact      with      the      on       actual       field       experience.       Thirty-eight       of       the
                          urban       poor.       The        researchers        were        dissatisfied      questions       are       drawn       from        the        Riessman        refer-
                          with     the      types      of      tests      already      available      to      ence,      28       from       Lewis       and       the       remaining       four
                          measure       individual's       opinions        about        the        poor.      from       other       sources.       They        primarily        deal        with
                          As     a     result      a      Likert      scale,      the      "Philadelphia      factual       matters       which       could       be       empirically       ver-
                          Student          Health          Organization          Opinions          About      ified      such      as      the       amount       of       illegitimacy       and
                          the     Poor"      test      was      constructed.      There      are      70      family      conflict,       nature       of       political       opinion       and
                          qIu                                                             orks        of      the       economic       outlook       of       indigent        persons        gen-
                          estions derived primarily from the w
                          Miller and Riessman 15 and Lewis                      .16  Miller          and      erally.
                          Riessman     in     their     article     describe     the     life      style         This        instrument        must        be        viewed        as        com-
                          of     the     working     class     in     the     United     States.      It      pletely      exploratory      at      this      point.      No       work       has
                          includes        working        class        attitudes        toward        the      been     done     here     to     test     its     reliability      and      valid-
                          family,         children,         employment,         politics,         educa-      ity  although  this  may  be  forthcoming.
                          tion     and     numerous      other      issues.      Lewis,      on      the         Student       attitudes       toward       the       poor       did       change
                          other      hand,      describes      the       lower       class       subcul-      significantly      over      the      course      of      the       summer       as
                          ture    of    Puerto    Ricans     both     in     San     Juan     and     in      table     24      indicates.      Staff      attitudes      were      not      Sig-
                          New      York      City.      Both      of      these       sources       were      nificantly        different.         However,         this         would         be
                          used     to      obtain      statements      that      might      be      true      expected       since       the       staff       was        mainly        concerned
                          or    not     true     of     the     urban     poor     in     the     United      with           administrative           matters           which            provided
                          States.       The       research       here       is       not       concerned      little     contact     with     the     urban     poor.     In     this      table,
                          with        whether        Riessman        and        Lewis'        statements      the      higher      the       value       the       more       agreement       the
                          about    the    social    classes     are     accurate     or     not,     but      students      have      with      the       Riessman       &       Miller       de-
                          only      whether      students       agree       or       disagree       with      scriptions.
                                                                  Table      24.-Opinion       of       Student and Staff About the Poor.

                                                                                     Stud,@t.
                                                                                               SD                 t            p                  x
                          Before ....           .................  ........... 327.83             21.761        2.40        0.01           5 331.25         22.331        0.52               N.S.
                          After ....   .......................      .......... 338.00         24.24    5                                   1330.13          33.00
                          Difference            .....................  --------- 10.17         2.38                                             7.88        10.67
                          Segregation:  Since  many   of  the                                   students      citizens     than     had     been     their     custom      in      the      past,
                          would  be  working  in  black  ghQttos                        and        ge-n-      a     test      in      attitude      change      in      terms      of      racial
                          erally      coming      into       closer       contact       with       black      prejudice         was         deemed         appropriate.         Quite          an
                                                                                                              extensive      search       of       the       literature       for       attitudes
                          11 S. M@ Miller and Frank Riesi;man, "The Working Class Subul-
                          ture: A New View," Social Problems, 9 (Summer 61), pp.  86-97.                      toward       Negroes       was        made.        Most        of        the-scales
                          "I Oscar LewiE;, La Vida (New York: Random House,                 1954).            encountered       were       far       too       simplistic       to        measure

                          100


                                         d       prejudice       that       might     itern      scale      which      asks      respondents       for       their
       subtle,  unacknowledge                                                                          out       racial       integration       of        schools.
       be      held      among      educated       white       students.       No     feelings  ab
       completely        satisfactory        measure         was         located,     Table     25     below     reflects      the      before      and      after
                     g     the      most      sophisticated      appeared      to     responses     to     the     issue.     The      higher      the      score,
       but arnon
       be          Rosenbaum          and          Zimmermanis          "Attitude     the more prointegration the response.
       Toward     Segregation     Scale."     11     This      is      a      25-
                                                   Table     25.-Attitude      of     Students and Staff Toward
                                                                                 Segregation.
       Bef-r@ @    ....................... -------- ......              12.69               0.79                                                0             N.S.
       Af   ter ....... -------------------------- ...I........ --- 120.33
       Diff erence   ........... --------------------------------- -1.75 1.22
              There      was      no      significant      change      in      attitude     for   the    most    part    this    decision    is    arbitrary,    a
              toward     segregation     either     by     the     staff     or      by     review     of     the     students     and      their      involvement
              the students.                                                                 scores     indicates     from      personal      experience,      that
              Involvement       a,,nd       Attitude       Change:       One       pos-     this    is    -not    an    unreasonable    point    at    which    to
              sible    reason    for     the     absence     of     attitude     change     draw      the      demarcation       line       between       involve-
              might    be    the     assertion     that     attitude     change     oc-     ment and uninvolvement.
              curred     only      among      students      who      became      deeply     The     contingency     tables     in     which     a      significant
              involved     in      the      summer      project      and      attitudes     relationship       exists        between        involvement        and
              remained       relatively       constant       for       those        who     attitude change are presented below.
              were    uninvolved.    In     order     to     test     this     hypothe-
              sis,     that     attitude      change      depends      upon      degree     Table      26.-Student       involvement       and       Opinionation.
              of       involvement,       the       research       has       correlated
              these two factors.
              On     the     whole,     attitude     change     is     not      related     Increased right opinionation        ..... @@.   23              16
              to     involvement,      except      for      two      instances.      In     Increased left opinionation       ............ 6                14
              these     two     cases,     however,      the      attitude      becomes          Total     ...................................... 29        30
              less      favorable      among      the      involved      and       more     Table 27.-Student involvement and Opinions About the
              favorable       among       the       uninvolved.       The       follow-                                    Poor.
              ing paragraphs  explain these  findings.
              In      the      questionnaire      of      the      closing      confer-                                              involv
              ence,    students    were    given     a     list     of     PSHO     ac-     More empathic      ---------------------------------- 14        25
              tivities,      such      as      lectures,      work-groups,      confer-     Less empathic      ....... .......... ............... 15             5
              ences,     social     outings     and      weekly      meetings      (see           Total     ----- ....... ......................... @9
              app.    2).     They     were     asked     to     check     which     of
              these     they      participated      in      or      attended.      From
              this    list     was     constructed     an     index     of     involve-       In   these  two  cases, there  is              an            association
              ment,     the     greater     the     number     of     activities     in     between       involvement       and       attitude       change,       but
              which     one     participated,     the     greater     the      involve-     in     both     cases     those     involved      rp-flected      attitude
              me,nt.      The      possible      range      extends      from      par-     changes     in      a      direction      opposite      that      expected
              ticipation    in    no    activities    to     19     activities.     The     by     the     project.     That     is,      the      involved      moved
              actual    range     was     participation     in     one,     to     par-     more   to    a    rightist    and    the    uninvolved    to    a    left-
              ticipation    in    19    activities.    In    the     date     presented     ist    orientation    politically    and     the     involved     to     a
              below,      involvement      has      been      defined      as      par-     less     emphatic     and     the     uninvolved      to,      a      more
              ticipation    in    five    activities,    or     more,     and     unin-     emphatic orientation toward the poor.
              volvement     in      four      or      fewer      activities.      While        There      is      no       significant       association       between
                                                                                            involvement         and         attitude         toward         comprehen-
               i7  Marvin  E.  Shaw  and  Jack  M.  Weight,  Scales  for  the  Measure-     sive     medical     care,     total     medical      attitudes,      lib-
              meta of Attitudes, op@ cit., pp. 168-177.
                                                                                                                                                                 101


                                                ine    and     attitude     to-       continue  to  work  in   the   ensuing   year   with   the
                            socialized     rnedic                                     community   organization   or   the    institution    with
                     eralisrn,                                                        which  they  were  placed,  56   percent   had   no   such
                     ward integration             then    is    that,     while                                   ncertain.
                     The surprising     fin d in 9                                    lans, and 16 percent were u
                     f or the most part there    is    no    contingency    be-       p                                         nt        iiidi-
                                                and      project       involve-       C,,,,-iculo,  Reform:   Thirty-nine   perce
                     tween  attitude  change                    .sts,   it    is      cated  that  they  had   specific   plans   for   attempt-
                     ment,   where   such   a   contingency   ex'                     ng   curricula   reform   or    faculty    education    in
                     antithetical to the project's intentions.                        i        sional   school    in    the    following    aca-
                     A  note   of   caution   should   be   interjected,   how-       their profes  ereent     were     uncertain     and     30
                     ever,   concerning   the   relationship   between    opin-       dernic year, 27 p
                     ions  about  the  poor  and  involvement.  It   is   quite       percent had no definite plans.       of      the      sum-
                     possible   that   those    who    came    into    intimate       poverty Practice: At the close            ly         prac-
                     contact  with   the   poor   learned   that   one   cannot       mer,  22  percent  had  plans  to  eventual
                     make   sweeping    generalizations    about    the    poor       tice  their  profession  in  a  poverty  area,   61   per-
                     and   consequently   lowered   their   score    on    this       cent   were   undecided   and   17   percent    did    not
                     scale    of    indicating    uncertainty     or     making       have such plans.
                     agreement   or   disagreement   with    less.definitive-         council  ia   Medicine:   During   the   course   of   the
                     ness   than   initially.    As    mentioned    previously,       summer,   26    students    counseled    87    individuals
                     this  is  the  first  usage  of  this  scale,  and   until       about  a  career  in  medicine.   No   effort   was   made
                                                                Its      remain                 arch   to   elicit   in    what    depth    this
                     it  has  been  validated,  the   test   resu                     in the rese
                     open to question.                                                counseling   took   place,   nor   whether   some    indi-
                        Concl@on:   The   results   of    the    administration       viduals,   particularly   the   youth    interns,    %vere
                     of  a   total   of   eleven   attitudinal   scales   gives       the recipients of rnulticounseling.
                     evidence  of   change   only   on   two   of   these   for       Active   Reform:   Students   were   asked   if    as    a
                     students     (right     opinionatioli     and     opinions       result  of  their  participation   in   PSHO,   they   had
                     about   the   poor)   and   on   four   for   the    staff       become active and 59 percent were not.
                     (team    approach    in    medical    treatment,     right       The    section    on    problem    papers    by    '.%Iiss
                     opinionation,   liberalism   and    possible    socialized       Lynch   reflects   a    great    deal    of    information
                     medicine).   Testing   whether   the   lack   of    change       relevant   to   the   perceptions   of   PSHO.   Only    a
                     is   a   result   of   noninvolvement   in   the   project       few  items  on   this   topic   were   covered   b@,   the
                     reveals   that   involvement   and   attitudinal    change       questionnaire   method.   In    general,    however,    it
                     are  not  generally   related,   except   in   two   cases       appears   that   there   is   a   considerable    discrep-
                     where   the    noninvolved    had    significantly    more       ancy   between   what    students    expected    to    ac-
                     positive  changes   in   attitude   than   the   involved.       cornplish  and   what   they   felt   actually   was   ac-
                                                                                      complished.   This    discrepancy    holds    true    both
                        Student       Accomplishments        and        Student       at   the   individual   level   and   for   PSHO   as   an
                                    Perceptions      of      PSHO                     organization.   Students   were   asked   at   the   open-
                        Student     Acco?nplishment:     Very     little     of     the ing   orientation   "how   effective    do    you    think
                        research   effort    has    been    devoted    to    evaluating your  summer  activities  will   be   in   improving   the
                        the   impact   of    PSHO    on    the    community    or    on conditions  of  the  poor.:   At   the   closing   confer-
                        institutions     in     which     students     were     placed. ence  the   same   question   was   repeated   with   only
                        While    highly    desirous    of     obtaining     information a   change   in   wording,   that   is,   dHow   effective
                        about   specific    accomplishments,    it    is    practically do  you  think  your  activities  were  ...   11   Results
                        impossible    to    measure    the     collective     influence on  the   pre-and   post-question   show   a   sharp   de-
                        of     80      health      science      students      dispersed cline  in   estimated   effectiveness.   Originally,   al-
                        throughout   a   city   of   2   million    people.    Informa- most  all  students  felt   that   they   as   individuals
                        tion   in   other   sections   of   the   report   reveals   in would  be  to  varying   degrees   effective,   and   only
                        descriptive    fashion    the    efforts    and     attainments 5   percent   thought   they   would   have   no   effect.
                        of   specific   projects.   Here   mention    can    only    be However,   by   the   closing    conference,    over    50
                        made    to    several    minor    indices    of     accomplish- percent   thought   they   personally   had   no    effect
                        ment.                                                         and  only  33   percent   thought   they   had   been   to
                          Continuity      of      Projects:      Twenty-seven      per- some   extent   effective.   Moreover,   only   one    in-
                        cent   of   the   students   indicated    they    planned    to dividual   originally   thought   he   personally    might
                        102


                                                                                                                     in  an  effort  to  determine  what  might  be  the
                 be  ineffective;   nine   individuals   felt   this   way   at                                      source  of  dissatisfaction,  an  open-ended  ques-
                 the    close    of    the    summer.    In    general    terms                                                                        he   projects    asked    "what
                 then,   there    was    a    considerable    downward    shift                                      tion at the close of t                                            with    the
                                                                                                                     major problem if any, dQ you see
                 in    effectiveness    judged    by    students    from    the                                          al  organization                 of    PSHO."    Below     are
                 beginning   to   the   end   of   the   summer.    Table    28                                      intern
                 reflects these facts.                                                                               the classified results.
                 Table  28.-Judgment  of  Students  and  Staff  as   to   indi-                                      Table 30.-Judgment of Students  on  Major  Internal
                 vidual  Effectiveness  in  improving   Conditions   of   Poor,                                                              Problems   of   PSHO
                 Before and After.
                 Degree of effectiveness                    (percent)                                                Lack of formal organization               ....................  .........          25.4
                                                                        After                                        Lack of clear-cut goals           ..........................................       15.3
                                                                                                                     Lack of leadership .        .......................  .......................       13.6
                 Exertmely effective        .....           1.6                                                      Lack of communication            .............................  ............       5.1
                 Very effective     ................ .      1.6            ....       ....
                 Moderately  eff ective       ......        30.6            8.3       ...        12.5                Overly  theoretical       ..............................................           5.1
                                                            li9.7                   25.0                             Inadequate    site              development  ..............................        5.1
                 Slightly effective                                        25.4                                      ----
                 No  eff 6ct  @......................       4.8            50.8     50.0         62.1                Inadequate    area             coordination  ...................  ..........       3.4
                 Slightly  ineffective        .......       ....            1.7                                      .... Absence      of community personnel on  staff                ........         3.4
                 Moderately  ineffective  ..                1.6             3.4       ....                           .... Inadequate preceptors      ......................................
                 Very  effective  .... .......              ....            5.1       ....                           ...IInadequate representation  of  nonmedical
                 Extremely ineffective                                      5.1     25.0         12.5                students      .......  .................................... ............  ......   1.7
                                                                           99.8     loo.         100.0               Inadequate    office                management  ............................       1.7
                      Total       .............. .....      9.9                                                      No answer-none  ...         ............................................. ..       18.6
                 S Stud@nlr b,-f.@1-62.
                 N Students after@59,                                                                                          Total ............  ...............................................           o@0.1
                 N Staff =S.                                                                                         N=5
                 XI=49.9;  df=8;  p=0.001.
                                                                                                                     Students  were   asked   at   the   final   session   to
                 Students   and   staff   were   a    so    asked    both    at                                      indicate  how  satisfied  they  felt  in  general  about
                 the  orientation  and   final   conference   "how   e-ff   ec-                                      their  role  in  PSHO.  In  table  31  below,  one   can
                 tive  do   you   think   the   PSHO   project   as   a   whole                                      see  that  58   percent   indicated   that   they   were
                 will   be   (was)   in    improving    conditions    of    the                                      very  or  somewhat  satisfied  and   32   percent   were
                 poor."   There   was   here    also    a    significant    de-                                      very  or  somewhat   dissatisfied.
                 crease    iyi    students    judgment    of     organizational                                      Table     31     -Satisfaction      of      Staff      and      Students      With      Role
                 effectiveness.   At    the    outset,    over    90    percent                                                                        in  PSHO.
                 felt   the   organization   would   be   effective   to   some
                 extent,   whereas   in   the   end    this    had    decreased                                                                                             (Pe
                 to   about   53   percent.   Only   one   individual    judged                                      Very satisfied        .................................... 15.3                    12.5
                 the   project   would   be   ineffective    during    orienta-                                      Somewhat  satisfied  ..          ........................ 42.4                     50.0
                 tion,   but   13   held   this   judgment   at    the    final
                                                                                                                     Uncertain       ......  ................................... 10.2
                 convocation.    Data    on    this    question    are    shown                                      Somewhat  dissatisfied               ........ ..........  25.4                     37.5
                 in table 29.                                                                                        Very  dissatisfied         ...........................      6.8                            ----
                                                                                                                             Total        ...................................... @ou                            0
                 Table      29.-Judgment      of      Students      and       Staff       as       to       Effective-        tudant
                   tiveness       of       PSHO       in       Improving       the       Conditions       of       the
                   Poor,       Before       and        After.                                                          While it seems probable that                                   there       would
                 D,,@e f                                                                                             always   be   a   percentage   of   student   discontent
                                                                       (percent                                      with  their  position  no  matter  what   its   -nature,
                                                               efore          A                                      the  fact  that  one-third   of   the   students   indi-
                 Extremely effective                 ........  1.6            ....          ....                     .... cate  dissatisfaction  and  another   10   percent   un-
                 Very effective                          ....  1.6            ....          ....                     certainty   may   be   disproportionate.   Also,    only
                 Moderately  effective                 ......  38.7           3.4         12.5                       .... 15  percent  responded  as   being   "very   satisfied."
                 Slightly  effective                 ........  50.0           49.2        50.0                       25.0
                 No  eff ect      .........          ........  6.5            25.4        25.0                       75.0 From  this  tabulation  it   would   seem   that   the
                 Slightly  ineffective                 ......  1.6            6.8           ....                     administration  of  the  project  in  the  eyes  of  the
                 Moderately  ineffective                       1.6            5.1           ....                     --- students       wag        lacking.        The        lack        of        formal        or-
                 Very ineffective                                             6.9           ....                     .... ganization,        goals        and        leadership        all         involve         the
                 Extremely ineff ective                     ....      ....    3.4         12.5                       .... basic         structure         of         the         organization.         As         men-
                            Total       ...............     .... TO      0       O--
                 -Stu,                                                                                               tioned        earlier,        however,        the         project         was         inten-
                                                                                                                                                                                                                103


                                             centralized    in    order    Cal and social attitudes  of  the  project  workers.
                  tionally designed to be de                               It  attempted  to  learn  whether  this   experience
                  that  students  themselves  might   establish   their                  provoking   attitude   change.    This
                  own   goals   on   an   individual    basis    rather    is successful in
                  than  be  handed  guidelines  and   directions   from    previous  PSHO  research,  however,  has  been   be-
                                                            t      show    set  by  two  major  limitations:  (a)  the  absence
                  a central authority. These findings migh                 of a  control  group  by  which  comparison  in  at-
                  that  students  were  displeased  with  an   unstruc-                 might  be  made,  and   (b)   the   in-
                  tured  program  and  would  be   desirous   of   more    titude change               rongly   student    par-
                                              ization.  In  any   case,    ability to determine how st
                  direction and formal organ                               ipants identified with the attitudes in
                  it should  be  made  explicit  that  student  dissat-    tic                                            ques-
                  isfaction  may  result  from  other  sources  in  ad-    tion prior to their  participation.  The  small  ex-
                  dition to the internal  organization,  and  in  fact,    perimental  comparison   reported   here   has   at-
                  this  conceivably  may  not  be  the  primary  source    tempted  to  correct   these   limitations.   Herein
                  of dissatisf action.                                     is presented  a  comparison  of  second  year  medi-
                  Finally,  students   were   asked   if   they   would    cal  students  both  before  and  after  the  summer
                  participate in  PSHO  if  it  were  repeated  in  the    with  the  medical  student  participants  of   PSHO
                  f uture:  32  percent  stated  that  they  would,  22    at the same time periods.
                  percent  that  they  would  not,   and   46   percent
                  were uncertain.                                          Methodology:
                                'ble  to  make  any  definitive  state-
                  It is impossi                                            The  Dean  of  the  medical  school  of   the   Uni-
                  ments   about   student    perceptions    of    PSHO;
                  however,  it  would   seem   reasonable   that   stu-    versity   of   Pennsylvania   permitted   the    re-
                  dents   were   somewhat   less   than    enthusiastic    searchers  to  record  the   names   and   addresses
                  about  the   summer   project.   There   appears   to    of  61  second-year   medical   students   attending
                  have been  a  decided  change  in  their  anticipated    classes  and  working  in   hospitals   during   the
                  effectiveness   both   individually   and   organiza-    summer.   The   same    questionnaire    given    to
                  tionally,  two  out  of  five  were  uncertain  about    PSHO  medical  students   during   orientation   was
                  or dissatisfied  with  their  role,  and  only  three    mailed  to  Penn  students  during  the  first  week
                  out of ten  were  readily  willing  to  reparticipate    of the project.  The  questionnaire  was  coded  for
                  in a future project.                                     anonymous   replies   and    contained    background
                                                                           data questions and  four  attitudinal  tests:  atti-
                                                                           tudes  towards  the   poor,   socialized   medicine,
                  Penn    Medical    Student    and    PSHO     Medical    general   medical   attitudes,   and   the   Rokeach
                               Student Comparison                          opinionation  scale.  The  entire   instrument   re-
                                                                           quired   approximately   one   hour   to   complete.
                  Int?-oduction                                            Most  of  these  students  were  telephoned  in  ad-
                   This  report  compares  the   attitudes   of   medi-    vance and  informed  that  they  had  been  selected
                  Cal  students  who   attended   school   during   the    as  a  member  of  the  control  group  and  that  a
                  summer  with  those  of  medical  students   partici-    questionnaire   addressed   to   them   was    being
                  pating  in  PSHO.  Within   PSHO   there   were   in-    placed in the  mail.  No  student  objected  to  re-
                  itially 3 individuals,  both  male  and  female,  at-    ceiving the questionnaire.
                  tending   medical   schools.   The    remaining    35      Originally,  the  researchers  wanted   to   Corn-
                  PSHO   participants   were   students   of   numerous    pensate the  Penn  students  for  their  effort  and
                  other   disciplines   ranging   from   nursing    and    funds  that  could  be  devoted  to   this   purpose
                  dentistry  to  social  work  and  law.  This   report    were available.  It  was  known  that  medical  stu-
                  compares  the  39   @PSHO   medical   students   with    dents  were  exceptionally  busy,   both   attending
                  a  group   of   nonparticipating   medical   students    courses and working  long  hours,  often  at  night,
                  who   were   actuallv   attending   medical    school    and  consequently  seldom  had   free   time.   Some
                  during the summer.                                       monetary  compensation   for   the   time   required
                  The Problem:                                             to fill out the questionnaire, it  was  felt,  might
                                                                           insure a  larger  and  more  adequate  return,  par-
                   PSHO  research  in  the  past  has  been  interested    ticularly since  the  researchers  were  asking  for
                  in  learning  what  effect  actual  participation  in    a return at  two  diff  erent  times  of  which  the
                  community  work  projects  has  on  both  the   medi-    absence  of  either  would  make  the  participants'

                  104'


                        Members     of     the     medical      pro- as to be an insult  when  answered  by  intelligent,
          results unusable-  unseleed          that          payment sensitive individuals.          with        fiaws,
          fession,  however,  CO            ed       that       most This test, although certainly filled
          would be 4 iunethical."   They    suggest                is  designed  to  uncover  how  intolerant  an   in-
          medical  students   would   be   willing   to   contribute                 ng    points    of    view     and
          to  a  research  project   voluntarily   since   it   cOn- dividual is of OPPOs' accepts    his     own     view.
                             ion-students          would          be how dogmatically he
          cerned their  profess             Ilows       in       the Failing to  agree  strongly  with  one's  own  POSI-
          willing to participate freely as fe                pletely tion and  failing  to  reject  strongly  alternative
          medical community- This was not corn                     positions  theoretically  gives  evidence  of  one's
          the case.                                                tolerance  level.  At  the  same   time   the   mild
                             naires    mailed    to     the     stu-                   @s   political    stance.    The
          of the 61 question             e     by      the      post acceptance reveals one                    requires
          dents, three were undeliverabl     returned             at Rokeach instrument unquestionably
          office and 38  were  completed  and                      erefinement  and  greater  sophistication.   in   the
                           ,imer.   This    is    a    return    rat interest  of  overcoming  the  limitations  of  pre-
          the start of the sun                                                                       to    know     the
          of   67   percent.   As   for   the   po@t-test    mailing vious studies, namely the inability dents        prior
          which began when  the    projects    closed    in     late ideological position  Of  PSHO  Stu
          August  1968,  only  32  or  54  percent  of   the   total to the entry  in  the  project,  the  Rokeach  scale
          students    fully    cooperated    with    the    research was used. its validity  and  reliability  have  been
                              completed              questionnaires.                  oth   in   this    country    and
          effort by returning             most       of        those heavily researched b            is      developed,
          When contacted by   telephone,                           eabroad.  Until  an  improved  scale
          who   did   not   cooperate   explained   that   they   WI the Rokeach  scale  will  probably  continue  to  be
                              to   devote   time    to    the    re-   th apologies.
          simply f ar too busy              reacted           v'ehe- used wi                         to    plan     suf
          search. A few other students                                 the   researchers   been   able
                               of    the     questionnaire,     how- Had
          mently                                                   ficiently  in  advances  a  matched  control   group
               to the content
          ever, claiming that it was highly biased.                would  have  been  selected.  Not  only  a  lack  of
          The    content    of    the    questionnaire,     actually time, but  other  difficulties  as  well,  prevented
          was   determined   by   the    nature    of    the    PSHO    sibilitY.  For  example,  we   did   not   know
                            e    attitude    scales    were    those this pos       eteristics   Of    PSHO    partici-
          project, that is, th              was           interested some of the chara
          relevant to the attitudes PSHO                       basis pants until after  orientation  in  June  1968.  Ap-
          in changing. They were selected on the                   plication  forms  do  not  ask  for  characteristics
          of   the   goals   PSHO   was   attempting   to    attain.     race  and  religion,   two   attitudes   which
          There  was  -no  implicit  interest   by   the   research- such as e  controlled  in  an  experiment   of   this
          ers   in   demonstrating   that   PSHO    students    were should b
                                  o     medical     students     at- nature. Secondly, a  delay  by  the  medical  school
          in any way superior t
          tending  school.  While   no   social   science   research in  granting  permission  to  review  student  char-
          is   ever   successful   in   being    completely    value acteristics  to  choose  matched  pairs,   even   on
          free,  the  research   was   not   out   to   prove   that attributes  such  as  sex  and  age,   precluded   a
          PSHO   participants   were   the    socia-Ily    concerned matched  control  group.  In   fact'the  use  of   the
                                                                   term "control  group"  is  dubious.  Actually,  this
          reformers   and    the    medical    students    attending
          school,   the   unconcerned   conservatives.    The    re- report   simply   draws   a    comparison    between
          search   simply   required   a   base   group   by   which medical  students  in  school   and   medical   stu-
          Comparisons   in   attitude   shifts   could   be    made, dents  in  PSHO.  A  full  report  is  provided  be-
          and   the   Penn   medical   students    were    a    con- low  as  to  what  changes  in   attitude   occurred
                    -nd available group.                           among   PSHO   medical   students   compared    with
          venient a                                                the  Penn  medical  students,  the   difference   in
            A  major   criticism   by   the   Penn   students   cen- attitudes  between  the  two  groups  and,  finally,
          tered    around    the    Rokeach    OPinionation    Scale     parison  of   the   social   background   fea-
                            11   pp.   95-96).   This   scale    at-a
          (gee app. 3 anu                                           corn
          tempts  to  measure  an  individupLI's  political   I)OSI- tures of both groups.
          tion   by   asking   for   agreement    or    disagreement The  samples  are  small   and   the   returns   by
          with   brief,    opinioned    statements.    The    state- Penn medical  students  limited,  so  that  the  re-
          ments   admittedly   are   dated,    concerning    politi- search  should  be  viewed  as  an  exploratory  at-
          cal   issues   and   personalities   no   longer   contem- tempt  to  extend  PSHO  research  with   the   hope
          porary,  and  the   items   are   so   blunt   and   naive that future  projects  of  this  nature  might  come
                                                                                                                      105


                                                                                           as    a    result    Of    the    summer    experience.     on     the
                        to more decisive findings,                                         left    opinionation     portion     of     the     Rokeach     scale,
                                                                                           the      PSHO      medical      students       maintained       almost
                        Findings:                                                                                             from     pre-test     to      Post-
                                                        ily   that    little    attitu-    identical average scores                                  so       re-
                        The    findings    are     genera                      students    test. Penn medical students' attitudes al
                        dinal change occurred among PSHO                    e      were    mained     constant     over     the      summer.      There      was,
                        from pre-test to post-test, but that ther                                                                  rence       between        the
                                                        n    the    two    groups    at    however, a significant diffe
                        strong    distinctions     betwee                                  two    groups     at     both     time     periods,     PSHO     tend-
                        both time periods.                                                 ing   to   be   more   leftist   in   outlook.    Table    32    below
                                                                                           describes    the    before    and    after     results     on     this
                        Ideology:                                               medical    scale.    The    higher    the    score,    the    more    left    the
                        The results indicate that the PSHO                      titudes    opinionation.
                        students did not alter their political at
                                                        Table  32.-Mean  Left Opinionation  Scores,  PSHO and
                                                                           Penn Medical Students.

                                                                                                                 ical
                                                                                                                              Differen                           p

                        for, ------------ .......... ...... ......
                        After  .......  .............  ...................... 84.6   36            72.5           30            12.1         3.8           0.0005
                        Difference ...... ........................ ............ .4                  -.3
                         t                                                                            .14
                         p  ................................... ---------  ......... N.S.            N.S.
                        On    the     right     opinionation     scale     PSHO     medi-     as    to    whether    the    PSHO    project    is    -necessarily
                        cal    students    tended    to    become    less    and     Penn     effecting     attitude     change.     Quite     possibly,     -na-
                        medical    students     more,     rightist     in     orientation     tional    and     international     events,     particularly     in
                        over   the   summer.   In    the    pre-test    the    difference     an    election    year,    could     be     influencing     student
                        in     scores     between     PSHO     and      Penn      medical     scores.      Whatever      the      source,      however,      both
                        students    was    5.4    (p=0.05)    while    at    the    close     groups    appear    to     have     changed     position     during
                        of   the    summer    the    difference    had    increased    to     the    summer     months.     Table     33,     below,     reflects
                        13.8    (p=0.0005).    It    is    then    open    to    question     these        findings.
                                                          Table 33.-Mean Right Opinionation Scores, PSHO and
                                                                              Penn Medical Students.

                                                                                                        x
                        Before  ..... ............ ..................... 62.8         39              68.2         36               5i4        1.9           0.05
                        After .............................. ........................ 59.1 38         72.8         30             13.8         4.7             .0005
                        Difference ..........  ................................ -3.7                   4.6
                           t  ..... ....... ................ @:@ ...................... 1.4            1.4
                           p  ------------------------------------------------------ .10                 .10

                           One tail test.
                          Neither     group     reflected     a     change     in      Total       The    right     and     left     opinionation     scores     can
                        Opinionation,    that    is,    the     combination     of     right    be     used     to     measure     liberalism     and      conserva-
                        and    left    opinionation,    over    the    course     of     the    tism,    by    subtracting     right     from     left     opiniona-
                        summer.     However,     in     the     pre-test,     PSHO      stu-
                        dents     were     significantly     more      opinionated      than    tion.    Scoring    high    on    right    and    low    on     left
                                                                                                measures      a      conservative       political       orientation,
                        the    Penn    students     although     this     difference     de-
                        creased   in   the   post-test   in    which    both    scored    at    while    scoring    high    on    left    and    low    on     right
     I                  approximately the same level.                                           indicates liberalism.

     i
     @5                 106


                                                             more            liberal     moved       in       contrary       directions       which       leads       the
                   PSHO    students    did    not     become                             post-test      results       to       show       far       greater       differ-
                   as   a   result   of   participation.   Although    the    scores     ences      than the     pre-test.      Here      also      it      would      be
                   move   in   this   direction,   they   are    not    sufficiently                                      at       PSHO        is        the        agent
                                          e       than       chance       variation.     difficult  to  assume  th
                   large  to  indicate  mor                                              responsible       for       the       attitude       change.       Had       the
                   The     Penn     medical     students     in     the     pre-test     Penn          students          score           remained           approximately
                   scored   slightly   liberal   and   in   the    post-test    less     the       same,       while       only        PSHO        students        scores
                   liberal,    although    here    too    the     difference     may     changed,      then      there      would      be      reason       to       con-
                   be   due   to   chance   variation   in   scoring.   The    corn-     tend       that       the       PSHO        experience        induced        the
                   bination     of     these     slight     movements,      however,     change.       The       trend       of       Penn        medical        students
                   adds    up    to    large    differences    between    the    two     "downward"           and            PSHO            students            "upward"
                   groups.    While    the    difference     between     the     two     may      reflect      the      trend      in       the       United       States
                   at    the    beginning     of     the     summer     was     14.5     generally        toward        a        "Polarization"        of         liberal
                   (P=0.01).    it    increased    greatly    by    the    end    to     and        conservative        attitudes.        Table        34        surnmar-
                   26              .   This   is    similar    to    the    findings     izes     the     findings      on      liberalism;      the      higher      the
                   .4 (p=0.0005)
                   on     the     right     opinionation:     the     two     groups     score the more liberal.the attitude.
                                                    Table       34.-Mean        Liberalism Scores, PSHO and Penn
                                                                           Medical       Students.
                                                                              PS                       nn medical
                                                                                                                                                                        p
                   Before ....... ----------  -------------------------------    21.7 39             7.2       36                14.5          2.6                   0.01
                   After ------- ........  --------------------------------------    28.4 38         2.0       30                26.4          4.8                  .0005
                   Difference . ---------------------------------------------   6.7              -5.2
                   t                      ..........  .............   1.2                            1.0
                   p------------------------------------------------------    N.S.               N.S.

                   One tail test.
                   Medical Attitudes:                                                          between     the     two     groups,     initially     PSHO      had      a
                   Both     groups     completed      two      sets      of      questions     significantly     higher     average     se-ore      in      favor      of
                   concerned     with     attitudes     within      the      field      of     comprehensive       care       than       Penn       students;        how-
                   medicine.     A     more     elaborate     explanation      of      the     ever,      by      August      both      groups       average       scores
                                                                                               moved       closer       together,       pSHO's        slightly        de-
                   content    of    these     atttiude     scales     can     be     found                                                     easing       so       that
                   on  pp  287.  One  was  Boswell              &                 Newman's     creasing     and     Penn's     slightly     incr
                   "Medical      Attitudes      Test"      consisting       of       three     no significant difference remained.
                   subscales:       attitude       toward       comprehensive        -med-
                   ical     care,     attitude     toward      the      team      approach     Team Approach:
                   in      medicine,      and       attitude       toward       preventive      Neither     group's      attitude      toward      the      team      ap-
                   medicine.      The       second       was       Mahler's       "Social-     proach    in    medicine,    that    is    favoring     the     use     of
                   ized    Medicine    Attitude    Scale"    (see     app.     3,     pts.     nonmedical        professionals        such        as        psychologists
                   11 and V).                                                                  and       social       workers       and       favoring        conference-
                                                                                               like      discussions      with       medical       specialists       such

                   -orap                  re:
                   C  i-ehensive         Ca                                                    as     nurses     and     technicians     in     the     treatment      of
                   This      scale      concerns      attitudes       toward       regard-     a     case,     reflected     a     change      over      the      summer.
                   ing   a   patie-nt's   total    health    as    within    the    physi-       However,          PSHO          students          demonstrate          a
                   cian's     purview,     the     willingness     to      assume      re-     more      favorable      attitude      on      this      measure      than
                   sponsibility        for        additional        family         members     do     the     Penn     medical     students     in     the      beginning
                   health    care    needs,    and     concern     with     social     and     of    the    summer,    but    not     necessarily     at     its     con-
                   environmental        conditions        which        might        influ-     clusion.     The     difference      between      the      two      groups
                   ence health status.                                                         initially      was      2.9       (p=:O.Ol)       but       only       1/5
                   PSHO     students      did      not      alter      their      attitude     (p=0.10)      after.      The      average      score       for       Penn
                   on    this    dimension.    In    regard     to     the     differences     slightly        increased        and        the        PSHO        average
                                                                                                                                                                        107


                                                                                                             score,     the     more     favorable     the     attitude      toward
                        slightly    decreased    thereby    eliminating    a     signifi-                    preventive medicine.
                        cant difference in the post-test.                                                        There    was     also     a     considerable     difference     be-
                        Preventive Medicine:                                                                 tween   the   two   groups   in    both    the    pre-    and    post-
                        PSHO     students'      attitude      toward      the      impor-                    test;     PSHO     in     both     cases     evincing     a     higher
                        tance    of     preventive     medicine     as     opposed     to                              ntive     medicine     score     than      Penn      students-
                        curative   medicine   did    refiect    a    significant    posi-                    preve
                        tion    change.     Table     35     below     indicates     that                    Total Medical Attitude:
                        Penn     medical     students     average     score      remained                          SHO     students'      and      Penn      students'      averages
                        relatively    constant    while     that     of     PSHO     stu-                        p
                        dents   increased.   In    this    table,    the    higher    the                    on    a    combination    of    all    three     measures     refiects
                                                                  Table 35.-Mean Preventive Medicine Scores, PSHO and
                                                                                          Penn   Medical    Students.
                                                                               -x                                                                       Difference                               p
                        Before   ..................... .......         .......        36.3           39                32.4             38                 3.9            3.6             0.0005
                        After .. ...................................  -----------------   38.4       38                33.6            32                  4.8            3.9               .0005
                        Difference      ........ 6@ ............ ---------  -----------   2.1                             1.2
                             t                        -----------  ................     2.1                               1.0
                             p  ---------------------------------------------- 1-@ ...   .025                          N.S.
                        no    changes    from    pre-    to    post-test.     There     is,                      cral     Government.     The      PSHO      students'      attitude
                        however,     a     significant     difference      between      the                      in   this   area   was   more   in   favor   of   a   f    ederally
                        two     groups     at     both     stages      of      measurement.                      regulated    medical    system    at     the     end     of     the
                        PSHO     students     score     higher     than      Penn      stu-                      summer     than     at     the     beginning      although      the
                        dents    both    at    the     beginning     (t=9.7,     P==O.0005)                      statistics     indicate     that     possibly      this      change
                        and conclusion  (t=6.8, p--O.005).                                                       is    due    to    random    variation     in     responding     to
                        Socialized Medicine:                                                                     the    questions    rather    than    an    actual    change     in
                            This    test    measures    to    what    degree    an     indi-                     attitude.    Table    36    below    shows     the     pre-     and
                        vidual    favors    a     health     care     system     in     the                      post-test     results     for     PSHO     students     on     this
                        United    States    which    is    supervised    by    the     Fed-                      index.
                                                                     Table 36.-Mean Socialized Medicine Scores, PSHO and
                                                                                             Penn Medical Students.
                                                                                        -x                                                                 Differei                               p
                         Before      .................................... ------- .....    49.6       39                  35.6           36                    14.0          3.4          0.0005
                         After     ....................   -----------  ..........         55.0        39                  35.3           31                    19.7          5.4          0.0005
                          Diff erence     ..................................  ........... 5.4                                  .3
                                t                                -------------------      1.4                                .05
                                p    ------------------------------------------------------- .10                          N.S.

                               One tail @t.
                              This     table     also     shows     that     PSHO      students                   Attitude T6,ward the Poor:
                          are    far    more    inclined    to    favor    socialized    medi-                         About two-thirds of the PSHO project sites
                           cine than are Penn students.                                                           were with community organizations in urban

                           108


                                Table 37.-Mean opinions About the Poor Score, PSHO
                                            and Penn Medical Students.
                                                               -x    stu ents      Difference  t         p
                                               323.7 39        341.1     36          17.4     4.2      0.0005
          Before ....   ............................................      333.4 38 327.3 31 6.1 1.2    0.10
          After ......................................................-
                                               9.7             -    13.8
          Difference   ..............................................    1.9    3.3
          t............ ..........................I-----I --------- .025    .005
          p..................... "I-,--,   .........................
              il test.
                                                                     ther  factors.  It  may  be  that  intimate
          slum  areas  and  most  of  the  remaining   one-    well as o
          third were  with  official  institutions  serving    contact results in a lowering of  overall  score,
          such areas. Intimate exposure to the living  con-    since the respondent may come  to  feel  that  it
          ditions and problems of the  poor  were  expected    is inappropriate to generalize widely  about  the
          as a part of the summer activities. In  order  to    poor after having personally observed their  life
          find whether personal  contact  lead  to  changes    conditions.
          in attitudes toward the poor, the  research  team    The researchers feel  that  the  attitude  toward
          developed a 70-item test  (see  pp.  100-101  and    the  poor  test  developed  by  PSHO  is  an  im-
          app. 3). It consists  of  statements  to  be  ac-    provement  over  existing  tests,  but   requires
          cepted or rejected  by  the  respondent  concern-    item analysis  and  additional  study  before  it
          ing the political philosophy,  family  structure,    is adopted by future research projects.
          economic views and other social matters,  of  the    The   findings   indicate   that   both    groups
          poor.  The   test   was   constructed   hurriedly    changed attitudes toward the  poor.  These  facts
          shortly   before   the   summer    project    was    are illustrated in table 37 below. The higher the
          launched  in  June  1968  and   consequently   no    score, the more familiar with  the  circumstances
          time was  available  to  perform  extensive  pre-    of the poor.
          testing, nor to establish its validity and  reli-
          ability. The results show a great deal  of  atti-    The  table  reveals  that  PSHO   students   sig-
          tudinal  shifting  both  by   Penn   medical   an    nificantly increased scores while  Penn  students
                                                               decreased in regard  to  the  .,poor.  While  one
          PSHO  medical  students,  so  that  its   content    might  expect  PSHO  student  scores  to   change
          needs to be very  carefully  investigated  before
          it is used in the future. The  basic  problem  is    as a result of  exposure  to  indigent  community
          determining the scoring  of  the  questions.  For    life, the change by Penn students is not  readily
          the present research  they  were  scored  when  a    explicable.
          subject  indicated   agreement   with   the   two    Backgi-ound Comparison:
          major  scholars,  monographs   from   which   the
          questions  are  drawn  (see  p.  100).   However,    As mentioned earlier  in  the  research,  a  more
          one scholar  describes  the  working  class,  not    structured research design  would  have  required
          the lower  class,  so  that  agreement  with  the    a matched  control  group  for  the  experimental
          items taken from his reference  may  not  be  ac-    comparison.  Time  limitations   prevented   this
          curate in regard to  the  lower  class.  If,  for    possibility and, as a consequence, the  research-
          example some of  these  items  apply  exclusively    ers  opted  for  what  they  hoped  would  be  an
          to the working class, then  answering  in  agree-    acceptable matched  group  control.  Thus'  rather
          ment with his assertions  is  inaccurate  in  re-    than  matching  pairs,  it  was  hoped  that  the
          gard to the lower class and  the  scoring  would,    average background  characteristics  of  the  two
          therefore, need to be reversed.  A  second  prob-    groups would be  sufficiently  similar  to  allow
          lem concerns the  wisdom  of  generalizing  about    group comparisons. What follows  then  is  a  de-
          the poor. Although the test is designed  for  at-    scription of the background  differences  of  the
          titudes about the urban poor  specifically,  this    two groups. The  groups  were,  of  course,  sim-
          Population's characteristics  undoubtedly  varies    ilar in some traits on the average and  consider-
          according to  rate  and  geographical  region  as    ably different in others.
                                                                                                               109


                          Both      groups      consisted      of      89      percent       males,      Table 39.-Social Class of PSHO and Penn Medical
                          and      approximately      95      percent      of      each       group                                Students.
                          was      white.      However,      the      Penn       medical       stu-
                          dents     were     on      the      average      significantly      older
                          and      had      significantly      different      religious       back-      Upper   ..................  ..... 38.5   15             35.1       1
                          grounds.      The      average      age       of       PSHO       medical      Middle  ........................ 38.5    15             56.8           21
                          students    was     22.9     years,     whereas     the     Penn     stu-      Working    ........  ........... 20.5     8              8.7            3
                          dents    were    slightly    over    24    years    of     age.     (This      Lower   ........................ 2.5      1              ....          0.
                          difference     is      statistically      significant-X2      =      28.4           Total     ..............                                          37
                          df@7,          p=0.001.)
                          The     two     groups      also      differed      significantly      in      Family  income  of  the  parents  of                     the          two
                          terms      of       family       religious       background.       Almost      groups  does  not  vary  significantly                           although
                          half     of     the     PSHO     medical     students      come      from      Penn      students      come      from      families      that       earn
                          Jewish    families,     whereas     more     than     half     of     the      more     money     on     the     average.      The      mean      income
                          Penn     students      have      a      Protestant      family      reli-      of     Penn     students'      parents      was      $18,776      whereas
                          gion. This data is shown in table 38 below.                                    PSHO     was     $16,664,     a     difference     of     over     $2.000
                                                                                                         annually.     This     does     not     amount     to      a      statis-
                                                                                                         tically       signiflcant       difference,       however        (X2@5.6,
                          Table    38.-Family    Religion    of    PSHO    and     Penn     Medical      df=6, p=0.50).
                                                      Students.                                           In       regard       to       educational       experience        which
                          Religic-n                          Stu  ents                                   might     have     influenced     the     manner     in     which     the
                                                                                                         two       groups       answered       the       questionnaire,       Penn
                          Protestant    ....  ........... 20.5        8           5(.8            21     students     in     general     had     significantly      more      aca-
                          Catholic   --.  .............I--- 17.9      7           21.6            8      demic       preparation       by       enrollment       in        courses
                          Jewish  ............  ...... 48.7          19           18.9            7      concerning           community           medicine.           Twenty-seven
                          Other  .@..  ...................... 12.7    5             ...           0      percent    of    the    Penn,    but    only    8    percent    of    the
                                Total    ......  ....... 9@8                                             PSHO      students      had      coursework      in      this       area.
                                                                                                         On      the      other      band,      however,       PSHO       students
                                                                                                         had       significantly       more       actual       experience       in
                           In     terms     of     social     class,     PSHO     students      and      community     work.     Over     38     percent     of      the      PSHO
                          Penn      students       differ,       but       not       significantly.      students      had      previous       participation       in       social
                          Most     students     in     both     groups     come     mainly     from      action     projects,     whereas      less      than      11      percent
                          the   middle    and    Upper    classes    (see    p.    XX    for    the      of     Penn     medical      students      had      this      experience.
                          method     of     determining      social      class).      Table      39      Table     40     below      reflects      these      differences      be-
                          gives   the   data   on    social    clas,-,.                                  tweerl the two groups.
                                                                Table 40.-Community Medicine Coursework and Practical
                                                                         Experience of PSHO and Penn Students.

                                                                                                         Stu
                                                                                                  Per
                          Yes .........  ......................     7.7           3               27.0           10           38.5          15                  10.8
                          No  .................................    92.3          36               73.0           27           61.5          24                  89.2             33
                                 Total -..  ..... ........
                             X2=5.00; df=l; P=0.05.           XI=7.74; df=l; p=0.01.
                            In     summary,     a     comparison     of     the     two      groups      characteristics;      sex,       race,       social       class       and
                          shows     that     Penn      medical      students      are      signifi-      family     income,     the      two      groups      are      essentially
                          cantly       older,       have       had        significantly        more      similar.
                          course      work      in      community      medicine      and       less         How      much      these       background       differences       con-
                          practical      experience      in      social       action       programs      tribute    to     the     differences     in     responses     to     the
                          than     PSHO     medical     students.     In     terms     of     other      attitude    scales    is     purely     a     matter     for     specula-

                          110


       tion. it is possible that age alone could  account    in the pre-test and on six in  the  post-test.  In
       for the difference  in  answering.  Therefore,  we    cases where the  difference  dissipated  over  the
                                          the      summer    summer,  it  is   generally   movement   by   both
       can only note the possibility that                    groups in  the  other  group's  direection.  There
       experience is  only  one  contributing  factor  to    is no way to determine  why  there  was  no,  dis-
       the differences in response to the  questionnaire.    tinction  between  PSHO  and  Penn   students   on
       conclusion:                                           comprehensive  care,  team  approach,   totalopin-
        There  was  no  change  in  PSHO   medical   stu-    ionation, and attitudes toward  the  poor  in  the
       dents attitudes  from  pre-test  to  post-test  in    post-test as there' was  in  the  pre-test.  Quite
       terms of left  opinionation,  total  opinionation,    possibly  events  external  to  both  groups  were
       liberalism,  comprehensive  medical   care,   team    creating a stimulus for opinion change.
       approach in medicine,  and  medical  attitudes  in     Since the ten attitude  scales  have  differenti-
       general. There is a  possibility  that  PSHO  stu-    ated  between  the  two  groups,  particularly  in
       dents became less rightist in  political  ideology    the initial testing, one is tempted to think  that
       and more in  favor  of  socialized  medicine,  but    the tests are relatively accurate and there  exist
       these changes  may  be  due  to  random  variation
                                                     I -'    other f actors to account for the absence of  more
       The two measures  on  which  there  are  definite,    widespread   attitudinal   change    within    the
       significant  changes  are:  more  favorable  atti-    PSHO  student  group.  The  most   apparent   rea-
       tudes toward  the  poor  and  more  favorable  at-    son would  be  the  assertion  that  PSHO  project
       titudes toward preventive medicine.                   on the whole is not a source  of  pervasive  atti-
         As  for  the  Penn   medical   students,   there
       was no change in left  opinionation,  total  opin-    tude  change.  This  would  be   corroborated   by
       ionation,  liberalism,  comprehensive  care,  team    the fact that  there  was  little  manifest  atti-
       approach,  preventive  medicine,   medical   atti-    tudinal  change  among  the  total  SHO   partici-
       tudes in general, and socialized  medicine.  There    pants  (see  pp.  95-101).  Whether  this  is  the
       was  possibly  a  more   right-leaning   political    case or not, remains  open  to  question  and  de-
       stance at the end of  the  summer,  but  here  too    bate.  It  should  also  be  mentioned  that   the
       the resulting difference  may  be  simply  scoring    California 1966 research  project,  using  a  com-
       fluctuation. Penn  medical  students  became  Sig-    pletely different set of attitude scales  found  a
       nificantly  less  favorably  inclined  toward  the    change only in attitudes toward the poor    .211
       poor in the post-test.                                  It should be stipulated very  clearly,  however,
         As to the difference  between  the  two  groups,    that  the  absence  of  profound  attitude  change
       however, they are significant on all  ten  indexes    is possibly not a just reason to question    . the
        29 USC-SMC Stu(lent Health Project, op. cit., P. 17. value of the total PSHO experience.


                                           Section V

                                            APPENDIXES

                                             APPENDIX 1
                               Pre-Test Background Questionnaire
                           Philadelphia Student Health Organization
             The following questionnaire consists of six parts. Please read the instructions to each part
           and answer each one carefully.
                                    PART 1: BIOGRAPHICAL DATA

        1.   Name
        2.   Home address
        3.   School address
        4.   Age
                                               (months)
        5.   Field of Study
        6.   Undergraduate major
        7.   Race
        8.   Family religion
        9.   Family's annual income:
             up to $2,999                       $15,000 to $19,999
             $3,000 to $5,999                   $20,000 to $24,999
             $6,000 to $8,999                   over $25,000
             $9,000 to $14,999
        10.  Father's occupation:
                                         if deceased or retired list former occupation)
                                 (be specific.
        11.  Mother's occupation
        12.  Have you previously had any actual experience with social action programs in poverty
             areas such as SHO. If so please list locations and dates:
        13.  Have you ever had a course in comprehensive medical care or community medicine:
                      yes         no
        14.  Please rank in decreasing order of importance (from 1 to 5) your major reasons for par-
             ticipation in the Philadelphia SHO project for the summer:
             -the opportunity to learn about urban slum conditions firsthand.
             -the opportunity to live and work in Philadelphia.
             -the opportunity to help advance the civil rights movement.
             -the opportunity to earn $900.00.
             -the opportunity to associate with health science students.
             -the opportunity to learn about community medicine firsthand.
             -the opportunity to help the poor.
             -the opportunity to work with a practicing health professional.
                                                                                                  113


                     -the opportunity to help bring about social change.
                     -others (please list).              I will be the biggest problem You face in carrying out your
                15.  Describe what You Presently fee                                                 ing the conditions of
                     work activities this summer:           summer activities will be in improv
                16.  How eff ective do you think your
                     the poor:                                                 Slightly ineffective
                               Extremely eff ective                            Moderately ineff ective
                               Very effective                                  Very ineffective
                               Moderately eff ective                           Extremely ineffective
                               Slightly eff ective                                                   improving the condi-
                               No eff ect   ou  think  the  SHO  project   will   be as a whole in
                 17.  How      eff ective do y
                      tions    of the poor:                                     Slightly ineff ective
                               Extremely effective                              Moderately ineff ective
                               Very effective                                   Very ineff ective
                               Moderately effective                             Extremely ineffective
                               Slightly effective
                               No effect    think your summer work experience will add to your professional edii-
                  ig.  How much do you
                         cation:                                                Very little
                               A great deal                                      Nothing
                               Considerably
                               Moderately

                                                                APPENDIX 2
                                               Post-Test Background Questionnaire
                                           Philadelphia Student Health Organization
                                                          ons'sts of six parts. Please read the instructions to each part
                        The following questionnaire c        I
                   and answer each carefully.
                                                     PART -1: EVALTJATIONAL DATA
                     1.     Name                               ork experience this summer has added to your profes-
                     2.  How i
                         sional education:                                         -Very little
                                @ great      deal                                  -,nothing
                                -considerably
                                     oderately       was the summer experience helpful in acquiring knowledge for your
                      3.  To what extent, if any,
                         future career:                                            -not helpful at all
                                 -very helpf ul
                                                                                   -detrimental
                                 -moderately helpf ul
                                              helpf ul
                                 -slightly                 the summer experience helpful @ in acquiring       specific skills f or
                      4.  To what extent,    if any, was
                          your future career.
                                                                                   @ot helpful     at all
                                 -very helpful                                     -detrimental
                                  Moderately helpful
                                  -slightly helpful

                        114


      5. Which of the following type of school do you attend:
                -professional                             -technical
                -graduate                                 -Other (specify)
                -undergraduate
        6. What was your grade point average (4 pt. system) for the last semester of school attended:
        7. In terms of academic standing where do you rank:
                -top 10 percent of class                  -top 50 percent of class
                -top 25 percent of class                  -below the top 50 percent of class
       8. Please rank in decreasing order of importance (from 1 to 5) your major reasons for par-
          ticipation in the PSHO project for the summer:
                -the  opportunity to learn about urban slum conditions firsthand
                -the  opportunity to live and work in Philadelphia
                -the  opportunity to help advance the civil rights movement.
                -the  opportunity to earn $900.00
                -the  opportunity to associate with health science students.
                -the opportunity to learn about  community medicine firsthand.
                -the opportunity to help the poor.
                -the  opportunity to work with a practicing health professional.
                -the  opportunity to help bring about social change.
                -other (please specify)
        9. Please rank in decreasing order of importance (from 1 to 3) the major benefits as a
           result of participation in the PSHO project, if any:
                -the  opportunity to learn about urban slum conditions firsthand.
                -the  opportunity to live and work in Philadelphia.
                -the  opportunity to help advance the civil rights movement.
                -the  opportunity to earn $900.00
                -the  opportunity to associate with health science students.
                -the  opportunity to help the poor.
                -the  opportunity to work with a practicing health professional.
                -the  opportunity to help bring about social change.
                -the  opportunity to learn abo ut community medicine firsthand.
                -other (please specify)
        10. Describe what you presently feel was the biggest problem you faced in carrying out
           your work activities this summer:
        11. Did you live in the area in which you worked:
                      -yes, if yes was it a poverty area: -yes
                      -,no                              -no
        12.   Did you attend the initial PSHO orientation session at Eagleville-
                      -yes
                      _no
        13.   Did you attend the PSHO picnic at Parvin State Park:
                      -yes
                      _no
        14. Did you attend the PSHO midsummer conference at Eagleville:
                      -yes
                      _no
        15. Please indicate how frequently, if at all,  you  attended  the  "Tuesday  night  group
            meetings:"
                      -regularly                             -irregularly
                      -somewhat regularly                    -not at all
                                                                                                   115


                             indicate which of the following PSHO activities you attended or participated in,
             16.   Please
                  if      any:
                        -Cherry's "The Jungle."
                        -Woodruff's "A Black Analysis  of  Our  Society."
                        -Energies of @lantua
                        -Communities Relations and the Police.
                        -Rat Control and Health Problems in the Ghetto.
                        -First Aid Course.
                        -Friends Peace Committee Non-violent, Direct Action Course.
                        -Workgroup    on Curricula Reform.
                        -Workgroup on Black Admissions.
                        -Workgroup on Education (Elaine Hagen's planning group).
                        -Workgroup on Communication & Publicity (Chip Smith & Joan Horan)
                        -Workgroup  on  Project  Continuity  (Ron   Blum)
                        -Workgroup on the Newsletter (Dick Devereaux)
                        -Workgroup on Lucia's Play.
                        -Other (please specify) -
               17. Do you presently plan to practice your profession in a poverty area:
                             -yes
                             _no
                             -uncertain
               18. Do you presently have any specific plans for attempting curricula reform or faculty education
                    at your college in the fall:
                             -yes
                             -no
                             -uncertain
                19. Do you presently have plans to continue to work in the fall with the community organization
                    or institution with which you were placed this summer:
                             -yes
                             -no
                             -uncertain
                20. Are you presently active in any group seeking social change as a result of your    participa-
                     tion in the PSHO summer project.
                             -yes
                             -no
                 21. During your summer activities did you counsel anyone about a career in medicine:
                             -yes, if yes how many-.
                             -no
                 22. How effective do you think your summer activities were in improving the conditions of the
                         poor:
                             -extrem v effective                        -silghtly ineffec  e
                             -very effective                            _moderately ineffective
                                        y                               @very ineffective
                             -moderatel  effective
                             -Mightly effective                         -extremely ineffective
                             -no effect
                  23.      How effective do you think the PSHO project was as a whole in @ improving the conditions
                        of the poor
                             --extremely effective                      -Slightly ineffective
                                                                                atel ' ineffective
                             -very effective                            -itoder     y
                             _moderately effective                      -very ineffective
                                                                        -extremely ineffective
                             -slightly effective
                             -no effect

                      116


       24, Indicate how You feel in general terms about your role in the Summer project:
                  -very   satisfied                            -somewhat dissatisfied
                  -somewhat satisfied                          -Very dissatisfied
                  -Uncertain                                   et in the future, would you participate:
       25, Assuming'that PSHO repeated its summer proje
                  -yes
                  @o
                  -uncertain                                         al organization of PSHO: (,explain)
       26. What major problem, if any, do you see with the intern
           Use the back of this page for other comments, criticism, observations, suggestions, etc.

                                                  APPENDIX 3

                                               Attitude Scales
                                  PART II: BOSWELL AND NEWMAN MAT
            Instructions: This is a study of what medical  students  and  people  in  general  think  about  a
         number of social and medical questions. The best answer to  each  question  below  is  your  personal
         opinion. We have tried to cover many different points  of  view.  You  will  find  yourself  strongly
         in favor of some and disagree strongly with others.  For  some  statements  your  opinions  will  not
         be as clear cut. Whatever way you feel about any of the statements you can be  certain  that  a  good
         many people feel the way you do.  Be  sure  to  answer  every  item.  After  all,'no  knowledge,  but
         only your opinion is involved. Think quickly: your immediate  reaction  to  the  statement  is  prob-
         ably the best one.
             Read each statement carefully. Below it are five possible answers numbered 1, 2,  3,  4,  and  5.
         Circle the answer you think best represents the way you feel.
             1. How important do you hink it is for the doctor to know the effect  of  the  patient's  illness
         on his family in  order  to  provide  adequate  treatment?
                     1. Not important at all                      4. Pretty important
                     2. Pretty unimportant                        5. Very important
                     3. Not so important
             2. The greatest service a physician can provide is  in  following  longterm  health  and  adjust-
         ment of patients and families rather than in concentrating only o   n  the  treatment  of   immediate
         illness complaints of his patients.
                     1. Strongly disagree                         4. Agree
                     2. Disagree                                  5.. Strongly agree
                     3.   Undecided
             3. In medical practice today there are sufficient    specialists so that'a physician in   general
         Practice should not assume long-term responsibility for his patients.
                     1. Completely disagree                       4. Agree for the most part
                     2. Disagree                                  5. Agree completely,
                     3.   undecided
              4. The medical school should train  students  for  specialties  rather  than  general  practice.
                     1. Disagree completely                       4. Agree
                     2. Disagree                                  5. Agree completely
                     3. Undecided
                                                                                                           117


                  5. Do you think that as a physician you would prefer to have for your patients all members
                                                    . dividuals'?
             of a family rather than patients as in                    4. Yes
                            1. Definitely not                          5. Definitely Yes
                            2. No
                            3. Undecided               the physician   is to immediately relieve the suffering of
                  6. The most important function of
             the     patient.                                           4. Agree
                            1. Strongly disagree                        5. Strongly agree
                            2. Disagree
                            3. Undecided                           stress good health and promote disease pre-
                   7. In a general practice there is no reason to  ay for the alleviation of his disease.
              vention since the average patient only wants to P
                            1. For practically no cases at all          4. For most cases
                            2. For very f ew cases                      5. For practically all cases
                            3. For  some  cases                                 I practice to take time to f Ollow UP
                   8. How practical do you think it is for a doctor in clinica
               provocative  clues  other  than   the   presenting   symptoms9
                            1. It is always impractical                  4. It is usually  practical
                            2. It is usually impractical                 5. it is always practical
                            3. Undecided
                    9.     Do you think medical training in the clinical years should concentrate most of the stu-
               dent's time on evaluation and treatment of specific disease processes9
                            1.  Definitely  not                          4. Yes
                            2. No                                        5. Definitely yes
                            3. Undecided
                     10. A specialist such as an otologist, gynecologist, psychiatrist, etc., generally would be less
                effective on a routine home call than a general practioner.
                            1. Strongly disagree                          4. Agree
                            2. Disagree                                   5. Strongly agree
                            3. Undecided
                     11. Do you think th  at  Iin a medical setting, the doctor should have all personnel involved in
                                                         in case discussions regardless of their profession?
                the treatment of patients participate
                               1. Almost  never                           4. Usually
                                                                          5. Almost   Always
                               2. Not very often
                               3. Quite often
                      12. To what extent do you think a medical doctor in a clinical team should consult with
                 the team members, such as social  worker,  psychologist,  etc.,  before  making  ba'sic decisions in the
                 management of the patient, such as discharge, referrals, or pronounced changes in therapy?
                               1. In none of his cases                      4. In most of his cases
                               2. In some of his cases                      5. In nearly all of his cases
                               3. In about half of his cases
                      13. How important do you think it is to have nonmedical specialists included on a treat-
                   ment team in a medical setting?
                               1. Not important at all                      4. Pretty important
                               2. Pretty unimportant                        5. Very important
                               3. Not so important
                       14. The medical doctor in a clinical team consisting of psychologist, social worker, nurse,
                  therapists, and technicians should take a decidedly directive rather than coordinating position
                  if treatment is to be effective.
                               1. Strongly disagree                         4. Agree
                               2. Disagree                                  5. Strongly agree
                               3. Undecided

                   118


                                                                     actively participate  in  organized
          15. How important do you hink it is for a physician to
      state public health programs 9  all                    4. pretty important
                 1. Not important at                         5. Very important
                 2. Pretty unimportant
                 3. Not so important                ether or not he wants to accept the opinion Of a
          16. A medical doctor is free to decide wh
      consultant. 1. Almost 'never                           4. Qnite of ten
                                                             5. Almost always
                  2. Seldom
                  3. Undecided                     al social worker is unnecessary provided an experl
           17. in general clinical practice a medic
       enced nurse is available.       lv                     4. Agree f or the most part
                  1. Disagree complete-,                      5. Agree completely
                  2. Disagree
                   3. Undecided
            18. A medical doctor should accept the opinion of a consultant without reservation.
                   1. Never                                    4. most of the time
                   2. Seldom                                   5. Al-Nvays
                   3. Undecided
            19. After a physician has explained the medical diagnosis and prognosis of a patient to his
        relatives he refers the family to the social worker for further discussion of their reactions to. the
        patient's diagnosis and illness. How good a practice do you think this is"
                                                               4, A fairly good practice
                     1'A very poor  T)ractice                   5. A very good practice
                    2. A somewhat Poor practice
                    3. Undecided
                                       pay for medical services should not influence treatment given by
             20. A patient's ability to
         the doctor.
                     1. Strongly agree                          4. Agree
                     2. Disagree                                5. Strongly agree
                     3. Undecided                    With curative medicine is uninteresting and unprofit-
              21. Health supervision as compared
         able to the physician.
                                                                 4. Yes
                     1. Definitely not
                     2. No                                       5. Definitely yes
                     3. Undecided
              22. Hygiene, often defined as the science of health, is as much a science as internal medicine
          and pediatrics.
                      1.  Disagree  completer                     4. Agree
                                            y
                                                                  5. Agree completely
                      2. Disagree
                      3. Undecided                                                               state .of de-
                3. Specific knowledge necessary for prevention   of disease is so limited at this
               2
           velopment that the time of a practicing physician is much better spent in curative medicine.
                                                                  4. Agree for the most part
                       1. Completely disagree
                       2. Disagree                                5. Completely agree
                       3. Undecided
                24. For a well-rounded medical education, work in pediatries'and surgery is decidedly more
                                           tive medicine.
           important than work in preven
                       1.  Strongly  disagree                      4. Agree
                                                                   5.' Strongly agree
                       2. Disagree
                       S. Undecided
                                                                                                          '119


                                          ne necessitates a degree of understanding of patient's attitude toward
                  25. Preventive medici                e current practice of medicine.
             health and disease that is unusual in th                 4.  Agree  for  the  most  part
                       1. completely disagree                         5. Completely agree
                       2. Disagree
                       3. Undecided     p actice the demand for treatment of disease is so great that hardly any
                   26. in  present   day   r             ith prevention of  illness.
              time can be  spared  to  concern  oneself  w             4. Agree  for  the  most  part
                        1. completely disagree                         5. Completely agree
                        2. Disagree
                        3. Undecided       0 you  think it is for a physician to participate in programs of accident
                   27.   How   important   d                                       mportant
               prevention?                                             4.  Pretty  i
                         I. Not important at all                       5. Very important
                         2. Pretty unimportant
                         3. Undecided       of disease is directly related to the properties of disease itself, there
                    28.   Since   prevention             entive aspects in separate courses.
               is no special  reason  to  teach  the  prev              4. Agree
                         1. Disagree completely                         5. Agree completely
                         2. Disagree
                         3. Undecided
                                                                      s of disease prevention as personal habits of
                     29. There is little value in stressing principle               of effecting more lasting Change is
                most adult patients are so firmly established that  the  possibility
                rather unlikely.
                          1. Disagree completely                         4. Agree
                          2. Disagree                                    5. Agree completely
                          3. Undecided
                     30. Prevention of disease as a medical activity     is primarily the responsibility of health de-
                partments rather than the responsibility of bedside      physicians.
                                                                         4.    Agree
                          1 . Disagree completely                        5. Agree completely
                           2. Disagree
                           3. Undecided

                                                     PA'RT III: THE R-0 SCALE
                      Instructions:  The  following  are  questions  concerning  what  students,  think  and  feel  about  a
                 number  of  important  social  and  personal  questions.  The  best  answer  to  each  statement  below  is
                                                                                                    g points  of  view;  you
                  your  personal  opinion.  We  have  tried  to  cover  many  different  and  opposin
                  may  find  yourself  agreeing  strongly  with  some  of  the  statements,  disagreeing  just  as  strongly
                  with others, and  perhaps  uncertain  about  others;  whether  you  agree  or  disagree  with  any  state-
                  ment, you can be sure that many people feel the the same as you do.
                       Mark each  statement  in  the  left  margin  according  to  how  much  you  agree  or  disagree  with
                  it. Please  mark  every  one.  Write  +1,  +2,  +3,  -1,  -2,  -3  depending  on  how  you  feel  in  each
                  case.
                             +I: I agree a little                          -1: I  disagree  a  little
                             + 2: 1  agree  on  the  whole                 -2: 1 disagree on the whole
                                                                            -3: 1 disagree very much
                             +3: 1 agree very much
                             1-1-2-3          (1) It's all too true that the rich are getting richer and      the poor are
                   +3 +2 +
                                                   getting poorer.
                   +3+2+1-1-2-3               (2)  It is very foolish to advocate government support of       religion.
                    +3+2+1-1-2_3              (3), This much is certain: The only way to defeat tyranny in China is
                                                   to support Chiang Kai-Shek.

                       120


                                             (4) It's perf ectly clear that the decision to execute the Rosenberg's has
                                  +3+2+1-1-2-3 done us more harm  than  good.           he believes that college
                                                          be pretty short-sighted if
                                             (5) A person Must                        ial loyalty oaths.
                                 @+3+2+1-1-2-3 professors should be forced to take sPee ida put out by the real
                                                  ly those who believe the propaga
                                      +1-1-2-3 (6) It,s main              . st a federal slum clearance program,
       +3 +2                                 estate interests who are again member the Hoover days will tell
       +3             +2              +1-1-2-3 (7) Anyone who's old enough to re           reelected.
                                             you that it's lucky thing Hoover was never                   roof that
                                             (8) The American  rearmament  program  is  clear  and  positive  P
                                  +3+2+1-1-2-3 we are willing to sacrifice to preserve our freedom.  will be better
                                             mostly the noisy liberals who try to tell us that we
        +3             +2             +1-1-2-3 (9) it's
                                             off under socialism.         rs who talk about government owner-
                                        -1-2-3 (10) it's usually  the  troublemake
        +3 +2 +1                             ship of public utilities.    t is the private enterprise system which
                                        -1-2-3 (11) History clearly shows  that  i
        +3 +2 +1                             is at the root of depressions and  wars.   that the way to solve our
                +                      1-1-2-3 (12) It's perfectly clear to all thinking persons
        +3 +2                                -financial problem is by soak-the-rich tax program.        f ailure.
                                                                          t the United Nations    is a
                                             (13) it's already crystal,clear tha                    ii that the only
                                   +3+2+1-1-2-
                                       1-1-2-3 (14) Anyone who is really for democracy knows very we      backward
         +3 +2 +                             way for America to  head  off  revolution  and  civil  war  in
                                             countries is to send military aid.                      f  air Deal pro-
                                             (15) There are two kinds of people who fought Truman's
                                  +3+2+1-1-2-3
                                             gram: the selfish and the stupid.        s who yell the loudest about
                                  +3+2+1-1-2-3 (16) It's the radicals and the labor racketeer
                                             labor's right to strike.                                 that the Corn-
                                                          t be pretty gullible if he really believes
         +3            +2             +1-1-2-3 (17) A person mus          trated into government and education.
                                             munists  have  actually  infil ould believe that the 'United States is
                                                         uided  idealist  w
                                  +3+2+1-1-2-3 (18) Only   a   Mlsgt    warmonger-
                                             an imperialis    nse tells you that prejudice can be removed by
                                  +3+2+1-1-2-3 (19) Plain common se
                                             education,  not   legislation.                           the time about
                                                                          reds who keep yelling all
          +3            +2            +1-1-2-3 (20) it's the fellow travellers  or
                                             civil Rights. st be pretty stupid if he still:@elieves in differences
                                  +3+2+1-1-2-3 (21) A person mu
                                             between the races.           ant if he things that ROckef eller is going
                                        -1-2-3 (22) A person must  be  very  ignor
          +3 +2 +1                           to  let  the  "big  boys"  run this country.       you that Alger Hiss
                                          -2-3 (23) Anyone    who    knows    what is going on will tel
           +3 +2 +1-1                                                     ed his couDtrY-            that it would be
                                             was  ,  traitor   who   betray brain in his head knows
                                  +3+2+1-1-2-3 (24) Any   person   with   even   arv be run by men like General MacArthur.
                                             dangerous  to  let  our  count                               is not really
                                                 ughtful persons know that the American Legion
           +3           +2            +1-1-2-3 (25) ThO
                                             interested    in    democracy.
                                             only a simple-minded fool would think that Senator Joseph Me-
           +3           +2            +1-1-2-3 (26)
                                             Carthy is a defender of American democracy.                that the world
                                             (27) you can't help but feel sorry for those who believe
            +3           +2           +1-1-2-3.couldn't  exist  without  the   Creator.
                                  +3+2+1-1-2-3 (28) Any intelligent person can plainly see that the real reason America
                                             is  rearming  is  to  stop   aggression.                          wants to
                                  +3+2+1-1-2-3 (29) The truth of the matter is this: it is  big  business  thaIt
                                             continue the cold war.
                                                                                                                     'i2l


                 +3     +2     +1-1-2-3  (30)  History will clearly show that  Churchill's  victory  over  the  Laboul:
                                               Party in 1951 was a step forward for the British people.
                 +3+2+1-1-2-3            (31)  Even a  person  of  average  intelligence  knows  that  to  defend  our-
                                               selves  against  aggression  we  should  welcome  help-including  Franco
                                               Spain.
                 +3     +2     +1-1-2-3  (32)  It's the agitators and left-wingers who are  trying  to  get  Red  China
                                               into the United Nations.
                 +3+2+1-1-2-3            (33)  It's simply  incredible  that  anyone  should  believe  that  socialized
                                               medicine will actually help solve our health problems.
                 +3     +2     +1-1-2-3  (34)  It's the people who believe everything  they  read  in  the  papers  who
                                               are convinced that Russia is pursuing a ruthless policy  of  aggression.
                 +3     +2     +1-1-2-3  (35)  It's mostly those who are itching for  a  fight  who  want  a  universal
                                               military training law.
                 +3     +2     +1-1-2-3  (36)  It's perfectly clear to all decent  Americans  that  congressional  com-
                                               mittees which investigate communism do more good than harm.
                 +3     +2     +1-1-2-3  (37)  It's just plain stupid'to say that it was  Franklin  Roosevelt  who  got
                                               us in the war.
                 +3     +2     +1-1-2-3  (38)  A study of American history  clearly  shows  that  it  is  the  American
                                               businessman who has contributed most to our society.
                 +3     +2     +1-1-2-3  (39)  It is foolish to think that the Democratic Party  is  really  the  party
                                               of the common man.
                 +3+2+1-1-2-3            (40)  Make no mistake about it! The  best  way  to  achieve  security  is  for
                                               the government to guarantee jobs for all.,

                                               PART 1V: THE PSHO-OAP SCALE
                     Instructions: In the following series of  questions  we  are  interested  in  your  opinion  about
                 poor people in  general.  We  are  interested  in  your  own  personal  opinion  therefore  there  are
                 no "right" or "wrong" answers.  Please  indicate  how  you  feel  about  each  statement  by  deciding
                 if you agree or disagree, and the strength  of  your  opinion.  Then  circle  the  appropriate  number
                 in front of the statement in the following fashion:
                          +3:   Strongly   agree                          -1: Slightly disagree
                          +2:   Moderately    agree                       -2: Moderately disagree
                          +1:   Slightly   agree                          -3: Strongly disagree
                            0:   Uncertain
                     Many  of  the  statements  may  seem  absurd  and  impossible  to  answer  by  simply  noting  how
                 strongly you  agree  or  disagree.  Nevertheless,  answer  every  item  even  if  you  must  guess  at
                 some. Keep in  mind  that  the  questions  concern  the  URBAN  POOR  in  general  and  not  any  spe-
                 cific minority  group.
                 +3+2+1     0      -1-2-3     (1) Most poor people are poor because they     are lazy.
                 +3+2+1     0      -1-2-3     (2) There is little antagonism  or  conflict  between  poor  parents  and
                                                  their children.
                 +3+2+1     0      -1-2-3     (3) The poor are   greatly  concerned  with  gaining  social  status  and
                                                  pre tige.
                 +3+2+1     0      -1-2-3     (4) Children in poor families are expected  to  obey  parental  authority
                                                  immediately.
                 +3+2+1     0      -1-2-3     (5) Wives of the poor frequently face the threat of desertion.
                 +3+2+1     0      -1-2-3     (6) The poor generally resis  t innovation in preference for  traditional
                                                  ways of doing things.
                 +3+2+1     0      -1-2-3     (7) The poor would  rather  learn  things  from  books  than  from  other
                                                  people.

                 122,


                                             (8) while desiring a good standard of living, the poor are not at-
      +3+2+1             0              -1-2-3 tracted to a middle class style of life,. rned with "getting by"
      +3+2+1             0              -1-2-3 (9) most poor families are dominantly  conce
                                             rather than "getting ahead."
      +3+2+1             0-1-2-3             (10) The poor are compensated for their poverty by enjoying a more
                                             sensual lif e.        difficult to have informal, comfortable
                         -1-2-3              (11) The poor usually find it
       +3+2+1            0                   relationships with other persons.
             +1          0-1-2-3             (12) The poor are not readily open to reason.    f class diff er-
       +3+2                                  (13) The poor are -not class conscious, although aware o
       +3+2+1            0-1-2-3
                                             ences.    ally read very little and ineff ectively.
              +1         0-1-2-3             (14) The poor usu                                           er-
       +3+2                                 -3 (15) in poor families there is a. great deal of f amilY discord and int
        +3+2+1           0-1-2               ersonal conflict.                           ii
                                             p                       of intellectuals as  egg-heads."
                                             (16) The poor generally think
        +3+2+1           0-1-2-3                                   a considerable interest in encouraging a
        +3+2+i           o-1-2-3             (17) Generally the poor have children.
                                             college education for.their           such as movies to active
        +3+2+1           o-1-2-3             (18) The poor prefer passive  entertainment
                                             entertainment such as parties and dances.         one in a slow,
        +3+2+1           0-1-2-3             (19) The poor are able to build abstractions, but it is d
                                             physical fashion.    not interested in planning for long-term
         +3+2+1          0-1-2-3             (20) The poor are usually immediate gratification of needs.
                                             goals, but rather prefer
                                             one of the major problems of the poor is unemployment and the
         +3+2+1          0-1-2-3             (21)
                                             threat of laYoff.
                                             (22) The poor generally judge a political candidate on the basis of per-
         +3+2+1          0-1-2-3             sonality rather than on qualifications or platform.
         +3+2+1          0-1-2-3             (23) The poor family is frequently "child-centered."
                         -1-2-3              (24) The poor are largely uninterested in politics.            in
         +3+2+1          0                              efer I abstract planning to direct, concrete action
         +3+2+1          0-1-2-3             (25) The poor pr
                                             attaining goals.      les, aunts and cousins of the poor usually
          +3+2+1         0-1-2-3             (26) The  grandparents,  unc
                                             rjaaintain close family ties.
          +3+2+1         0-1-2-3             (27) The poor view most Political leaders as corrupt "bigshots.." d to
          +3+2+1         0@1-2-3             (2s) The poor prefer voluntary associations to be loosely organize
                                             those with rflore structure.                           ant author-
                                                      milies the husband is generally not the domin
          +3+2+1         0-1-2-3             (29) in poor fa
                                             ity figure.
           +.8+2+1       0-1-2-3             (30) The poor are quite well informed about most social and political
                                             issues.
           +3+2+1        0-1-2               (31) The poor prefer strong, directive leadership to that of nondiree-
                                             -3
                                             tive leadership.
           +3+2+1        0-1-2-3             (32) The poor generally have sufficient contact with Most social insti-
                                             tutions such as the school.
           +3+2+1        0-1-2-3             (33) Humor among the poor often takes the form of physical acts such
                                             as "horseplay."                        e not sharply differentiated
            +3+2+1       0-'1-2-3            (34) The duties of husbands and wives ar
                                             in poor families.
            +3+2+1       0-1-2--3            (35) Usually the poor will accept jobs that provide moderate economic
                                             security as opposed  to  those involving risk but the possibility of
                                             high monetary return.
                                                                                                              123


                                           (36) Most poor people believe that the                              legiti-
                +3+2+1     0      -1-2-3                                           "insanity plea" is not a
                                                 mate defense in a criminal trial.
                +3+2+1     0      -1-2-3   (37)  The poor usually hold flexible opinions.
                +3+2+1     0      -1-2-3   (38)  The outstanding weakness of the poor is a lack of education.
                +8+2+1     0      -1-2-3   (39)  The poor rarely have  firm  convictions  about  such  issues  as  re-
                                                 ligion, morality and custom.
                +3+2+1     0      -1-2-3   (40)  Physical punishment is  the  basic  disciplinary  technique  for  the
                                                 children of the poor.
                +3+2+1     0      -1-2-3   (41)  Most poor people are not willing to work even  if  given  the  oppor-
                                                 tunity.
                +3+2+1     0      -1-2-3   (42)  The poor are an outgoing, friendly and amiable people.
                +3+2+1     0      -1-2-3   (43)  The poor rarely rely on  such  facilities  as  banks,  hospitals  and
                                                 department stores.
                +3+2+1     0      -1-2-3   (44)  There is  a-considerable  amount  of  preoccupation  with  sex  among
                                                 the poor.
                +3+2+1     0      -1-2-3   (45)  The wives of the poor  generally  accept  a  tradtionally  submissive
                                                 role in relation to their husband.
                +3+2+1     0      -1-2-3   (46)  Mothers in poor families  tend  to  deprive  their  children  of  ma-
                                                 tternal affection.
                +3+2+1     0      -1-2-3   (47)  Even  the  poor  who  show  initiative  and  industry  are  prevented
                                                 from improving their lot by overwhelming circumstances.
                +3-'r2+1    0     -1-2-3   (48)  Most poor people are  concerned  with  the  future  rather  than  the
                                                 present "here and now."
                +3+2+1       0-1-2-3       (49)  There  is  a  high  incidence  of  common-law  marriages  among   the
                                                 poor.
                +3+2+1       0-1-2-3       (50)  The poor tend to be narrow-minded and self centered.
                +3+2+1       0-1-2-3       (51)  The  poor  are  generally  isolated  and  withdrawn  from  their  own
                                                 community.
                +3+2+1       0-1-2-3       (52)  The poor have a low level of literacy.
                +3+2+1       0-1-2-3       (53)  Children of the poor generally do  not  have  long  protected  child-
                                                 hoods.
                +3+2+1       0-1-2-3       (54)  In most poor areas there is an absence  of  local  community  spirit.
                +3+2+1       0-1-2-3       (55)  There is a good deal of metaphor and analogy  used  in  the  language
                                                 of the poor.
                +3+2+1       0-1-2-3       (56)  The poor are not easily capable  of  kindness,  generosity  and  com-
                                                 passion.
                4        3+2+10-1-2-3      (57)  The' poor  are  tough  people  who  cope  with  problems  that  would
                                                 overwhelm many middle class individuals.
                +3+2+1       0-1-2-3       (58)  The poor tend to be provincial and ethnocentric.
                +3+2+1       0-1-2-3       (59)  Children of the poor are initiated into sex late   in life.
                +3+2+1       0-1-2-3       (60)  The  poor  are  members  of  few  social  organizations  beyond  that
                                                 of the family.
                +3+2+1       0-1-2-3       (61)  The poor live  in  areas  in  which  there  are  numerous  murderers,
                                                 drug addi@, thieves and prostitues.
                +3+2+1       0-1-2-3       (62)  The poor are   quite impulsive iri their behavior.
                +3+2+1       0-1-2-3       (63)  The poor usually belong to numerous voluntary associations.
                +3+2+1       0-1-2-3       (64)  Most poor persons consider poverty to be their fate.
                                           (65)  Most -poor persons have a feeling  of  helplessness,  dependency  and
                +3+2+1       0-1-2-3'            inferiority.
                +3+2+1       0-1-2-3       (66)  The poor have a basic distrust of the police.
                +3+2+1       0-1-2-3       (67)  The language used by the poor is simple, direct     and earthy.

                 124


                                                                          class values and try to live by them.
              I         0          -1-2-3 (69) The poor are aware of  middle Ilegitimate children among the poor.
     +S+2+                                                                                            and adven-
                                        -3 (69) There is a high incidence of i      new experience
     +3+2+1            0             -1-2              w a need for excitement,
              1         0          -1-2-3 (70) The poor sho
      +3+2+                             ture.
                                            PART V: THE SMA SCALE                                    ink about a
                                           of what medical students and people in general th
                ,uctions: This is a study                                 to each statement below is your per-
           Inst,                           uestions.   The   best   answer
      number of social and medical q                                              -ng these alternatives:
       sonal    Opinion.                your response to the following statements usi
           Please                indicate                         -1: Disagree
                       +2: Strongly agree                          -2: Strongly disagree
                       +     1:     Agree                                                 of private practice is
                       0:       Undecided
                                        (1) The quality of medical care under the system
       +2+1            0             -1-2 superior to that under a system of socialized medicine.     uctive PoPu-
                                        (2) Socialized medicine will produce a healthier and more prod
        +2+1            0            -1-2 lation.                                       less incentive for Young
                       -1-2             (3) Under the socialized medicine there would be               test good to
        +2+1           0                men to become doctors.
                                                          is necessary because it brings the grea
        +2+1           0-1-2            (4) Socialized medicine f people.
                                        the greatest number o              ne would be rnechaniral and super-
        +2+1           0-1-2            (5) Treatment under socialized raedici
                                        ficial.                                         ne of the true aims of a
         +2+1          0-1-2            (6) Socialized medicine would be realization of 0
                                        democracy.                                                      between the
         +2+1          0-1-2            (7) Socialized medicine would upset the traditional relationship
                                        family doctor and the patient.
         +2+1          0-1-2            (8) 1 feel that I would get better care from a doctor whom I am paying than
                                        from a doctor who is beinLy oaid by the government.
         +2+1          0-1-2            (9) Despite many practical objectionsy I feel that socialized medicine is a
                                        real need of the American people.
                                        (10) Socialized medicine could be administered quite efficiently if the doctors
         '+2+1         0-1-2
                                        would cooperate.                                                          and
                                                                                                     een doctors
          +2+1         0-1-2            (11) There is no reason why the traditional relationship betw
                                        patient cannot be continued under socialized medicine.
          +2+1         0-1-2            (12). If socialized  medicine  were  enacted,  politicians  would  have  contr.ol over
                                        doctors.                              cal practice is the one best adapted
                    +2+10-1-2           (13) The present system of private inedi
                                        to the liberal philosophy of democracy.
                    +2+10-1-2           (14) There is no reason why doctors should not be able to work j   ust as well
                                        under socialized -medicine as they do now. -
                    +2+10-1-2           (15) More and better care will be obtained under socialized medicine.
                    +2+10-1-2           (16) The atmosphere of socialized medicine would destroy the initiative and
                                        the  ambition  of  voung  doctors.
                                                                                          eine upon the  eople with-
                    +2+10-1-2           (17) Politicians are trying to force socialized medi              p
                                        out giving them the true facts.
                    +2+10-1-2           (18) Administrative costs under socialized medicine would be exorbitant.
               +       10-1-2           (19) Red tape and bureaucratic -problems would make socialized medicine
            +2
                                        grossly inefficient.                                      pri acy of the indi-
           1 ,
           @ i       @+10-1-2           (20) Any system of socialized medicine would invade the       v
                                        vidual.
                                                                                                                     125


                                                PART VI: THE ATS SCALE
                  instructions: This last series  of  questions  survey  students  opinion  on  the  issue  of  segrega-
                tion. Please indicate your response to the statements using these alternatives:
                       +3:   Strongly    agree                      -1: Slightly disagree
                       +2: Moderately agree                          -2: Moderately disagree
                       +1:   Slightly    agree                       -3: Strongly disagree
                +3+2+1-1-2-3           (I)   Racial  segregation  is  an  effective  and  practical  social  arrangement
                                             which has no serious effect on the vitality of democratic ideals.
                -@3+2+1-1-2-3          (2)   The  Negroes'  main  concern  is  with  equal  educational   opportunities.
                                             They have no intention of intei-ferring with the social  patternIs   of   the
                                             white community.
                +3+2+1-1-2-3           (3)   The best safeguard of a democracy is the solid stability of  social  tradi-
                                             tion such as is involved in the maintenance of segregation.
                                -2-3   (4)   Integration threatens one of the principles  of  democracy,  the  right  of
                +3+2+1-1
                                             each citizen to choose his own associates.
                +3+2+1-1-2-3           (5)   The end of segregation would bring a continuing  increase  in  social  con-
                                             flict and violence.
                +3+2+1-1-2-3           (6)   Although the IQ of Negroes  in  the  South  is  on  the  whole  lower  than
                                             the IQ of whites, this difference in intelligence is  mainly  due  to  lack
                                             of opportunity for  the  Negro  and  will  eventually  disappear  under  an
                                             integrated school system.
                +3+2+1-1-2-3           (7)   Since integration  "-ill  require  some  painful  adjustments  to  be  made
                                             in changing from segregated schools, the best solution  will  be  to  leave
                                             the races segregated.
                +3+2+1-1-2-3           (8)   Equal educational exposures  in  integrated  schools  will  help  both  the
                                             Negro and white students to profit from the best of two cultures.
                +3+2+1-1-2-3           (9)   Desegregation  can  in  most  cases  be  accomplished  without  being  fol-
                                             lowed by social conflict and violence.
                +3+2+1-1-2-3           (10)  Improving  Negro  education  via  integregation  will  lead  to  a   higher
                                             standard of living in  the  South  accompanied  by  more  and  better  jobs
                                             for everybody.
                +3+2+1-1-2-3              (11) The Supreme Court's decision on  segregation  was  a  politically  inspired
                                             invasion of  states'  rights  and  represents  a  miscarriage  of  justice.
                +3+2+1-1-2-3              (12) The Negro race is physically  and  mentally  inferior  to  the  white  race
                                             and integregation Nvould not help to erase the innate  differences  between
                                             the two races.
                +3+2+1-1-@             (13)  Integregated and therefore better education  for  the  Negro  via  ihtegra-
                                             tion is certain to result in increased feelings of responsibility  and  co-
                                             operation in his part.
                +3+2+1-1-2-3              (14) The successes of already completed  integration  attempts  are  clear  evi-
                                             dence that the fears of extreme pro-segregationists are unfounded.
                +3+2+1-1-2-3              (15) Negroes who are given the opportunity  to  go  to  integrated  schools  are
                                             apt to become demanding, officious and overbearing.
                +3+2+1-1-2-3              (16) Although certain radical Negro leaders try  to  make  people  think  other-
                                             wise, the majority  of  Negroes  do  not  want  integration  and  would  be
                                             satisfied with "equal but separate" school facilities,
                +3+2+1-1-2-3              (17) Desegration will develop a false sense of  power  among  Negroes  and  will
                                             move us closer to having a "Negro party" in America.
                +3+2+1-1-@                (18) The South  has  failed  to  adequately  draw  upon  the  resources  of  the
                                             Negro race  and  integrated  schools  will  enable  the  Negro  to  make  a
                                             greater contribution to the South eco-. nomically  and  socially  than  they
                                             have been able to make with segregated schools.

                126


                                          ou start letting Negroes  attend  the  schools  of  whites  they  will
         +3+2   +   1-1-2-3    (19) Once y                                                         dating    and
                                    demand complete social equality in all respects including
                                    club privileges.                 Ily unfair  to  the  Negroes  who  will'nOw
         +3+2+1-1-2-3          (20) The'desegregation law is basica
                                    have to compete on equal terms with the whites.
         +3+2+1-1-@            (21) Negroes and whites will find it easier to get along  together  in  the  same
                                    school than most people think.
         +3+2+1-1-2-3          (22) In dealing with the problems  of  desegregation  we  should  always  act  in
                                    terms of thechristian rule of  brotherhood  and  justice  for  all  and  not
                                    in terms of social attitudes based on tradition.
         +8+2+1-1-2-3          (23) The practice of segregation cannot help  but  reduce  our  political  influ-
                                    ence in international affairs.
         +3+2+1-1-2-3          (24) Desegrezation will  lead  to  a  permanent  lowering  of  standards  in  the
                                    public schools.
         +3+2+1-1-2-3          (25) Desegregation    is economically  wise  since  the  Soiith's  poor  economic
                                    state may in part be due to the double expense of segregation.

                                                    APPENDIX 4
                           Guidelines for Problem and Community Papers
         MEMO     TO:     PRECEPTORS     AND      PROJECT      WORKERS      IN-VOLVED      IN      GROUP      WORK,
                         TEACHING     CLASSES,      LEADING      RECREATION,      AND      OTHER      KINDS      OF
                         ACTIVITIES WITH COMMUNITIES AND ORGANIZATIONS.
         FROM:  KAREN LYNCH
         SUBJECT:  PROBLEM PAPERS (YELLOW GUIDELINES 1)
             You should present your  activities  of  the  summer  from  several  points  of  view.  I  would  like
         you  to  focus  on  the  problems  and  conflicts  you  have  encountered  in  working  with  your   group
         or community.
             You'll  probably  make  the  greatest  impact  by  describing  specific  problems  and  specific   ex-
         amples  of  the  things  which  have  happened  this  summer.   Focusing   on   problems   and   conflicts
         will highlight the critical  issues  you've  encountered.  These  may  appear  to  be  "personality  prob-
         lems,"  or  misunderstandings  between  you  and  community  people   or   you   and   health   producers.
         Examine these problems from the point of view of the process of getting services to people.
              These guidelines may help in thinking about your activities:
              1.  Groups.  If  you've  been  in  contact  with  groups  of  people-through   recreation   programs,
                  sex education classes, group therapy,  day  camp  psychiatric  followup,  or  other  similar  ac-
                  tivity-describe your activities with these grou@s,  your  intentions  or  plans  for  the  groups
                  and  the  development  of  these  activities.  Speak  in  examples  including  time,  names,  and
                  identifying information.
              2.  Health  problems.  If  you  have  come  across  health  problems,  become   involved   with   at-
                  tempts to meet health needs, discovered gaps  in  information  about  health  services,  or  mis-
                  informed attitudes, describe these problems in detail  and  your  attempts  to  deal  with  them.
              3.  Resources. If you  have  become  aware  of  resources  at  your  site-people,  experience,  orga-
                  nizations, places-which  can  be  effectively  utilized  in  the  delivery  of  health  services,
                  describe these, how you found them, and what potential they offer.
               The most vivid and striking approach to this  is  by  presenting  one  incident  or  project  activ-
          ity. This incident should  point  out  a  problem  in  the  health  care  system  or  in  community's  re-
          sPonse to health issues. It should show how you decided to  deal  with  it,  what  help,  difficulty,  or
                                                                                                               127


                 indifference you received from the medical "establishment,"  and  what  help,  difficulty,  or  indiffer-
                 ence  you  encountered  from  communities.  Be  as  specific  as  possible  in  your   descriptions   and
                 analysis.
                 RETURN     THE     PROBLEM     PAPER     TO     KAREN     LYNCH'SHO     OFFICE,     BY     AUGUST     14,
                 1968
                 MEMO     TO:     PRECEPTORS     AND     PROJECT      WORKERS      INVOLVED      IN      THE      DEVELOP-
                                 MENT     OF     SERVICES,     COMMUNITY     ORGANIZING,      PLANNING      WITH      COM-
                                  MUNITIES, ACTING ON SURVEY FINDINGS.

                 FROM:  KAREN LYNCH
                 SUBJECT:  PROBLEM  PAPERS (YELLOW GUIDELINE 2)
                      1.  What is the central issue you've worked on this summer?
                      2.  Why is this an issue, who identified it, and who wanted action on it?
                      3.  Describe  what  you've  been  doing  this  summer,  focusing  on  the  problems  and   conflicts
                          you  have  encountered.  You  may  want  to  include  a  chronology  of  activities,   including
                          names, titles, and ways of contacting people  of  the  community  and  of  the  "establishment."
                           include  a  description  of  how  the  medical  establishment  (or   nonhealth   establishment)
                          related to your  summer's  activities-the  cooperation,  conflicts,  and  problems  you  encoun-
                          tered with them and how you dealt with them. Describe specific incidents.
                          Include  a  description  of  the  way  health  consumers,  community,  patients,   clients   re-
                          lated to your activities. Were they resposive, hostile,  cooperative?  How  did  you  deal  with
                          their reactions. Des@ribe specific incidents.
                 RETURN    THE    PROBLEM    PAPER    TO    KAREN     LYNCH,     SHO     OFFICE,     BY     AUGUST     14,
                 1968
                 MEMO     TO:     PROJECT     WORKERS     INVOLVED     IN     SURVEY     WORK     AND     STUDIES     PRE-
                                  CEPTORS.
                 FROM:  KAREN LYNCH
                 SUBJECT:  PROBLEM PAPERS (YELLOW GUIDELINE 3)
                      1.  Why did you, undertake the survey or study? What, in  other  words,  is  the  rationale,  justi-
                          fication, or purpose of the survey or study?
                      2.  What is the intended use of your survey or study? Who, what group, is involved?
                      3.  Who asked that it be done? Who supervises or has overall responsibility for it?
                      4.  How did you  go  about  setting  up  your  survey  or  study?  Describe  the  planning  and  who
                          was involved, the  design  of  the  study,  sampling  procedures,  development  of  survey,  and
                          so on. Tell as much as you can about the  problems  of  developing  the  study  and  working  up
                          the findings.
                      5.  Did  you  follow  through  and  use  the  instrument-survey9  Did  you  present  (or   are   you
                          presenting) a report? To whom?
                      6.  Did you encounter hostile or  cooperative  responses  by  those  interviewed  or  studied?  Does
                          this tell you anything about the attitudes of your population?
                      7.  What are the descriptive findings of the survey or study?
                      8.  What were your results in terms of problems to deal with and action on findings?
                      If  you have presented a report to your site or anyone else, please enclose a copy of           that
                 with your problem paper.
                      If you acted on survey findings or undertook the development  of  services,  use  one  of  the  yel-
                 low  guidelines for presenting  those  activities.  If  those  guidelines  are  inappropriate,  go  ahead
                 and explain in your own terms what happened after the survey or study was completed.

                 128,


      RETURN THE PROBLEM PAPER TO KAREN LYNCHP SHO OFFICE, BY AUGUST 14,
      1968
                               WORKERS IN COMMUNITIES
      MEMO TO:  PROJECT
      FROM:  KAREN LYNCH
                COMMUNITY PAPERS (GREEN GUIDELINE)                                          cerned     with
          You know the local community where you are working this summer. Others con
      the delivery of health services don't know Your community. I would like  you  to  use  the  questions
      on this green page as a guideline for writing a description of the  local  community  you  are  work-
      ing in.
           This description of the  local  community  should  be  written  with  the  cooperation  and  ap-
      proval of your preceptor and organization.  Nothing  should  be  included  which  you  or  your  com-
      munity would find objectionable. The purpose of  these  questions  is  to  provide  Philadelphia  SHO
      and others interested in getting health  care  to  local  communities  with  information  about  your
      community so that they will be a better informed position  in  planning  their  programs  with  local
      communities.                                                         %
           1.   How is your community defined? Indicate  geographical  boundaries  and  characteristics  of
                the people and -the area which are important. (Keep this description relevant, but  brief.)
           2.   What services are provided your  community  and  how  adequate  are  these  services?  Some
                of the services you may wish to comment on are transportation  system,  shopping,  schools,
                rubbish and trash collection, police protection, and recreation.
           3.   More specifically, what is the condition of the  health  care  system  in  your  community?
                What services are  known  and  not  known?  What  is  the  response  of  the  community  to
                present services.
            4.  What major community health problems have you encountered this summer?
            5.  Has the community been  involved  with  health  planning?  Describe  experiences  you  have
                been involved with and experiences you have heard about.
            6. From your experience in the community, if you want  to  get  things  done,  how  do  you  go
                about it? If you have a plan or a grievance, for example, how do you  go  about  acting  on
                it in your community?
            As I mentioned above, these are only  guidelines  for  presenting  your  community  in  such  a
        way that those who haven't had the experience of working with  it  will  have  some  idea  of  your
        community  and  health  servic.es. I suggest that you keep the paper brief but accurate.
        RETURN    THE    PROBLEM    PAPER    TO    KAREN    LYNCH,    SHO    OFFICE,    BY    AUGUST    14,
        1968

                                                                                                          129


                                                           APPENDix 5
                                                       Personal  Contacts
              PHILADELPHIA         STUDENT          HEALTH          ORGANIZATION                     W-HHS-yl-
                                            SHEET                          Contactor                 ate
              PERSONAL               CONTACTS                                    State-                 nd
                                                                               Time: Begi
               1. NAME       OF       CONTACT                         4. CIRCUMSTANCES OF CONTACT
                                                                      Place of Contact
                         Male                                           n Home of contae,
                         Female                                          ri    Community health center
                         Puerto Rican                                          Welfare Agency
                         Negro                                                 On the street
                         White                                                 Hospital
                         Age                                                   Other
                         Last                                                                              lanned
                2.     YTATU:                                                                             other activity
                         community     worker                                                               act with this
                         Community     leader                              H
                         Health Prof essional                                  person
                                            s'onal                                              e follow-up contact with
                         Nonhealth  profes  I                                  There will not b
                         Medical   technician                                  this person           CT
                   rl City government ofricial                          5. PURPOSE OF CONTA
                   rl    other   SHO   worker                                  investigate housing conditions
                   tj    Oth                                                   Self   education
                   "-ONT                                                       Self   education
                 3.      C                                                            rc  for further work
                         Pei                in person                          Resou  e
                         Person     contacted                                 rl Patient advocacy
                         Person     contacted individually                     Referrals
                                                                                              dical services
                         Size of group      o-ntacted in group-                Providing     me
                         Names  of  others  c                                  other
                                                                                                                    CTION
                                                                                      BE  BRIEFLY  WHAT
                                                                         6.      DESCRI
                            St contact with person
                         Fir                                                   WAS TAKEN
                         Contactor initiated meeting
                         Contact initiated meeting
                         Other initiated meeting
                   7. EVALUATION OF CONTACT                           ed 5 4 3 2 1 unsatisfied with the contact.
                                            cted seemed to  be  satisfi
                         The   person   conta                                       disinterested in the contact.
                         The person contacted seemed to be interested  5  4  3  2  1
                                                              cooperative 5  4  3  21 uncooperative in the contact.
                         The person contacted seemed to be                                success 5 4 3 2 1 a failure.
                         The person contacted seemed to feel that the contact was a
                                                         success 5 4 3 2 1  a  failure.
                         I think that the contact was a
                                                                               in terms of special accomplishments.--
                                            state the  results  of  the  contact
                   8.  If  possible,   please

                                     omments'
                    9. Additional c

                       130


                                                                       the   attempt   by   a   removed    person    to    integrate
           Contact Sheets as a Research Technique                      and    summarize    a    second    party's    summer     work
                                                                                 For    example,    had    the    health     science
           The   purpose   of    asking    project    workers    at    activities.   ChristoPher's    used     his     own     co'n-
           Spring    Garden    community     center     and     St.    student at St.                        ting            teenage
                                                                  e    tact sheets  in  regard to  attrac
           ChristoPher's Child and comprehensive Car                                        In   classes,   he   would    be    able
                              n     their     personal     Contacts    gangs to sex educatio     essive    and     sensitive     ac-
           Center to report 0                   ting         method    to  present  a  more   expr                        uninvolved
           was  to  experiment   with   a   repor                      count than can a researcher who is
           which    might    provide    unique    and    previously              activity first haid.
           untapped   data   regarding    the    deficiencies    of    with    the            t   sheet"   then    seems    to    be
           the  health  care  system  and  to   help   develop   an    The "contact repor        ersonal       accounting       form
           evaluational   technique   for   future   SHO   research    most  applicable  as  a   p           .      t       workers.
                              onal   contact   sheet"   has   vari-    for use by the  individual  projec
           projects. The "pers  rits in this regard.                   Should  this  f  orm   be   used   in   f   uture   research,
           ous merits and deme                  usage    of     the    it   should   be   modified   to   a   certain   extent   and
           Probably    the    most     suitable to,   complete   it    student   should    be    thoroughly    briefed    on     its
           checklist would be for      students                                  s
                                     over   the   course   of   the    purpose,  The     modifications     should     expand     the
           on an individual basis,              e  to   write.   an              on    purpose    of    contact,    action     taken
           summer,  and  use  it  as  a  referenc                      sections  omplishments     of     contact.     An      effort
           end-of-summer   report.   in   this   sense   the   con-    and     ace               ourage     a     more     elaborate
           tact  report  sheets  are  an  adequate,  quickly  corn-    should  be  made  to   eric  s;    otherwise,     the     re-
                               which     students     can      make    reporting on these itern                  This          might
           pleted format by     etivities  and  use   them   as   a    maining data have no relevance.
           daily logs of their a a  final   report.   The   contact    be    accomplished     by     encouraging     student,     to
           personal record for  uitable   for   the   method   used    make   more   detailed    notes    rather    than    attempt-
           sheets do not seem s         as  a  report  to  a   cen-    ing to develop additional questions.
           in this research-that is,            unit  is  too  dis-                                                              ask
           tral  research  unit.  The   central                                  any future use of this form should
           tant  from  the  daily  activities  to  make   a   valu-      Also,
           able  report   on   health   system   deficiencies.   if    for   the   occupation   of   the   person   contacted    and
           in  the  case  of  the  present  research,  each   proj-    his  title,   and   the   specific   name   of   the   agency
           ect  worker  had  utilized  his   own   contact   sheets    or   organization   for   which    the    person    contacted
           as  a  reference  to  write  a  report  on  the   health    works.   As   a   reporting   technique    to    a    central
           system,  it  would   have   been   for   more   factual,    researcher,    however,    its    usage    is    not    recom
           informative,  specific,  detailed  and   readable   than    mended.

                                                          APPENDIX          6
                                  Project List: Project Sites and Participants
                               Black     Summer                          Project   workers:   Ka   ryne   Dunbar    (CW),    Dorothy
                                                                          Federman  (HSS), Ida Floyd (CW).
           Precel)tor: Lee Montgomery, Office of Urban      Aff    airs, Area coordinator: Jay Federman.
            Temple University.                                           Delaware  CountY   Health   and   Welfare   (Citizens   for
           Project workers.: Mike Roth  (HSS), Bob               Sussman                    BetterIPublic Health)
           Area  coordinator:  Paul   Fernhoff.                          Preceptor: Peter Brigham.
              CEPA-Consumer's    Editcation     and     Protecti-ve      Project  workers-.  Jan   Baxt   (HSS),   Sheldon   Halpern
                                    Association                             (HSS) -
                                                                         Area coordinator: Dick Devereux..
               e tor: Max Weiner, 6048 ogontz Avenue.                                      Eagleville Hospital
                           s:  Clarissa  Cain   (CW)'p   Garland   Demp-                                                           al
                           Jane    Friedman    (HSS),    Steve    Marder Preceptor:  Donald  Ottenberg.  M.D.,  Eagleville   Hospit,
                                                                            and Rehabilitation Center, Fagleville, Pa.
                                                                         Project   workers:   Debbie   Finkelstein   (HSS),   Darryl
                        nator:  Paul  Fernhoff.
                         en Concerned for Welfare Rights                    Robbins (HSS).       1 Fernhoff.
              receptor:  Leona  Thomas,  741   North   Preston   Street. Area   coordinator:   Pau
                                                                                                                                   131


                             East,wick    Community    Organization                        Jefferson Community Mental Health
                  Preceptors:   Regina   Eichinger,   8508   Harley   Avenue;     Preceptor:  Jerry  Jacobs,   Junto   Building,   12th   and
                     Joan Baker, 2816 South 81st Street.                            Walnut  Street;  John  Mock,  M.D.,   Philadelphia   Gen-
                  Project  workers:  Andrea  Benn  (YI),  Clark  Bird   (YI),       eral Hospital.
                     Renee   Edwards   (YI),   Eileen   Fair   (HSS),    Paul     Project   workers:   Mike   Geha   (HSS),    Payle    Jones
                     Frame (HSS), Bill Woods (HSS).                                 (HSS).
                  Area   coordinator:   Dick   Devereux.                          Area coordinator: Mary Lou Evitts.
                             Experiment   in    Community    Action                           Ludlow Community Association
                  Project worker: Lucia Siegel (HSS).                             Preceptor:  Marvin  Lewis,  1233  North  Franklin   Street.
                               Fai?-mont Community Council                        Project  workers:  Darlene  Bredell  (YI),   Gustine   Bre-
                  Preceptor: Marion Hilliard, 3956 Pennsgrove Street.               dell  (CW.),  Jerry  Braverman   (HSS),   Carol   Dinker-
                  Project   workers:   Frank   Ferri   (HSS),    Steve    Fox       lacker   (HSS),   Peter    Eisenberg    (HSS),    Richard
                     (HSS), Nathan Smith (YI).                                      Lockett   (HSS),   Denise   Smith   (YI),   Brenda   Wil-
                  Area   coordinator:   Jay    Federman.                            liams (CW).
                                                                                  Area coordinator: Cleve Dawson.
                                 Fishtown Civic Association                                   Mantua Community Planners
                  Project worker: Bill Halperin (HSS).                            Preceptors:  Forrest  Adams;  John   Ciccone;   MCP   Work-
                  Area   coordinator:   Cleve    Dawson.                            shop, 3625 Wallace Street.
                                        Gray's     Ferry                          Project  workers:   Phil   Graitcer   (HSS),   Frank   Hart
                  Preceptor: Velva Taylor, 1337 South 28th Street.                  (YI),  Ken   Logan   (HSS),   William   Roundtree   (CW).
                  Project   workers:   Rich   Bonanno   (HSS),   Rhoda   Hal-     Areea coordinator: Jay Federman.
                     perin (HSS), Francine Lewis (CW).                                                   Mill Creek
                  Area   coordinator:   Paul   Fernhoff.                          Preceptor: Onna Parker, 709 June Court.
                                     Haddington Homes                             Project  Worker:  Claudia   Mills   (YI),   David   Stewart
                  Preceptor:  Mary  Voughn,   5448   Aspen   Place.                 (HSS).
                  Project   workers:   Keith   Hansen   (HSS),   Mary    Rich     Area coordinator: Jay Federman.
                     (CW).                                                                         Misericordia Hospital
                  Area   coordinator:   Jay    Federman.                          Preceptors:  Henry  Hunter,  Department   of   Public   Re-
                             Ha?ltranft    Community    Corporation                 lations,  54th  and  Cedar  Avenue;  Dr.  Lynch,  Depart-
                  Preceptor:   Hector   Rodriques,   3257   Germantown   Ave-       ment  of  OB  GYN,  54th  &  Cedar  Avenue;  Dr.   Hesch,
                     nue.                                                           Outpatient Department, 54th & Cedar Avenue.
                  Project  workers:   Yvonne   Butterfield   (HSS),   Charles     Project   workers:   Gwendolyn   Anthony   (CW),    Richard
                     Cook  (YI),  David  Eisenberg  (HSS),   Natline   Thorn-       Bremer   (HSS),   Dan   Brzusek   (Hss),    Willie    Mae
                     ton  (CW),  Van  Williams  (CW),   Heidi   Wolf   (HSS).       Harris   (CW),   Leonore   Lee   (CW),   Susan   Skulnick
                  Area   coordinator:   Cleve    Dawson.                            (HSS), Bettina Stronach (HSS).
                                                                                  Area coordinator: Dick Devereux.
                               Hawthorne       Community Center
                  Preceptors:  Charles  Floyd,  5215  Spruce  Street;   Caryl                      North City Congress
                     Heimer,  M.D.,  235  South   Third   Street;   Jefferson     Preceptors:  Alvin  E.  Nichols,  Director;  Steve  Turner,
                     C  &  Y,  1332  Fitzwater   Street;   Hawthorne   Commu-       Mr.  Cameron,  Tony  Lewis,  1428  North  Broad   Street.
                     nity Center.                                                 Project  workers:  Meredith  Hand   (HSS),   Stanley   Rey-
                  Project   workers:   Susan    O@r    (HSS),    Don    Sesso       nolds (HSS).
                     (HSS), Nate Williams (CW)-.                                  Area coordinator: Cleve Dawson.
                  A-rea coordinator: Mary Lou Evitts.                                             Ogden Civic Association
                                     Holmesburg Prison                            Preceptor: Mamie Weaver, 4117 Ogden Street.
                  Preceptor:  Norman   Jablon,   M.D.,   Holmesburg   Prison,     Project   workers:   Martha   Arey   (HSS),   Alma    McEl-
                     Torresdale Avenue.                                             roy  (YI).
                  Project  workers:  Alan   Cohler   (HSS),   Lawrence   Kron     Area coordinator: Jay Federman.
                     (HSS).                                                       Preceptors:    Mike    Simmons,    3702    Spring    Garden
                  Area   coordinator:   Paul   Fernhoff.                            Street; Lou Ellen Williams, 7235 Paschall             ue;
                                        Horizon    House                            Rhoda Houston, 7225 Greenway Avenue.
                                                                                  Project  workers:  Lawrence  Budner   (HSS),   Renel   Bur-
                  Preceptors:  Armin  Loeb,  M.D.,  Research  Director,  1825       den (YI)  ! Dudley   Goetz"(HSS),   Chris   White   (YI).
                     Pine Street; Audrie  Russell,  Director  of  Case  Work-     Area coordinator: Dick Devereux.
                     ers, 1823 Pine Street;  Lee  Booth,  Director  of  Resi-     Pernet  Family  Health  Service  (Little  Sisters  of   the
                     dence,  504-6  South  42d   Street.
                  Project workers:  Steve  Ager        HSS),    Jim    Padget                           Assumption)
                     (HSS).                                                       Preceptors: Sister  Rita,  Sister  Marguerite,  1001  South
                  Area coordinator: Mary Lou Evitts.                                47th Street.

                  132


                                                                        Project workers: Art Pressman (IISS), Bill Robinson
           Project worker: Joan Gomes (HSS)-                            (HSS) -              Lou Evitts.
           Area coordinator: Dick DevereUX.                             Area coordinator: Mary
                      Presbyterian Hospital                                     Welfare Rights Organization
           Preceptor: Neville R. Vines, 51 North 39th Street.
           Project workers- Frank Greer (HSS), Garnette Hicks           Preceptor: Roxanne Jones, 1520 Green Street; 1021
           (CW), Jerry Lozner (HSS), Wilhelrnina Seamon                 South Fourth Street.
           (CW).                                                        Project  workers'  Marpha  Crafton  (YI),  Shirley
           Area coordinator: Jay  Federman.                             Fischer (HSS), Gene Shatz (HSS), John Zonano
           Southwest Center City Community Council (SWCC)               (HSS), Jean Wilkerson (YI).
           Preceptor: Joseph Cooper, 1732 Catherine Street.             Area coordinator: Dick Devereu)L
           Project workers: Isma Jackson (CW), Carla Oswald             West Philadelphia Community Mental Health
           (HSS), Ed Pisko (HSS).                                                         Consortium
           Area coordinator: Mary Lou Evitts.
                           spring    Garden                             1. Trouble Clinic.
           Preceptor: Pat Story, M.D., 1812 Green  Street.              Preceptors:  Jacob Schuts, M.D.;  Gordon Podensky,
           Project  workers:  Anita   Costa (HSS),      Tom Fiss        6001 Woodland Avenue.
           (HSS),Walley Pillich (YI), William Smith (YI).               Project workers:  Bart Butta  (HSS), Robert Lewy
           Areea coordinator: Paul Fernhoff.                            (HSS).
                 Spruce Hill Community Association                      Area coordinator: Dick Devereux.
           Preceptor- David E. Boyce, Department of City and            11. Recreation Project.
           Regional Planning, University of Pennsylvania, 4428          Preceptor: Christine Westfall, PGH.
           Pine Street,                                                 Project workers:  Richard Bernstein  (HSS), Harry
           Project workers: Stephen Terzian (HSS).                      Hirsh (HHS), Lucia Sosnowski (HSS).
           Area coordinator: Dick Devereux.                             Area coordinator: Dick Devereux.
           St. Christophe,?s Child and Youth Comprehensive                            Young Great Society
                             Care    Center                             Preceptors: Lillian Johnson; William Spotwood, 603
           Preceptor: Evelyn B. Wilson, Director; Nina Perry,           North 33d Street.
           Mrs. Kennedy.                                                Project workers: Ivan Cohen (HSS-). Thomas Devlin
           Project workers- Dick Bagge (HSS), Forrest Lange             (HSS), Freida Farlow (CW), Patricia Ford (YI).
           (HSS), Richard Morrison (YI), Hetherwich Ntaba               Area coordinator: Jay Federman.
           (HSS).
           Area coordinator: Cleve Dawson.                                                Project Staff
              Temple Community Mental Health Center                     Director: Robert L. Leopold, M.D.
           Preceptors: Stanton B. Felzer, Ph.D., Assistant Di-          Student directors:  Chip  Smith, Ron Blum,  Elaine
           rector; Alvin Thomas, Director, Community Organiza-          Haagen
           tion, 1531 West  Tio-ga  Street.                             Research directors: Karen Lynch, Jon Snodgrass.
           Project  workers:  Bess  Aronian (HSS), Philip Harber        Area coordinators:  Cleve  Dawson,  Dick  Devereux,
           (HSS),   Anne   Sheehan   (HSS).                             Mary Lou Evitts, Jay Federman, Paul Fernhoff.
           Area coordinator: Cleve  Dawson.                             Secretaries: Carrolyn Morgan, Rita Boler, Edith Barn-
                         University Settlements                         hill.
           Preceptors: Jerry Gardner, Mike Norris, 2601 Lombard         Advisory council: Walter J. Lear, M.D., Sue Leslie;
           Street.                                                      Jim Shelton; William A. Steiger, M.D.
                             U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE
                                                     Public Health Service
           Philadelphia    Student     Health     Project-Summer     1968

           U@S. GOVERNMENT PRINTING OFFICE: 1969  0-355-229
                                                                                                                            133


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