PN - Reiff, Michael/////
            CN   - Colorado Student Health Project////
            CN   - University of Colorado Medical Center////
            CN   - Student Health Organization of Colorado////
            CN   - United States. Division of Regional Medical Programs////
            Ti   Colorado Student Health Project, summer 1968/
            TC    . Editor: Michael Reiff.
            IM   [Bethesda, Md.,/Health Services and Mental Health Administration,/19701
            CO - V, 101 p.:illus.
            CA -WA 546 AC6 C8c 1970:02NLM,Ol SSY
            EL   FULL LEVEL
            IT - MONOGRAPH
            MT    CORPORATE NAME MAIN ENTRY
            DA    710316
            Ul - 1255244


           COLORADO STUDENT HEALTH PROJECT summer 1968


                           COLORADO STUDENT HEALTH PROJECT
                                                    SUMMER 1968

                                                       Sponsored by
                            STUDENT HEALTH ORGANIZATION OF                           COLORADO
                                                   in conjunction with
                           THE UNIVERSITY OF COLORADO MEDICAL CENTER

                         Student Coordinator      ---------------------------- Michael Reiff
                         Associate Student Coordinator     ------------------- Randall Lortscher
                         Area Coordinators -------------------------------     Vemon Bry
                                                                               Lisa Wilson
                         Faculty Sponsors      ------------------------------  C. Henry Kernpe, M.D.
                                                                               Prof. Howard Higman
                         Research Fellms       --------------------------I---- Alfred Claassen
                                                                               John Quicker
                         Executive Secretary      ---------------------------- Sharon Kabella
                         Editor        --------------------------------------- Michael Reiff

                                       U.S. Department of Health, Education, and Welfare
                                                      Public Health Ser@e
                                        Heala Servz'ces and Mental Health Administration
                                              This prcVed was supported in full by
                                           The Division of Regional Medical Programs
                                                    (Contract No. 43-68-1528)


                                            This report does not necessarily represent
                                            the t*ws of the Pub@ Health Se@e


                                                        Table
                                                           of
                                                      Contents

                     ACKNOWLEDGMENTS           ------------- I---------------------------        v
                     PREFACE     -----------------------------------------------------           2
                          Action  and  Reaction
                          by Michael Reiff        --------------------------------------------   2
                          The Project Sponsors' Preface
                          by C. Henry Kempe, M.D. and Professor Howard Higman         -------    5
                     CHAPTER I-THE SITES                -------------------------------------    7
                          The  Grand   Valley -------------------------------------------        8
                            A.  The   Project
                                 by  Vernon  Bry ----------------------------------------        8
                            B.  The  Health  Care   System -------------------------------       10
                          The San  Luis  Valley -----------------------------------------        12
                            A.   The  Project
                                 by Randall Lortscher       ----------------------------------   12
                            B.   The  Health  Care  System -------------------------------       13
                            C.   A Study of Folk Medicine in the San Luis Valley
                                 by John Quicker and Alfred Claassen     --------------------    14
                            D.   Folk  Medicine  Questionnaire ----------------------------      18
                          Denver ----------------------------------------------------            18
                            A.  The   Project
                                 by Lisa  Wilson ----------------------------------------        18
                            B.   The  Health  Care  System -------------------------------       20
                                 East    Denver ------------------------------  -  ----------    20
                                 West    Denver ------------------------------------------       23
                     CHAPTER II-THE STUDENT REPORTS                     ---------------------    25
                     CHAPTER        III-THE        INTERNS -------------------------------       51
                                                                                                 59
                     CHAPTER               IV-PERSPECTIVES -------------------------------
                          New    Perspectives
                          by  Peter   Bonavitch -----------------------------------------        60
                          community Presence-A Justification
                          by Bonnie Camp, M.D         ---------------------------------------    63
                          Discussion        -------------------------------------------------    64
                     CHAPTER         V-THE          EVALUATION
                     -by Affred Cl     n and John Quicker      ------------------------------    73
                                                                                                       in


                      APPENDIX             ---------------------------------------------------    85
                           partio_ipants and Preceptors      ----------------------------------   86
                           Conference Schedules      -----------------------------------------    89
                           Demographic Data         ------------------------------------------    91
                           Student Attitude Scales      --------------------------------------    93
                           Individual Evaluations       --------------------------------------    100
                           Student Questionnaire  ---------------------------------      -----    101

                   iv


                                        ACKNOWLEDGMENTS
                      We wish to thank the following people for their efforts  and  support
                  during the 1968 Colorado Student Health Project: Dr. Robert  Q.  Marston,
                  Dr. Richard Manegold, and  Dr.  Herbert  Mathewson  of  the  Division  of
                  Regional Medical Programs for their guidance throughout the project;  Dr.
                  Howard Doan and  the  staff  of  the  Colorado-Wyoming  Regional  Medical
                  Program for their interest and  involvement;  Mr.  George  Knox  and  Mr.
                  Donald Brennan for their administrative assistance; Dr. Bonnie  Camp  and
                  Miss Marcia Looney for their many hours spent in reviewing  this  report,
                  and Mrs. Louinda  Benson  and  Mrs.  Martha  Hodgkinson  for  preparation
                  of the manuscript itself.

                       This report is dedicated to our fond memories of Suzanne Campbell.
                                                                                                v


                                                                                  Pref ace


                                     COLORADO STUDENT HEALTH PROJECT

                                          ACTION  AND          REACTION
          As  students  in  health  professional  schools  we  ence: the country's first interdisciplinary  group
          find large  gaps  among  ourselves,  our  patients,  of health science students. This  group  initiated
          our  institutions,  and  the  allied  health   pro-  several   action   oriented   community   projects
          fessions.  Our  curricula   emphasize   the   basic  which  ranged  from   a   concentration   on   the
          sciences  and  their  clinical  correlations-rarely  health problems  in  the  San  Joaquin  Valley  of
          are  we  introduced  to   community   health.   Our  California to  work  with  the  Medical  Committee
          learning material is  the  medically  indigent  pa-  for Human Rights in Mississippi.
          tient. We are taught  the  skills  of  viewing  him  In  Autumn  of  1965  these  students   felt   the
          as a  pathological  specimen,  seldom  as  a  human  need to share  their  experiences  on  a  national
          being.  Health  care  delivery  is  often  seen  as  level. Sixty-five students  from  25  health  pro-
          medical crisis solving rather  than  an  obligation  fessicinal schools met at the University  of  Chi-
          to deal with a total life  style  inseparable  from  cago  for  the  First  Assembly  of  the   Student
          environmental  and  socioeconomic  conditions.   To  Health  Organizations  (SHO).  The   decision   to
          the ghetto dweller  health  care  is  considered  a  establish  a  summer   fellowship   in   community
          low  priority.  These  health  care  consumers  are  health for  1966  grew  out  'of  these  meetings.
          often  alienated  from  a  health  care  system  in  Funding  was  approved  by  OEO  and  this   first
          which  they  lack  franchise.  Hospitals  are   too  Student  Health   Project   (SHP)   was   formally
          often  viewed  as  institutions  where  one   comes  sponsored by  the  University  of  Southern  Cali-
          prepared to die, deteriorate,  or,  at  best,  wait  fornia  School  of  Medicine   and   the   Student
          for hours to  be  seen.  A  manifestation  of  this  Medical  Conference   of   Los   Angeles.   Ninety
          health care crisis is the  lack  of  representation  fellowships were  secured  for  students  from  40
          of minority groups in our own schools.               health schools across the  country.  The  students
           The  Student  Health  Organization   has   evolved  formed  interdisciplinary  teams  aided  by   pre-
          in reaction to these situations.  Its  history  has  ceptors  familiar  with  community  health   prob-
          been  well  documented.1-4  It  has  now  witnessed  lems,  community  workers  and   local   agencies.
          four national  assemblies  and  3  -years  of  Stu-  The objectives of  the  program  were  to  aid  in
          dent Health Projects. Its  numbers  are  now  esti-  the procurement of health services, a  role  which
          mated  at  over  2,000.  This   involvement   arose  later  became  known  as  "patient  advocacy,"  to
          from a  small  but  committed  nucleus  of  medical  catalyze   community   action    around    health-
          students  at  the  University  of  Southern   Cali-  related issues, and to educate the  students  con-
          fornia. The first formal  activity  of  this  group  cerning  the  problems  of  health  care  delivery
          was to sponsor a  student  forum  on  controversial  to ghetto areas.
          health and social issues deleted from  the  classi-    The  movement  has  since  grown.  In  the  sum-
          cal medical curriculum. This led  to  the  publica-  mer of 1967 three health  projects  based  on  the
          tion of a journal, Borborygmi,  and  eventually  to  model of  the  previous  year  were  launched  irf
          the  formation  of  the  Student  Medical   Confer-  New  York,  Chicago,  and  California.  These  in-
                                                               volved 260 students  of  medicine,  medical  tech-
           McGa@ey,  et.  at.,  A  Study   in   Medical   Action-The   Student nology, dentistry, dental technology,  osteopathy,
          Health Organizations. NEJM, 279:74-80, 1968.
           1 Gordon,  L.  J.,  Ed.,  Chicago  Student  Health  Project,  Summer nursing, social work, and law.  The  new  projects
          1967, Chicago, Ill., 1968, Chicago Student Health Project. added  ghetto-area  high  school  students,  "high
           3 Brod, T. M., Ed., 1967  California  Student  Health  Project,  Los
          Angeles, California, 1968, California Student Health Project. school interns," to the teams  in  an  attempt  to
           4 Fisch, S., Williams. J., Ed., The Student Health  Project  of  the interest   them   in   medical   and   paramedical
          South Bronx, New  York,  N.Y.,  1968,  South  Bronx  Stttdent  Health
          Project.                                             careers.

          9.


                                                       z5umMER   1968
           These  projects  again  stimulated   more   student   for whom  continuity  of  care  is  often  an  insur-
          involvement  during  the.academic  year   and   have   mountable   obstacle;   the   seasonal   worker   who
          led to concern  not  only  in  the  Area  of  ghetto   is  often   unaware   of   existing   programs   and,
          health, but also in school curriculum  reform,  stu-   many  times,  lives  in  areas  where  no  such  pro-
          dent  involvement   in   planning   school   policy,   grams  have  been  instituted;  and  the  urban   and
          programs  demanding  the   incorporation   of   more   rural  ghetto  dweller  who  is   becoming   progres-
          minority students into our  health  schools,  and  a   sively more  alienated  from  a  health  care  system
                                                  'thin    our   in  which  he  has  no  voice  and  is  used   as   a
          concentration on internal changes wi
          own institutions.                                      "teaching case."
           The   1968   Colorado   Student   Health    Project     The  summer  was  one  of  education,   some   con-
          derives  from  our  own  student  participation   in   crete   achievements   and   numerous   frustrations.
          these former activities. It reflects the same  joint   An initial  frustration  was  the  delay  in  funding
          student-faculty-community      sponsorship,      and   which  made  it  impossible  to  plan   programs   in
          shares  many  common  goals  with   past   programs.   advance   with   community   agencies.   This    lack
          As stated in  the  grant  proposal,  our  particular   of structure has  been  criticized  by  many  of  the
          objectives  encompassed   the   areas   of   commun-   fellows,   interns,   community   groups,   and   the
          ity  service,  self-education  and  biomedical   ca-   sociology  students  in  their  evaluation   of   the
          reers.5  The  community  service   aspect   involved   project.  The  -philosophy  of  unstructured   objec-
          defining  community  health   needs   as   perceived   tives has  been  an  integral  part  of  many  former
          by the  residents  and  ourselves,  sensitizing  the   SHP'S.  In  this  type  of  situation   the   student
          existing health care institutions  to  these  needs;   learns to base his priorities on  the  needs  of  the
          promoting the full utilization  of  existing  facil-   community   rather   than   his   preconceived    no-
          ities and the  evolution  of  new  health  services;   tions.  This   has   been   described   by   MeGarvey
          and  attempting  to  make  active  participants  out   et al: I
          of  largely  passive  health  care  recipients.   We        ... the student  was  given  a  large  de-
          attempted  to   augment   our   own   education   by        gree  of  autonomy,  and   was   supported
          living  and  working  in  the  environment  of   our        by   extensive   consultative   resources.
          gipatients"; learning  to  understand  the  inequal-        With  minimum   structure,   the   student
          ities of the health care system for  the  poor,  and        was  forced  to  identify  problems.   and
          in turn to  plan  health  programs  as  they  relate        discover  solutions,  drawing  upon  his.,
          to   community   needs;   experimenting   with    an        own resourcefulne  ss.  Pressed  to  begin
          interdisciplinary  approach  to   health   problems;        defining  his  identity  as  a  member  of
          and  considering  ways  which  these  types  of  ex-        the health professions,  the  student  be-
          periences  might  be  incorporated  into  our   uni-        gan a process of  self-discovery  and  re-
          versity  curricula.  The  objectives  of  the   high        direction  of   professional   commitment.
          school   "intern"   program   included    augmenting     The  argument  for  more  structure  is   that   it
          our effectiveness in their  conununities  and  stim-   leads  to  more  achievement.   Yet   the   following
          ulating these students  in  the  directions  of  in-   pages  document  many  successes  of  the   students.
          creased   community   involvement   and   biomedical   Why,  then,  did  they  feel  that  the  project  was
          careers.                                               only  moderately  successful  with  regard  to   its.
            The project sites  included  five  rural  and  two   service  aspect?  As  a  group  concerned  with  con-
          urban  settings."   This   variety   of   placements   tributing  to  alterations  in  the'present   methods
          afforded the students  the  opportunities  for  con-   of health  care  delivery,  we  cannot  be  satisfied
          trasti,ng  health  care  facilities   and   delivery   with  therapy  analogous  to  treating   -the   dying
          among  a  number  of  unique  groups:  the   migrant   patient  with  aspirin.,  To  organize  projects   of
          worker  who  qualifies  for  few  health  care   and   greater  import  would  necessitate  intense,   long-
          welfare benefits  because  of  his  transience,  and   range  involvement.  T  question,   then,   may   not
                                                                 be  one  of   structure   versus   nonstructure   but
            $(;rant Pro@, Colorado Student Health ProJect. -Rummer rather  deep  commitment  as  opposed   to   a   sum-

             See ChaPters 1, 2 Rnd 5.                               See footnote 1, P. 2.


                                                    SUMMER 1968
         mer of exposure. If this 10 week period  has  led   future projects should  be  organized  on  a  more
         to the realization of such commitments,  we  have   sustained  basis;  and  should  involve  a  closer
         fulfilled the prerequisite  toward  a  more  ger-   look at our own communities, the  institutions  in
         mane level of function.                             which  we  work,  and   the   schools   which   we
           What  have  we  learned?  We  have  seen   many   attend .7
         of the problems and barriers to the  delivery  of     The  ultimate  success  of  this   project   can
         health care to the "medically indigent." We  have   only be  determined  when  we  become  the  health
         begun to , develop realistic methods  of  dealing   care system  rather  than  its  observers.  It  is
         with these problems. These insights  have  stimu-   hoped that the following report  will  reflect  on
         lated the growth of new ideas and  -Derspectives.   our prognosis.
         As one student noted:  "We  have  been  observing
         the end stage of a- disease process-we have  been              MICHAEL REIFF,
         working in communities  where  you  see  the  re-              Student Coordinator,
         sults of the present health care  system  ...  We              Colorado Student Health Project.
         have been patching up this  end:,'  but  ignoring
         the process itseIL"  The  implications  are  that    IA discussion of these new perspectives is included in Chapter  4.

          4


                                       COLORADO STUDENT HEALTH PROJECT

                                   THE PROJECT SPONSORS' PREFACE

           The two faculty  sponsors  chosen  by  the  Orga-   facilities and  resources.  The  following  reports
         nizing  Committee  of   Colorado   students   faced   fail to show, as clearly as we  would  have  liked,
         the  SHO  Colorado  summer  project  with  a   good   the kind of  admiration  that  developed  for  some
         deal of optimism  and  only  a  few  concerns.  Our   of  the  rural  physicians  in   private   practice
         optimism  related  to  the  firm  feeling  that  we   among  many  of  our  students,   almost   all   of
         were being asked to advise a  group  of  idealistic   whom  on  arrival  saw  private  physicians  in   a
         young  health  professionals  who  wanted  to   get   stereotyped and hostile @  way.  The  material  de-
         involved in the rural and  urban  health  needs  of   scribes well, on  the  other  hand,  the  red  tape
         our State and in the knowledge that  out  of  their   handicapping  many  programs   designed   to   help
         experience   would   come   models   for   us   'as   the poor to achieve health care.
         teachers, for research and  services,  relevant  to     During  the  welcoming   session,   we   insisted
         the  education  of  health  professionals  both  at   that the  University  of  Colorado  Medical  Center
         the student and  faculty  level.  Our  concern  re-   sponsorship  brought  with  it  the  acceptance  of
         lated to the fact that the students  represented  a   certain arbitrary  rules  set  by  the  University.
         great  spectrum  of  motivations   and   attitudes.   We  were  concerned  that  a  number  of   students
         Some were likely to  expect  a  good  learning  ex-   would leave  the  proj6ct  when  we  insisted  that
         perience  with  the  firm  expectation  that   they   during  working  hours  no  buttons,  whether   for
         would  initiate  some   meaningful   change   which   political candidates or for  the  cause  of  peace,
         could be carried on  by  others  when  they  return   could be worn. We were told  that  in  other  proj-
         to their respective  schools.  Some  students  were   ects many students  would  have  walked  out  right
         emotionally  deeply  involved  in  the   innnediate   then but nobody did.
         concerns over the war  in  Vietnam,  the  political     The   relationship   between   the   coordinating
         election, the shortcoming  of  their  current  edu-   con"mittee  and  the  faculty   sponsors   remained
         cational experiences, et cetera.IAmong   the   lat-   cordial. We learned a good deal  from  each  other.
         ter, we  expected  to  find  and  did  find  a  few   Because we  managed  to  stay  in  the  background,
         who saw no hope in  gradual  change  in  the  medi-   such  rebellious  attitudes  which  developed  from
         cal care delivery system, in  attitudes  of  physi-   time to time were directed at the  student  leaders
         cians  currently  in  practice  and  in  government   rather than against ourselves.
         programs   designed   for   the   improvement    of     We believe that  the  ultimate  assessment  of  a
         health care for all.                                  project such as  this  requires  some  time.  Aside
           We faced a difficult task in  assigning  students   from the effect on health  care  in  the  immediate
         to projects  where  they  could  make  a  contribu-   project area which  will  be  influenced  by  local
         tion and  at  the  same  time  not  cause  such  an   and Federal support  in  the  years  to  come,  the
         enormous  upheaval  in  the  local  community   and   effect on the participating students is not  easily
         in our relationship  to  local  physicians  and  io   foreseen. Not all  students  who  express  interest
         governmental  programs  as  to   leave   behind   a   in health care of the poor will end  up  delivering
         medical  care  situation  worse  than   when   they   such  care  when  their  time  comes.   Some   have
         came. For this reason  we  justified  our  involve-   found the poor  to  be  unmotivated,  unattractive,
         ment  in  placement  by  pointing  out  that   this   and unrewarding to  a  degree  that  they  will  be
         summer project would  not  leave  behind  a  single   unwilling to limit their professional life  to  the
         viable  health  care  system  and  that,'therefore,   most needy.
         all efforts had to go  towards  improving  existing     We think,   in any case, thai  this  may  be  too

                                                                                                                 5


                                         COLORADO STUDENT HEALTH PROJECT

           much to ask and that a  single  system  of  medi-               C. HENRY KEMPE, M.D.,
           cal involvement of  all  professionals  with  all                 Professor and Chairman,
           levels of population would be greater justice  to                 Department of Pediat7ics,
                                                                             University of Colorado Medical
           patients and health professionals alike.                          Center.
             We  feel  admiration  and  affection  for   the
           students who  came  to  Colorado  in  the  summer               HowARD HIGMAN,
           of 1968 and are  grateful  for,  the  opportunity                 Professor of Sociology,
           to have been chosen as faculty sponsors.                          University of Colorado.

           6


                                                                   Chapter 1

                                                                   The Sites


                                          COLORADO STUDENT HEALTH PROJECT
             The  summer   projects   were   based   in   three   with our  local  high  school  student,  who  would
           major areas  of  the  State.  The  rural  placements   give us-an  introduction  to  the  com  unity  from
           were situated in  the  Grand  Valley  on  the  west-   her point of view.  After  this,  further  contacts
           ern  slo'pe  and  the  San  Luis  Valley   in   south- were made  with  local  physicians  and  officials,
           central Colorado. The  urban  aspects  of  the  pro-   and we were told  that  there  were  few,  if  any,
           gram   centered   around   two   areas   in   Denver   problems present in the  area  of  health  care  in
           itself.  The  areas  are  discussed  separately   in   Grand  Junction.   Consequently,   we   drew   back
           this chapter. Each section  contains  a  description   and through  the  process  of  elimination  decided
           of the individual projects as  well  as  a  sununary   that if anyone knew the problem,,i of  the  region,
           of the students'  impressions  of  the  health  care   the  local  Vista  volunteers  would@   They   were
           system in their respective locations.                  quite eager to give us an overall  picture  of  the
                                                                  area,  and  from  this,  three  realms  of  inquiry
                      THE GRAND VALLEY                            were    launched.
                                                                    One consisted of looking  into  the  local  teen-
           A. The Project                                         age problem, and what to do  about  it  during  the
             The  Grand  Valley  was  chosen  as  one  of   the   summer.  One  member  of  our  team  tackled   this
           two project sites  which  would  serve  as  a  model   problem and  over  a  1  month  period  found  that
           for the rural aspect of health care  in  the  United   there  were  two  main  activities  in  which  the,
           States.  Grand  Junction  was  made  the   coordina-   teenager  of  the  area  participated-local  dances
           ting  center  for  the  three  other  areas  on  the   at  "The  Barn,"  and  nightly  excursions  through
           western slope of the  Rocky  Mountains  due  to  its   the local shopping  center  parking  lot.  Although
                                                                  it was r
           strategic  central  location  with  respect  to  the           ecognized that neither of these  activities
           other  placements:  Palisade,  Fruita,  and   Delta,   led to self-improvement, little Iiupport  could  be
           Colo. Although Grand Ju-n                              gained  for  such  things  as  opening   the   high
                                        ction   is   surrounded
           by agriculture  on  three  sides,  the  town  itself   school or college gymnasiums  or  starting  a  teen
           is one of small businesses  and  prides  itself  for   center. Consequently, this aspect  of  the  problem
           .its selection as  an  All-American  City  in  1962.   was dropped  and  a  new  area  explored;  that  of
           It abounds with civic and  social  activities,  such   the  mental  health   needs   of   the   community.
           as  the  local  TACT  chapter,  which  is   striving   Through  association  with,  and  assistance   from
           to maintain  the  All-American  status.  Its  heter-   sympathetic   members   of   the   Grand   Junction
                                                                  area,  a  program  was  started  for  patients  re-
           ogeneous  population  of  25,000  consists  of   85-
           90 percent Anglo-Saxon, 10-15 percent Mex'             cently  released  from  the  State  mental   insti-
                                                          ican-
           American  and  less  than  1  percent   black,   but   tution to help in their  readjustments  back-  into
           during the harvest  and  hoeing  seasons,  the  city   the community. This proved  to  be  quite  gratify-
           comes  alive  with  an  influx  of   representatives   ing from all points of view,  and  the  result  was
           of  many  different  Indian  tribes   and   southern   the establishment  of  a  Precedent  for  following
                                                                  programs designed  to  allow  the  stigmatized  ex-
           Negroes.                                               mental    patient,a fair cha,.ice to come back  to  a
             Three   students  were  placed  in  each  of   the
           four  areas.  Their  charge  was  to  grapple   with   community   and   embark   upon   another    attack
           the  objectives  of  the  summer  project   reviewed   cn reality.
           in the preface. To achieve these  goals,  12  hearty     The two          students pursued  the  goals  of
                                                                  the  summer  project  in  a  different  vein.  They
           students  embarked  upon   the   task   with   great
                                                                  decided to look into the overall  health  care  re-
           vigor.  Their  entrance  into   the   Grand   Valley   sources available to those ;An the  Grand  Junction
           was unobtrusive,  but  contacts  with  local  physi-
           cians  and  officials  were  made  immediately,  and   area.  To  accomplish   this,   numerous   meetings
                                                                  anci  conferences  were  attendee]   to   determine
           avenues  of  exploration  were   mapped   off.   Re-
           gional  headquarters  were   established   and   the   just  how  the  health  care  system  in  the  area
           project was set to march forward.                      operated. It was  found,  to  the  surprise  of  no
             But,. where  to  march?  In  Grand  Junction,  the   one, that those with money  had  little  difficulty
           first order of business  was  to  become  acquainted   in attaining  what  healtb-  care  they  n(4ded,  a

           8


                                                       SUMMER 1968

         situation  not  uncommon  throughout   the   United   make   the   problems   potentially   amenable   to
         States.  But  what  about  those  -without   enough   solutions.  The  three  students  in  Palisade  and
         money  to  buy  health?  To   our   amazement,   @t   another  three  in  Fruita  worked  more   in   the
         was  found  that  even  those  without  money   had   area of approaches  to  meeting  the  health  needs
         almost the same services  available  to  them  with   of the migrant population.  Both  of  these  groups
         regard to health. All they had to do  was  to  take   aided the  students  in  Grand  Junction  with  the
         advantage  of  them,  and  if  they  needed   other   problems   concerning   the    resident    Mexican-
         health services that were not available,  all  they   American  minority,   and   the   Indians   working
         had to do was  ask  for  them  and  they  could  be   in the uranium mines.
         set up.  Thus,  we  wondered  if  any  health  care     The first step for all  areas  was  to  see  just
         problems really did exist  in  these  rural  areas.   what  kinds  of  respective  health  services  were
         We then went to those  people  unable  to  pay  and   needed  by  the  three  groups.  This  was  ineffi-
         asked  them  if  they  had  any  needs  for  health   ciently done by talking with people  in  the  vari-
         care that were not met.  Some  said  no,  but  from   ous areas, but  some  feeling  for  the  needs  was
         our  point  of  view,  many  had  clearly   visible   obtained. Next,  the  services  offered  were  made
         health problems such as  poor  nutrition  and  san-   clear, and then the approaches  to  the  two  basic
         itation facilities. Very few utilized  any  of  the   problems were outlined.
         existing  preventive  care  programs.  Why   didn't     The Food Stamp      Program    was     emphasized
         they take advantage of  these  free  services?  The   for  the  migrant  workers  and   information   re-
         answers to  this  question  were  phrased  in  many   garding  available  health  services  was  outlined
         ways,  but  they  boiled  down  to  two  basic  ob-   and distributed. The means to  use  these  services
         stacles  over  and  above  that   of   not   having   were  provided  by  the  students.   Transportation
         enough  money.  One  problem  was   the   lack   of   was  arranged,  and  preventive   screening   meas-
         knowledge  as  to  what  "health"   consisted   of,   ures  such  as  throat  cultures  were   performed.
         and  what  services  were  available  to  them   to   This  screening  provided  highly   revealing   in-
         help  attain   "health."   Another   problem,   was   formation about  the  previously  ignored  pool  of
         what  could  be  called  an  alienation  from   the   streptococcal  infections.  Also,  the  idea  of  a
         existing sources of  potential  benefits.  Although   centralized  mobile  migrant  clinic  sponsored  by
         those  in  the  financial  and  ethnic   minorities   the local hospital and staffed by  local  volunteer
         may  have  known  of  the  programs  and  services,   physicians  was  discussed  with  some  hope   that
         they felt that they were not  intended  to  be  in-   it  will  materialize  in  the  harvest  season  to
         cluded in them,  and  therefore,  participated  in-   come.
         frequently.  These  two  problems  apparently  were     The  Indians  working  in   the   uranium   mines
         not recognized or  were  overlooked  by  those  who   were  living  in  indescribable  squalor  with   no
         provided the possible services,  and  consequently,   sewage   systems   and   runoff   drinking   water,
         the remaining two  students  embarked  on  a  proj-   without   purification.   Although   they    earned
         elct to try and make  services  which  were  osten-   union wages, the area was  so  isolated  that  they
         sibly available, actually  available.  Three  major   were  unable  to  do  much  on  their  own  to  im-
         minority groups were  found  to  be  in  a  similar   prove  conditions.  When  the  knowledge  of   this
         situation in  the  Grand  Junction  area:  Most  of   group was brought to  their  attention,  the  local
         the   Spanish   or   Mexican-American    population   health authorities began to  act  and  the  problem
         in the city itself,. a group of 100 to 300  Indians   was finally approached on  a  level  where  results
         working  in  various  mines  in  the  mountains  to   could be accomplished. Through our  visits  to  the
         the  southwest  of  Grand  Junction  and  the   In-   mining  camp,  we  were  able  to   introduce   the
         dians  and  Mexican  workers  who  came   to   work   miners and their families to the  available  health
         in the fields of the outlying areas.                  services, and  the  Public  Health  Department  be-
          It  took  1  month  to  come  to  the  above  con-   came aware of how  it  could  expand  its  services
         clusions, which left little time to  develop  solu-   in  meaningful  ways.  Such  minor  expansions   as
         tions to many of  the  problems,  but  it  was  de-   immunizations  and  health  counselling  were  pro-
         .Cided  to  see  what  types  of  approaches  would   vided by the students, but the  impact  was  mainly

                                                                                                                 9


                                         COLORADO STUDENT HEALTH PROJECT

          an enlargement of the scope  of  ideas  and  under-   to  expedite  the  process  of   allowing   greater
          standing  about  how  to  approach  the  two  basic   fulfillment for all individuals of this Nation.
          problems mentioned earlier.
            In the Grand Junction area itself,  the  students                         SKip BRY,
          served to  expand  the  programs  and  outreach  of                         Area Coordinator,
          the established agencies, and  to  make  the  agen-                         Grand  Valley Project.
          cies  aware  that  there  were   other   approaches
          to the existing problems.                             B. The Health Care System
            This  was  done  by  such  concrete  methods   as
          bringing 50 to  60  children  to  the  immunization   1. The  Present  System  of  Health  Care  for  the
          clinics. Classes  that  could  be  formally  called       Poor
          health   education   were   expanded   and    where     The town  of  Delta  has  one  "semi-active"  and
          previously  four  to  15  children  had   attended,
          30 to 50 children  were  now  able  to  be  expos!d   three active doctors, and a  county-supported  hos-
          to  various  aspects  of  health.  In  addition  to   i)ital with a capacity of 30 to  40.  Palisade  has
          allowing the established institutions to see va       two  doctors;   and   Cedaredge,   Hotchkiss,   and
                                                                Peoria, towns  of  1,000,  have  one  doctor  each.
          ious applications of  their  programs,  the  people   According to one student,  "the  poor  may  receive
          who  should  have  been  able  to  use  their  pro-   identical medical treatment  to  the  middle  class
          grams were able  to  have  some  positive  exposure   ... provided they take the initiative  to  come  to
          to them, and hopefully, they will begin to  utilize   the doctor."
          the services  more  in  the  future.  The  students     In Delta,  the  physicians  make  allowances  for
          in Delta  manned  similar  programs  and  in  addi-   the poor's  medical  expenses.  They  will  "charge
          tion aided in a  study  of  school  dropouts  which   less,  distribute  advertising  samples,  prescribe
          is proving  most  valuable  to  the  school  system   generically according  to  their  understanding  of
          of that area.                                         the families' financial  situation."  Others  allow
           At the end  of  2  months,  the  SHP  students  in   patients to pay what they  feel  they  can  afford.
          the Grand Valley did  not  have  much  in  the  way   The hospital and one  doctor  bill  patients  with-
          of concrete  edifices  to  show  their  accomplish-   out  expecting  payment.  The  physicians  do   not
          ments  or  failings,  but  the  experiences  during   go out  after  the  patients  but  expect  them  to
                                                                come to them
          the  summer  served  to  point  out  some  of   the    Two   organizations,    the    Colorado    Migrant
          sources  of  the  basic  problems  preventing   the   Council  and  Holly  Sugar  Corp.  are  set  up  to
          provision of-health  care  on  a  level  compatible   provide health care  for  eligibles:  Migrants  iii
          with the  resources  available.  The  small  accom-   the  former,  and  employees  in  the  latter.  The
          plishments  were  quite  gratifying  but  the.over-   Colorado   State   Health    Department    provides
          all  immensity  of  the  basic  problem  often  was   free  medical  Care  and  drugs  to  migrants,  but
          overwhelming  and  made  the  summer  a   frustrat-   it is
                                                                     not  a  very  well   known   program.   Public
          ing one for all  involved.  However,  it  was  seen   health nurses seem to be  doing  an  adequate  task
          that the basic problems  regarding  health  in  the   of getting children of school  age  proper  medical
          rural  settings  are  qualitatively'the   same   as   and dental care, but  these  'programs  are  under-
          those in the urban areas, but  that  the  quantita-   staffed.  .
          tive aspect is  quite  different.  The  impetus  to    The   Welfare   Department   can   provide    ade-
          attack  and  resolve  the  problems  is   sometimes   quate medical assistance for its  eligibles,  while
          in striking  contrast  between  the  two  settings.   the  Mesa  County  Health   Department   in   Grand
          In spite of this, through understanding of  racial,   Junction  offers  a  mental  health  clinic,  a  TB
                                                                clinic  that  includes  X-rays  and  medicine,  and
          ethnic, cultural and  fina,.icial  minorities,  and   a  handicapped   child:ten's   program,   including
          the  reasons  for  the  current  predicaments,  Ob-   a diagnostic epilepsy clinic.  The  Health  Depart-
          tained through programs  such  as  the   SHP,   the   ment also provides  a  complete  orthopedic  clinic
          providers of health for the  future  will  be  able   paying  for  almost  everything  and   Li   plastic

          10


                                                        SUMMER 1968
        clinic  which  pays   for   hospitalization,   surgery,     E. Dental facilities are  needed  for  the  Fruita,
        orthodontia,  speech  therapy,  and   hearing   aids   -   Loma,   Mack,   and   New   Liberty   areas,   which
        for those  who  are  ineligible.  "Most  of  the  medi-   now  rely  on  the  "terribly   overcrowded"   dental
        cal  clinics,  however,  offered  by  the  Health   De-   clinic in Grand Junction.
        partment  are  on  a  referral  basis   by   a   doctor
        or  osteopath  ....  and  if   an   individual   cannot   3.   Bureaucratic   Problems   Which    Hinder    the
        afford  to  make  it  to  a   primary   physician   in-        Usefulness of  the  Present  Facilities  to  the
        itially, he has  no  chance  of  getting  into  any  of        Poor
        these  clinics   except   mental,   dental,   and   im-     A.         Lack   of   coordination   among    com-
        munization clinics, which need no referral."              munity   service   agencies,   due   to   personality
           Indians  are  cared  for   by   governmental   agen-   clashes  and  segmentation  of  aims."  Better   com-
        cies  on  their  reservations,  or  by  the  Bureau  of   munication  and  cooperation   could   increase   the
        Indian  Affairs  if  outside  hospitalization  is  nee-   effectiveness of local  agencies,  all  of  whom  are
        essary.                                                   striving  for   similar   goals   through   different
           In  Palisade,  health  care  is   adequate.   Public   means.
        health  nurses  follow  up   cases   when   and   where     1.  Public  health  payment  for   migrant   health
        possible.  They  are  limited  by  the  rather   mobile   care is  not  being  made  now  to  doctors  and  mi-
        life  many  of  the  migrants  live.  Lack  of  preven-   grants.  .
        tive measures, such  as  vaccination,  is  seen  to  be     2.  The  public  health  nurse   can   only   visit
        a  problem  here.  Two  doctors  in  this  area  extend   families  to  whom  she  has  been  referred   by   a
        their  office  hours  during  the  peach   harvest   to   local  agency  and,  therefore,  misses  persons  who
        care  for  the  additional  burdens  more  people  add.   have not come into contact with any agency.
                                                                    3.  People  on  welfare,  old  age  pensions,   and
        2.  The  Most  Pressing  Health  Care  Needs  for   the   social  security  hesitate  to  seek  needed  medical
             Poor                                                 help because  they  are  not  sure  they  can  afford
           A.  A  more   effective   outreach   program.   This   it  and  do  not  know   whether   their   assistance
        would  have  to   involve   an   increase   of   public   programs  will  cover  it.  Finding  out   what   the
        health  nurses  to  reach  more   of   the   population   agency  will  pay  involves   bureaucratic   channels
        more  often,  and  salary   increases   to   make   the   which a poor person finds overwhelming.
        area competitive.                                           4.  The  public  health  nurse  in  Fruita  for   1
           B.   A   better   transportation   system   to   St.   hour  per  week  cannot   prescribe   medication   or
        Mary's  Hospital,  which  is  often  inaccessible   for   make diagnoses.  This  causes  a  reluctance  on  the
        persons without a  car.  Since  the  hospital  is  cen-   part of the people to come and see her.
                                                                    B.  The  9  to  5  hours  of  the  welfare   agency
        trally  located  in   Grand   Junction,   more   people   are  often  impractical,  especially  to  people  who
        could utilize its facilities if they could  get  there.   need  assistance  at  an  hour  when  the  agency  is
           C.  Health  stations  in  some   of   the   outlying   not  open.  Also,  the  whole   idea   of   "appoint-
        districts could  be  useful,  as  they  would  be  more   ments"  is  often  foreign  to  a  person  who  needs
        personal  and  more   accessible.   For"   example,   a
                                                                  help "now" and not in 2 weeks.
        clinic  at  Fruita   would   be   easily   reached   by     C. The notion  of  filling  out  forms  and  appli-
        people from Loma    ' Mack,  and   New   Liberty,   and   cations  is  another  latent  bureaucratic   dysfune-
        could   include   checkups   and   immunization.    The                                                       t
        problem  could  be  solved  also  by  a  mobile  clinic   tion that  limits  the  welfare  and  other  agencies
                                                                  success.
        serving all  of  Mesa  County,  and  feeding  into  St.
        Mary's Hospital.                                          4.  Concrete  Proposals  for   Better   Health   Car@
           .D.  The  "invisible  poor,"  people  who  are  just        Programs
        missed   by   welfare   and   assistance   programs   -
        cause  their   income   is   above   the   maximum'pov-     A. Assistance  for  the  poor  in  getting  to  the
        erty  income,  but  not  enough  for  them  to   afford   doctor, rather than a health  clinic  for  the  poor,
        adequate  care,  would  benefit  nicely  from   a   low   which  would  accentuate  the  fact  that  they   are
        cost, comprehensive medical insurance plan.               poor and should, therefore, be segregated.


                                              COLORADO STUDENT HEALTH PROJECT
                B. A  low  cost  medical  insurance  plan  for  low    who often  use  it  as  the  only  way  to  exist  in
             income  families,  which   would   include   financial    the world.
             assistance for buying drugs.
               C.  Clinics  and  doctors'  hours  which  could   be              THE SAN  LUIS VALLEY
             at  night  for  persons  who  work  all  day  and  are
             only able to attend in the evening.                       A.  The Project
               D.  Increase  the  amount  and  use   of   informa:-     San  Luis  is  the  capital   of   Costilla   County
             tion on  family  planning,  health  care,  et  cetera,    'Oca  d  in  South  Central  Colorado.   The   county
             so  that  more  people   could   take   advantage   of    I
             these things.                                             is  a  valley  bounded  by  the  Sangre   de   Cristo
               E.   Development   of   vocational   training   pro-    mountains.  Agriculture  is  the   main   source   of
             grams,  like  nurse's  aid  training  program   or   a    income and all  farming  is  done  under  irrigation.
             laboratory   technician   program,   so   the   people    There are no industries  in  the  county;  62.8  per-
             could  learn  to  be  independent   and   help   them-    '2ent  of  the  people  have  incomes  under  $3,000.
             selves.                                                   Spanish-Americans   comprise    72.6    percent    of
              F.  Need  for   more   public   health   nurses,   at    the  population.  Many  of  t-hese  are   descendants
             least four or five,  to  take  the  burden  off  those    of the original Spanish settlers.
             who  are  there  now  and  increase  the  quality  and    This  area  was  the   smallest   project   site   as
             quantity of the care available.                           well as the most unique  in  that  the  students  and
              G.  Some   sort   of   training   in   the   Spanish-    the SHO  project  doctors  were  actually  in  charge
             American  culture   and   language   for   the   "pro-    of  health  care  delivery.  One   of   the   primary
                                                                       goals in setting up  the  project  in  San  Luis  was
             fessionals"   working   with   these   people.    This    to allow the students to  work  in  a  public  health
             would  open  communication  lines   and   assist   the    education-community    development     role.     This
             professionals  in  helping  the  people   help   them-    concept  remained  a  theory  as  the  students  con-
             selves.  Understanding  should  be  a  task   of   the    sumed  most  of  their  short  summer   stay   aiding
             professionals as well as the poor.                        in this delivery  of  medical  care  and  of  greater
                                                                       import   re-e@blishing   the    community's    knowl-
             5. Culture  Problem&  of  the  Poor  as  Problems  for    edge that the Sangre  de  Cristo  Clinic,  the  major
                Medical Care                                           public  health  facility  in  San  Luis  did  have  a
                                                                                                           p
             A.   The   transitory   life   of   a   migrant   com-    full time doctor  with  plans  for  year  round  med-
             pounds  his  other  health  problems.  Their  way   of    ical service.
             life leads to  a  lack  of  medical  records  on  them    The  support   from   the   local   medical   society
             and no personal relatio n   with   any   one   doctor.    through  the   direct   sponsorship   of   Dr.   Dale
             Also, each time  they  arrive  in  a  new  area,  they    Thomas  of  La  Jara,  Colo.,  was  greatly  appreci-
             must  begin  all  over  again  finding  out  what   is    ated.  The  students  learned  a  great  deal   about
             available for them, where  to  go,  who  to  see,  how    the  private  practice  of   medicine   by   spending
             much it  will  cost,  etc.,  and  even  if  they  have    1 day  a  week  with  Dr.  Thomas,  as  well  as  the
             been in the  area  before  this  is  still  a  problem    problems  encountered  in  delivering   health   care
             due  to  the  changes  in  what  was  there  and  what    in  this   community.   In   addition,   the   health
             is now there.                                             science  students  and  the   high   school   interns
             B.  Mistrust  of  "Anglo   medicine"   seems   to   be    had   many   learning   opportunities    under    the
             a problem too,  and  reliance  on  folk  practitioners    supervision of the two SHO project doctors.
             is  not  uncommon.  The   "system"   seems   to   per-    In   assessing   the    program    orientation    and
             petuate  and  encourage   this   mistrust   with   its    planning,  two  aspects  should  be  discussed.   The
             red tape and uncooperativeness.                           first  aspect  is  the  short  length  of  time   the
             C.  A  value  for  preventive   medicine   should   be    project had in. San Luis.  If  one  has  never  lived
             encouraged, not  just  seeing  the  doctor  or  worry-    in a rural area, there are  the  problems  in  under-
             ing about an illness when it becomes severe.              standing  the  power  structure,  the   problems   of
             D.  Alcoholism,   and   all   the   social   ramifica-    an  agricultural  economy,  the  social  behavior  of
             tions thereof, is  a  serious  problem  for  the  poor    the local residents, and flnplly the  local  Spanish-
             12


                                                      SUMMER 1968

        American  culture.  Given  the  array  of  unfamil-      First, the  Presbyterian  Medical  Service  oper-
        iar  factors,  the  students  were  somewhat   con-   ated  the  Sangre  de  Cristo   Medical   Unit,   or
        fused as to what they could  do  to  aid  the  com-   Clinic, just outside  of  San  Luis.  This  unit  is
        munity in dealing  with  its  health  requirements.   quite'a  comprehensive  outpatient   clinic,   which
        The  "Con  la  familia"  or  living  with  a  local   has  facilities  for  dental  and  medical  care  as
        family  on  arriving  in  the  community  was  con-   well  as  emergency  child  birth  and  minor   sur-
        sidered an excellent  introduction.  However,  this   gery.  Due  to  the  students'  presence  and  their
        was a brief  3  day  stay  and  what  the  students   procurement of a  full  time  physician,  the  pres-
        really needed was  someone  who  could  guide  them   ent medical staff of the clinic includes: one  full-
        in learning  about  the  community's  problems  for   time  physician,  one   LPN,   two   part-time   SHO
        the length of the project. In  future  projects  in   RN's  and  two  part-time   medical   students.   In
        the  San  Luis  Valley  a  past  SHP  member  could   addition  to  the  full-time  physician   mentioned,
        render  valuable  guidance  as  an   area-coordina-   doctors  from  Alamosa  and  Lajara  come   to   the
        tor. With this method of  leadership  the  students   clinic   Tuesday   through   Thursday   for.one-half
        could  widen  their  learning   experiences   about   day.
        the rural area.                                          The  State  public  health  nurse  for   Costilla
          With every evaluation,  the  question  is  raised   County operates several  different  clinic  sessions
        regarding the success of  the  project.  There  are   throughout  the  year  which  provide  free  medical
        many  persons  who  can  give  opinions;   however,   care  to  county  residents.  On  a  monthly  basis,
        the  most  important  person  is  the  student  who   the  nurse  with  the  aid  of  volunteer   doctors,
        actually worked and  invested  his  summer  in  the   conducts a "well  baby"  clinic  and  a  school  age
        project. In my  opinion,  some  of  the  successful   clinic at the Sangre  de  Cristo  Medical  Unit.  On
        features of the project were:                         a yearly basis, she offers clinics  for  Head  Start
               1.  A  constructive  interchange  of   ideas   children,  orthopedic   problems,   epileptic,   and
            between  persons  who   would   not   otherwise   cleft lip and palate cases.  In  addition  to  these
            have   direct   lines    of    communication@x-   and her normal duties, she is  involved  in  follow-
            amples,  high  school  students   and   medical   up  work  on  cases  referred  to  her  from  C.G.H.
            students,  RMP   administrators   and   project   and Colorado State Hospital    '
            members.                                             The  CAP  agency  in  San  Luis  has  an   "emer-
               2.  A  number  of  tasks  or  services  that   gency  medical  aid  grant"  from  OEO   which   en-
            benefited   someone   which   otherwise   would   ables  them  to  pay  for  any   medical   treatment
            have gone undon        xamples, getting  a  boy   rendered  at  the  clinic  to  a  "poverty  family."
            into school, getting a man a job.                 The  welfare  department  also  pays   for   medical
                                                              care to various eligible groups;  specifically,  old
                 RANDALL H. LoRTsCHER,                        age  pensioners,  and  Aid  to  Dependent  Children,
                 Asso@te Student Coordimtor,                  Needy and Disabled and general assistance.
                 Colorado Student Health Project.                Costilla County provides a  public  health  nurse
                                                              for the  schools  in  San  Luis,  who  seems  to  be
        B. The Health Care System                             primarily  concerned  with  the  general  health  of
                                                              the children.
        1. The Pre.-.ent System  of  Health  Care  for  the      Two  hospitals  in  L@Jara   and   Alamosa   pro-
            Poor                                              vide an extensive  amount  of  care  to  the  people
        I-                                                    of  the  Valley.  Both  have   adequate   operating,
          There are five different  types  of  health  care   delivery,  and  emergency  rooms,  plus   facilities
        systems for the poor near the  town  of  San  Luis.   to  deal  with  most  surgical  and  medical  cases.
        First, the  Presbyterian  Medical  Service  Clinic;
        second, a State public health nurse; third,  finan-
        cial  aid  from  the   Community   Action   Program   2. The  Most  Pressing  Health  Care  Needs  of  the
                                                                   Poor
        agency  and.  welfare  office;  fourth,  a   public
        school health nurse; and  fifth,  the  Alamosa  and      First, there is a lack of qualified  professional
        La-Tara Hospitals.                                    people to staff the medical  unit.  What  staff  has


                                               COLORADO STUDENT HEALTH PROJECT
               been available seem to  be  there  only  on  a  tem-      4.  Concrete  Proposals  for  Better  Health   Car(
               porary basis..  A  full-time  physician,  a  dentist         Programs
               and assistant,  a  lab  and  X-ray  technician,  and
                                                                         A.   A   comprehensive   outreach   program    that
               two nurses  are  needed  to  enable  the  clinic  to      would involve a "total cure,"  rather  than  "band-
               function  adequately.  Next,  the   people'need   to      aid" approach to the population.
               be informed of the  clinic's  facilities  and  their      B. Health  re-education  of  the  people  for  such
               eligibility to utilize them.                              things as dental hygiene and  nutrition.  A  latent
                A  second  quite  pressing  need  is  an  effective      function of  this  program  would  be  to  increase
               ambulance  service.  At  least  a   station   wagon,      and   improve   the   communication   between   the
               and preferably  a  4-wheel  drive  vehicle  for  the      community and the agencies.
               out-of-way places,  is  needed.  Many  persons  fail      C.  The  need  for  full  time  clinic  physicians.
               to use the clinic because of their  lack  of  trans-      The  implementation  of  a  new  grant  for  hiring
               portation  to  and  from  it;   and   patients   and
               accident  victims  often  require  movement  to  the      permanent  staff  members  will  be  beneficial  to
                                                                         this goal.
               more   comprehensive   hospitals   in   LaJara   and      D.  Creation  of  an  adequate  drug  store,   that
               Alamosa.                                                  can fill the doctor's prescriptions.
                Alcoholism  seems  to   be   a   pressing   problem      E  An  effective,  full-time   ambulance   service.
               of the area,  which  requires  an  effective  treat-
               ment  and   education   program.   Psychiatric   and      5.  Cultural  Problems  of  the  Poor  as  Problems
               social type counseling, in addition  to  a  fbllowup        for   Medical    Care
               on patients  who  have  been  on  the  alcohol  ward      The  pride  and  self-reliance  of   the   Spanish-
               at the State Hospitai, is also necessary.                 American is  seen  as  a  problem  when  it  limits
               A  final  need  is  for  a  more   adequately   sup-      their effective participation in the clinic.
               plied drug store.  Mpl,,-  Prescriptions  cannot  be      A.  Many  will  not  co'me  to  the  clinic   because
               filled because of an inzutficient amount  of  drugs,      they cannot afford it.
               and often these people ai-e forced  to  go  to  Ala-      B.  They  are   often   resentful   of   government
               mosa, when  they  can  afford  it,  for  their  pre-      "give  away"  programs.  They  do  not  want  some-
               scriptions.                                               one  giving  them  money,  but  want   jobs   where
                                                                         they can earn the money.
               3.   Bureaucratic   Problems   Which   Hinder    the      C. There is little or  no  conception  of  the  no-
                 Usefulness  of  the  Present  Facilities  to   the      tion  of  preventive  medicine,  and  most   people
                 Poor                                                    wait until they are  quite  ill  before  they  will
                                                                         come to the clinic. This is especially true of  the
               Like  many  poverty  areas,   the   age-old   diffi-      fathers of the households.
               culties  with  the  welfare   department   and   the      D. The notion of  "the  clinic"  is  still  new  to
               CAP  agency  seem  to  exist   here.   Specifically,      many  of  the  people.  Technical  innovations  are
               the welfare  department  is  often  "slow"  in  dis-      less readily accepted. in  their  society  than  in
               pensiiig inforriiation as to who  is  available  for      most,  and  many  are  not  ready,  to  accept  the
               what.  They  are  often  resentful  of   "outsiders"      clinic yet.
               meddling in their business.                               E. The use of folk m6diciiie  in  place  of  scien-
               The   CAP   agency   often   seems   reluctant    to      tific medicine is seen as  a  problem  due  to  the
               make  available   information   on   what   programs      often improper care  it  provides.  The  psycholog-
               are  available  and  to  whom.  The  reluctance   to      ical effect is to cause the people to feel  that  a
               disclose  information  on  emergency  food   stamps,      doctor is unnecessary.
               medical  care  assistance,  and  the  medical   unit
               has been noted.                                           C.  A  Study  of   Folk   Medicine   in   the   San
               A  full  time  clinic-director,  whose  interest  is        Luis Valley
               in the effective operation of clinic  and  the  max-      Introduction:
               !mum distribution of services  to  the  poor,  would      This study  is  concerned  with  the  use  of  med-
               be most desirable.                                        ical practices, other than  "scientific"  medicine,
               14


                                                     SUMMER 1968

        as used by a sample of people  in  and  around  the      We  constructed  a  questionnaire   which   con-
        San  Luis  Valley  medical  clinic.  According   to   sisted of 10 of the  more  common  illnesses  based
        Saunders,  "Folk'Medicine,"  like  scientific  med-   on  the  25  illnesses  Saunders   mentioned.   The
        icine, undoubtedly derives  much  of  its  prestige   commonness  of  the  illness   was   decided   upon
        and authority  from  the  fact  that  the  majority   by the four SHO students  on  the  basis  of  their
        of sick persons get  well  regardless  of  what  is   experiences  in  the  clinic  with  illnesses.4  We
        done.'  Although  most  persons  in  society  prac-   wanted to know what  the  person  would  do  if  he
        tice folk medicine  to  some  extent,  there  is  a   contracted  any  of  these,  and  if   this   would
        wealth of evidence indicating that  it  is  a  very   change  any  when  the  illness  became  more   se-
        important  part  of   the   Spanish-American   cul-   vere.  We  asked  what  he  would  do  if  he  con-
        ture .2                                               tracted  the  illness,  rather  than  what  he  had
          Saunders lists some 25  different  illnesses  for   done when he  had  it,  to  eliminate  anyone  from
        which  the  "village  folk"  had   remedies.3   One   saying "nothin  g"  since  he  had  never  had  it.
        of the goals of this study  was  to  take  some  of   This, it was hoped would  add  to  a  greater  com-
        the  more  common  illnesses   he   mentioned   and   pletion ratio of the  schedules,  even  though  the
        discover what forms of  cure  were  utilized.  This   illnesses  were  common  enough  so  that  it   was
        is in no way an empirical test of his  theory,  but   unlikely  that  one  had  never  contracted   them.
        rather a study designed  to  discover  some  trends   At  least  one  would  probably  know  someone  who
        in the  medical  practices  of  the  Spanish-Ameri-   had one of these illnesses so, at the  very  least,
        cans in an  attempt  to  implement  changes  toward   would know what would be done.
        modern medical practices.                               The  severity  factor  to  discover  change   was
        MethodoZogy:                                          included  to  help  better  define  phases  of  the
                                                              illness and  to  see  during  what  phase  of  each
          The SHO students in       the  Valley   had   the   particular illness the folk remedy  was  used,  and
        unique position of close   medical   type   contact   when the  doctor  was  used,  and  whether  or  not
        with a  fairly  large  number  of  Spanish-American   these were dependent  on  severity.  We  also  were
        people. They treated the people in the  clinic  for   interested in certain  demographic  facts  as  par-
        various ailments as  well  as  making  home  visits   tialling factors with severity and folk  practices,
        for followup and additional  care.  These  students   but the small size of the sample  restricted  their
        reported several  different  instances  of  healing   use.
        practices  which  appeared  rather  odd  to   them.     A word  must  be  included  here  about  the  na-
        For  example,  Miss   Campbell   noticed   that   a   ture of the sample. The  sample  was  collected  on
        woman  had  placed  a  necklace  of  a  string  and   an interview basis over  a  6-week  period  by  the
        dime  around  her  child's  neck  to   enable   the   four  SHO  students  and  one  health   intern   in
        child's teeth to grow straight. She  also  reported   conjunction with the rest of their  duties.  Inter-
        several instances of  strips  of  sheet  that  were   viewing  was  conducted  as  a  supplementary  task
        dipped  in  potato  juices  being  wrapped   around   to  their  normal  duties,  and  the   interviewing
        a  person's  head  to  help  cure  headaches.   She   was done  when  they  had  time  and  with  persons
        became curious  about  the  extent  and  prevalence   who were cooperative. I believe  the  main  limita-
        of these practices as  well  as  the.use  of  other   tion of this was the size of  the  sample  we  were
        ones. We decided that  one  of  the  best  ways  to   able to get  and  not  a  serious  form  of  sample
        accomplish  this  was   the   construction   of   a   bias.  However,  it  should  be  noted   that   the
        questionnaire to be  administered  to  certain  pa-   sample  did  consist  of  persons  who  were   med-
        tients of the clinic and in their homes.              ically  oriented  by  nature  of  their  participa-
          S---d,,@.,  Lle,  "Healing  ways  in  the  Spanish   Southwest."   in tion in the clinic.  We  could  assume  that  these
        E. Gartly Jaco, Patietzts. Physt'cians and  Illness,  The  Free  Press, persons  are  less  folk  medicine  oriented   than
        1958, P. 191.
         'See  George  Foster,  "Relationship  between  Spanish  and   Spanish- those who do not come to the clinic,  but  oii  the
        Anierican  Folk  Ikedicine,"  Journal  of  Am@can  Folklore,  vol.  66, other hand, it might be fallacious to  assume  that
        July-September,  1953,  p.  201-217;  and  Lyle  Saunders  and   Gordon
        He.@.  "Folk  Medicine  and  Medical  Practice,"   Joumd   of   Modic(a
        Educa;ion, vol. 28. September, 1933, p. 4@S.           4A copy of the questionnaire is to I>e  found  at  the  end  of  this
         'Saunders. op. cit.. v. 196.                         'Itudy.

                                                                                                               15


                                                                     COLORADO           STUDENT           HEALTH           PROJECT
                      those    who    do    not    come    to    the    clinic    are    neces-         and    are    more    reluctant    to     admit     to     being     ill
                      sarily    more    folk     medicine     oriented.     It     could     be         than     women.     Women     riot     only     admit     being      ill
                      that    those    who    do    not    come    to    the     clinic     are         more,   but   are    more    ready    to    talk    about    it,    too.
                      just     less     medicine     oriented     than     those     who     do         When    men    do    come    to    the     clinic,     however,     they
                      come,    and    the     clinic     users     would,     therefore,     be         are    usually    in    a    "hurry"    and    do    not     have     as
                      more    concerned     with     folk     as     well     as     scientific         much time to spend there as women.
                      medicine.     This      is      perhaps      an      academic      point,              Table   11    is    a    depiction    of    incidents    of    folk
                      but     one     which     should     not     be     overlooked.      With         medical      practices      for       each       specific       ailment.
                      these    things    in    mind,    we     can     now     consider     the         These     practices      are      utilized      most      often      for
                      findings:                                                                         toothaches,     and     stomach     aches      and      least      often
                                                                                                        for     colds     and     constipation.     This     could      indicate
                      Findings:
                                                                                                        that    the    former    two    ailments    are    the     ones     that
                                                                                                                                                                                                          @ip
                                          Table /.-Sample Description                                   the    people    least    trust     medical     science     to     help,
                      A.   Demographic:                                                                 and   the    ones    which    they    feel    best    able    to    deal
                            1.    Size: 23                                                              with.     Their      remedies      are      probably      most      suc-
                            2.    Where person interviewed:                                             cessful    here     and     most     accepted     and     trusted     by
                                                                                                        the people.
                                  a.   Clinic-
                                  b.   Home                                          -       52.'-'          To   accept   this    notion,    it    is    assumed    that    all
                                                                                     9       39.1
                                                                                                                                                                                                          -ra
                                                                                             -          ailments    have    an     equal     chance     of     occurring     and
                                  C.            Total                                        91.4       would,     therfore,     have     an      equal      probability      of
                                                                                                                                                                                                          -,Iac
                            3.    Age:                                                                  being    treated    by    folk    medicine.    In    the    course    of
                                  a.   Range      16 through 92
                                  b.   Mean:     32.1                                                   treatment,     some     remedies      lose      esteem      as      they                          th
                            4.    Sex: All females                                                      fail    repeatedly    in    their     effects.     This     causes     a                          -iia
                      B.    Folk medical practices:                                                     loss   of   faith   in    the    old    remedies    and    a    willing-                          @iac
                                                                                                                                                                                                          ,rh
                            1.    Total  number   of   incidences   of   folk   medical   prac-         ness    to    try    new    ones.    The     repeated     success     of
                                    tices: 97
                            2.    Total   number   of    incidences    of    nonfolk    medical         the    new    over    the    old    will    eventually     cause     the
                                                                                                        old    to    be    abandoned    for    the    new.     Reluctance     to
                                    practices: 384
                            3.    Percent  of  the  total  number   of   practices   that   are         try   the   new   is   due   to   the   efficacy   of   old   as    well                          the
                                                                                                                                                                                                          r cl
                                    folk: 21.5 percent                                                  as   the    availability    of    the    old    and    new    and    the
                      Discussion:                                                                       faith    in    each.    It    is     much     easier     to     maintain                          Ta
                          One    of    the    more    interesting     findings     of     table         faith    in    an    old    belief,    even    with    numerous    fail-
                      I    was    that    the    entire     sample     was     female.     This         ures,    than    it    is    to    develop    faith     in     something                          -OPI
                                                                                                                                                                                                          f
                      is     empirical     support      for      the      student's      report         new,    even    with     numerous     successes;     and     this     is                          ,Iild
                      on     the      Medical      Survey      Questionnaire      that      for         especially     true     of     the     more      tradition      oriented
                                                                                                                                                                                                          -,-ces
                      the    most    part,    men    do     not     attend     the     clinics,         societies.
                                                                                                                                                                                                          i..es
                                                                                                                                                                                                          @,-e a
                                                                                                                                                                                                          -.@ ta
                                                              Table //.-Incidents of Folk Medicine for Each Specific Ailment
                                                                                                                                                                                                          'Cien
                                                                                         Number    of    times   Number   of   tim@     Total  number   of      PerFent of total
                                                  Ailment                                folk  medicine   used   nonfolk    medical      times  a  medical     medic,l practi es
                                                                                                                  practices used          practice used     that are  folk  medicine                      -@iat
                                                                                                                                                                                                          i)eopl
                      General or specific aches and pains                                                    9                    56                     65                   13.  8
                      Skin conditions-                                                                       3                    15                     18                   16.  6
                      Colds-                                                                                 1                    58                     59                    1 . 7
                      Headache                                                                               8                    58                     66                   12.1                        )lk c
                      Earache-                                                                               16                   42                     58                   27.6                        !He i
                      Sore     throat                                                                        5                    32                     37                   12.2                        Sta
                      Toothache                                              ----                            18                   22                     40                   45.0
                      Stomach ache                                                                           22                   33                     55                   40.0
                      Diarrhea--                               ---        ---                                12                   37                     49                   24.5                        .@@-ste
                      Constipation      ---      ---      ---                                                3                    53                     56                      5.4                      iess

                      16


                                                                              SUMMER            1968
                            rable Il/.-Trends of Folk Medicine Practice Usage from Mild to Severe Cases of Ailments
                                                                              MILD                                                    SEVERE
                       Ailment                       Folk               Nonfolk      Total         Percent folk   Folk              Nonfolk     Total       Percent folk
                                                                                                   medicine     medicine           medicine                     medicine
                                                   medicine            medicine
            General aches and pains        ----                  3            19                   22     13.6                2           19             21            9.5
            Cold ----------------------                          I            31                   32     3.1                 0           27             27           --------
            Headache           -----------------                 4            22                   26     15.4                2           18             20            10.0
            Earache           -------------------                6            16                   22     20.7                4           16             20            20.0
            Sore throat          ----------------                3            18                   21     14.3                2           18             20            10.0
            Toothache          ----------------                 11            9                    20     61.2                7           12             19            36.8
            Stomach ache         --------------                  7            11                   18     38.9                6           10             16            37.5
            Diarrhea           ------------------                6            11                   17     35.3                3           15             18            16.7
            Constipation         --------------                  1            17                   18                                     19             20            5.0
                            Table /V.-Trends in the Use of Doctors and/or Clinics from Mild to Severe Cases of Ailments
                       Ailment                     Doctors               Other2    Total           3Percent       Doctor              Other      Total           Percent
                                                                                                   doctors 4                                                      doctor
            General aches and pains        ----                  1            21                   22     4.5                 9           15             24            37.5
            Cold ----------------------                          2            30                   32     6.2                 10          17             27            37.0
            Headache          -----------------                  1            25                   26     3.8                 8           12             20            40.0
            Earache          -------------------                 3            19                   22     13.6                9           11             20            45.0
            Sore throat         ----------------                 2            19                   21     9.5                 11             9           20            55.0
            Toothache          ----------------                  1            19                   20     5.0                 8           11             19            42.1
            Stomach ache         --------------                  2            16                   18     11.1                7              9           15            43.7
            Diarrhea          ------------------                 1            16                   17     5.9                 8           10             18            44.5
            Constipation         --------------                  2            16                   18     ii. i               7           13             20            34.9
            1 Doctor indicates the number of times  the  doctor  and/or  clinic  was  used         3 Total includes the number of times  the  doctor  and/or  clinic  and  all
            for the spee  c ailment.                                                               other sources were used.
                                                                 e  other  than  a  doctor         Percent doctor i is the percent of the total that used  the  doctor  and/or
            I  Other  indicates  the  number  of  times  a   soure
            and/or clinic was used for a specific ailment.                                         theclinic for the ailment.
               Table        III        shows        that,        without        exception,         when      seriousness      and/or      ambiguity      of      the      dis-
            whenever       an       ailment       becomes       more       seveIre,      the       ease    becomes    high,    the     person     will     turn     to     the
            people     have     a     tendency     to     rely     less      often      on         dominent     belief     system     of     his     culture     for     cure.
            the     folk     medical      practice.      When      an      ailment      is         From     this     our     study      would      indicate      that      the
            mild   and    the    cost    of    a    mistake    is    low,    folk    prac-         dominant       belief       system       of       the        Spanish-Ameri-
            tices    are    utilized,     but     as     the     risk     increases     so         cans    in    and    around    the    San    Luis     clinic     is     not
            does    the     belief     that     folk     medicine     might     not     be         folk      medicine      but      scientific      medicine.
            the     answer     for     cure.     This      findinLy      led      directly         While      this      might      seem'surprising      at      first,       a
            to     table     IV,      which      concerns      the      trends      toward         little    reflection    will    show    it    to    be     quite     plaus-
            scientific     medicine     as     the     severity     of     the     disease         ible.   First   of   all,   due   to   the    nature    of    the    study,
            increases.       We        find,        again        without        exception,         we     are     unable     to     make     a     statement     about     the
            that     as     the      severity      of      the      ailment      increases         relative     power     of     influence     of      each      of      these
            people      go      to      the      doctor      and/or      the       medical         beliefs.      We      know      from      observation       that       folk
            clinic     more.     As     the     threat     of     danger     from      the         medical      practices      are      common      and       fairly       ex-
            ailment    gets    greater,    the    belief    in     the     efficacy     of         tensive   in    this    culture,    and    that    there    is    a    fear
            folk    cures    go    down,    and     the     reliance     on     scientific         of     anglo      medical      doctors.      However,      these      Span-
            medical practices increases.                                                           ish-Americans       are        quite        exposed        to        modern
               Stanley     H.      King      has,      shown      that      there      are         medical     practices     via     the     clinics,      public.      health
            two       important       variables        which        determine        which         nurses      and      friends      and       children,       and       have,
            system     of     medical     beliefs     will     be     used,      -serious-         therefore,       experienced       many       of       the        "wonders"
            iiess      and      ambiguity.      Their       contention       is       that         of    medical     science.     Secondly,     the     average     age     of
                                                                                                                                                                             17


                                                    COLORADO STUDENT HEALTH PROJECT
                 the   sample,    32.1    years,    is    relatively    young.   C.  What would you do if you had: (Their interpretation)
                 Younger   groups    show    a    tendency    to    be    more   1.   Aches and pains             7.  Sore throat
                 aware   of   'change   and   more   ready   to   accept    it        a. mild                         a. hurts
                 than   older   groups.   Third,   the    sample    was    all        b. moderate                     b. cannot swallow
                                                                                      c. severe                            without
                 women   and,   as   the   students    have    shown,    women   2.   Skin condition                       difficulty
                 tend  to  go  to   the   doctor   more   often   t@ian   men,   3.   Cold                        8.  Stomach ache
                 and   seem   less   reluctant   to   accept   modern    medi-        a. mild                         a. mild
                                re
                 eine.  The  infe'  nee  of  this   study   is   that   modern        b. severe                       b. moderate
                                                                                 4.   Diarrhea                        c. severe
                 medicine  is   replacing   folk   medicine   as   the   prime        a. 1 day                    9.  Constipation
                 medical   value   although   the   former   is   still   very        b. 2 to 3 days                  a. 2 days_
                 significant    for    the    Spanish-American.     We     are        c. 4 days                       b. 3 to 4 days
                                                                                 5.   Earache                         c. over 4 days
                 also   suggesting   that   the   degree   of   severity   and        a. mild                     10. Toothache
                 ambiguity  of   an   ailment,   the   sex   of   the   sample        b. moderate                     a. mild
                 and   the   age   of   the   sample   are   very    important        c.  severe                      b. severe
                 factors    in    determining    what    type    of    medical   6.   Headache                    11. Fever
                 practice  will  be   used.   It   seems   further   that   if        a. mild                         a. warm
                 a   greater   and   a   more   rapid   change   toward   mod-        b. moderate                     b. hot
                 ern   medicine   is   desired,   the    young    women    are        C.  severe
                 the  group   to   work   with.   Time   and   space   prevent
                 an   adequate   explanation   of   this   last    hypothesis;                                   DENVER
                 however,  let  it   suffice   to   say   that   young   women        A. The Project  '
                 do   seem   to   be   the   carriers   of   modern   medicine        The   Denver   Project   gave   me    a    unique    oppor-
                 and   probably   exert   enough   familial    influence    to
                                                                                      tunity  to  view  the   city   in   which   I   had   grown
                 assist in implementing the change.                                   up-its  people  and   its   policies.   It   was   also   a
                  In  retrospect,  I   regret   that   many   of   the   find-        revealing   experience   to   view   the   hospitals   from
                 ings   must   remain   undiscussed.    As    in    any    re-        I
                 search,   many    questions    have    been    raised    that        the   outside,   as   a   helpless,    confused    patient,
                                                                                      rather  than  from  the  inside  (as   a   helpless,   con-
                 must   go   unanswered   and    until    a    more    compre-        fused   student).   This   contributed   to   the   profes-
                 hensive  study   can   be   designed   and   a   larger   and
                                                                                      sional   experience   and   perspective    of    all    the
                 more   complete   sample   taken,    many    of    the    in-
                                                                                      'OHP's.
                 teresting    cross-tabulations    will     remain     undone.
                                                                                      The   summer   was   a    period    of    adjustment    for
                 The   goal   of   this   study   has   been    to    discover
                                                                                      the   medical   school,   the   students,   the   community
                 trends.   of   medical   care   with   respect   to   certain
                                                                                      leaders,   and   the   people    of    the    neighborhood.
                 speci-fic  illnesses  for   which   it   was   claimed   folk        Rapport   had   to    be    established    between    each,
                 practices   were   used.   The   manifest    practical    use
                 of   this   is   better   medical   care,   the   latent'uses        and   for   the   students,   was   met   with    immediate
                 of  this  are  still  open   to   speculation   and   discus-        failure.   The   first   day,   eager   to   spread   their
                 sion, and will continue to be.                                       altruism,   many    were    discriminated    against    for
                                                                                      probably  the  first  time  in  their   life   by   finding
                                                                                      no  place  to  settle.  Suddenly,   all   the   "To   Rent"
                                              JOHN C. QUICKER,                        vacancies   had   been   filled   in   the    Mexican-Amer-
                                              ALFRED       J.        CLAASSEN.        ican   neighborhoods.   Unfortunately,   more    of    this
                                                                                      was   to   follow-those   who    were    most    idealistic
                                                                                      at  first  were  hit   the   hardest,   defeated   by   the
                 D.   Folk Medicine Questionnaire
                                                                                      system,   bolted   over   by   the   immense   need    that
                 A.   Where'was the person interviewed:                               every.day    became    more    apparent,    and     contin-
                      1.  Home                    Clinic                              ually  aware  that  time  was  all  too  short.   The   end
                      2.  Age                                                         of    the    summer    was    greeted    with    despair-we
                      3.  Sex                                                         had   changed,   but    the    areas    remained    largely
                      4.  Education
                 B.   Discussion about present illness:                               the   same.   The   feeling   that   remains   beyond   all


                                                   SUMMER 1968
        this, and is the basis for all SHO projects, is the    1. East Side
        quiet  (or  not  so)  determination  that  "I  will    A.   East   Side   Neighborhood   Center.   As'pro-
        return when I am more able to help."                   gressive and open as this was set  up  to  be,  the
        Despite the  individual  frustration,  as  a  group    three students placed here felt  that  their  ideas
        an   invaluable   amount   was   accomplished    in    were often  suppressed  by  a  @ff  hesitant  about
        terms  of  laying  the   groundwork   for   further    our involvement.  Our  preceptor,  a  staff  pedia-
        projects,  for  SHO,  RMP,  and   C.   U.   Medical    trician, was filled with good  ideas  and  enthusi-
        School.                                                asm, but implementation  was  close  to  impossible
        For  SHO  it  was  an   experiments   stop,   look,    without upsetting people  or  getting  involved  in
        and  listen  to  what's  happening  in  Denver.  It    red tape.
        confirmed  our  question   about   certain   inade-    The  center  is  well  looked  upon  by  the   com-
        quacies of the health care  program  and  strength-    munity; patients are treated  in  a  friendly  man-
        ened our desire to become involved in  its  change.    ner and with  respect  in  the  course  of  getting
        For  RMP  there  are  countless  projects  to   be-
                                                               truly  comprehensive  care.  One  drawback  is  the
        come involved  in,  but  the  basic  approach  must    long wait, a complaint so often  launched  at  Den-
        be altered in  any  case.  Plans  cannot  be  drawn    ver General and one of the reasons for  the  exist-
        up within the confines  of  a  medical  school  and    ence  of  the  center.  The  medical  students  and
        be expected to coincide with the life  of  a  -pov-    high school  interns  followed  patients  in  their
        erty  neighborhood.  The   glowing   example   this    course  through  the  center  and  discovered  that
        summer  was  a  medical  organization   with   much    a 2  hour  wait  at  the  pharmacy  was  customary.
        money  and  good  intentions,   that   decided   to    Often  patients  would  leave,  never  to  pick  up
        prove these intentions by carrying  out  a  project    their medication and thus  negating  all  the  work
        for  the  good  of  the  "low  income"   community.    and lab  studies  that  had  been  done.  When  the
        However,  implementation  according  to  the   life    .+ dents presented this to the  preceptor,  he  re-
        style of the doctors made it  not  only  impossible    Lu
        but a mockery of those whose plan it was.              sponded with  "yes,"  it  was  already  known,  but
        For the medical school it will h                       would have to be  proven  and  written  up  in  red
                                           opefully    open    -tape before anything could be done.
        the eyes of  the  faculty  that  the  present  cur-    Next  year's  project  could   use   two   students
        riculum offers -nothing  to  acquaint  the  student    here if at least  one  has  worked  in  the  center
        with  the  relationship  between  disease  and  en-    during the school year and established the  nec-  .
        vironment, between disease and the bearer        of    essary knowledge  of  the  people  and  the  setup.
        the disease.  A  medical  school  must  teach  more    .B. East  Side  Action  Center  is  indeed  a  site
        than the study  of  diseased  organs  in  the  con-    of  action;   programs   there   encompass   every-
        trolled conditions of the hospital;  it  must  pre-    thing from guitar lessons  to  shopping  trips  for
        pare its students to meet the  request  of  society    welfare mothers.  It  was  so  well  organized,  in
        for care that  is  compassionate,  continuous,  and    fact, that the students did not  need  to  be  cre-
        complete.  To   accomplish   comprehensive   health    ative  in  starting  programs,  but  were   content
        care  in  all  areas,  more  black   and   Mexican-    to  do  "band-aid  work,"  the  day-to-day  helping
        American doctors are needed.                           of   established   programs.   Nevertheless,   this
         The  Denver  Project  used  students  as   scouts;    turned out to be  a  valuable  experience  for  all
        each  was  placed  with  a  community  organization    students. The  community  uses  the  center,  which
        as a stepping stone  into  the  community  as  well    seems  readily  accessible  to  the   neighborhood.
        as an observer of the organization,  to  learn  the    Attitudes vary; some do not  like  the  element  of
        role of the particular  organization  in  its  com-    Black Power within the  center,  but  it  is  Black
        munity  and  the  response  of  the-  community  to    Power  in  constructive   sense-self-pride,   group
        it.  We  worked  in  two  of  the   major   poverty    pride, and the  idea  of  black  helping  black  to
        areas in Denver,  an  area  in  East  Denver,  pre-    get  ahead.  The  idea  of  white  health   science
        dominantly black,  and  an  area  in  West  Denver,    students going  in  to  help  should  be  seriously
        Predominantly Mexic,%n-American.                       considered  before  next  year's  placement.  Black
                                                                                                                 19


                                          COLORADO STUDENT HEALTH r.KUJrjU.L
            students  could  serve  as  more  of  an   identity   formation  and  a  good  model  of  community   in-
            figure for the teenagers.                             volvement.
             C.    Curtis    Park    Community    Center-place-     E.  Denver  General  Hospital  was  not  one   of
            ments  here  were  hampered  by  the  vacations  of   the original placements, but was  a  focus  of  in-
            the preceptors.  Footing  was  never  truly  estab-   terest for the students. It is not  unlike  similar
            lished,  and  the  students  Nvorked  on  independ-   general hospitals in  other  major  cities.  Trying
            ent projects. It is a questionable  site  for  next   to blunder  one's  way  through  red  tape  to  the
            year.                                                 source of the problem resulted in  little  feedback
                                                                  and  less   change.   Howev er, one  of  the  precep-
            2. West Side                                          tors, who had his office in  the  hospital,  proved
             A.  Aura@a  Community  Center   is   a   beautiful   to be  a  wealth  of  information  and  the  needed
            new building that looks as  if  it  were  built  by   encouragement   during   the   summer.   He    will
            accident  in  a  low  income  neighborhood.  It  is   be  an  invaluable  source   of   information   and
            very clean inside, but also  very  empty.  The  big   ideas for next  year's  project  or  anyone  inter-
            recreation room is idle all  day,  and  the  entire   --Sted in the West Side.
            building closes at 5 p.m.  These  factors  male  i@     Of  all  the   placements '.  the  most  successful
            seem as though the center  was  not  well  received   seemed  to  be  the  least  structured,  where  the
            by the  community  and  the  students  soon  became   students  were  forced  to  make  their   own   ap-
            involved  in  more  creative  projects   elsewhere.   praisal of the situation and  their  onvn  plan  of
            Placement next year  will  depend  on  the  current   action.  "Band-aid  work"   designed   by   someone
            programs and staff.                                   else does not justify  a  summer  project.  '-\Iany
             B.  Mdiiposa  Health  Station.   Though   oni@   a   other projects were explored,  too  many  in  fact.
            few blocks from Denver General,  it  seems  to  t)e   The  J.F.K.  Recreation   Center,   American   Can-
            much  preferred  by  the  neighborhood.  It  is  an   cer  Society  Pap  Smear  Program,  and  the   Den-
            active, friendly  place;  neighborhood  aides  from   ver branch of  the  "Hielga  Delano"  did  not  re-
            day one were willing to  take  students  with  them   ceive  adequate  response  from  SHP,  Nvhich   was
            on home  visits  and  to  help  them  get  involved   already spreading  itself  too  thin.  Nonetheless,
            and meet people  of  the  neighborhood,  which  led   the overall goal for the summer,  that  of  gaining
                                                              j   understanding  of  a  previously  foreign  area  of
            to  numerous  smaller  but  very  rewarding  pro  -   Denver  and  acquainting   the   communities   with
            ects  with  individual  families.  The  aides   are   whites who  were  genuinely  interested  in  becom-
            from  the  immediate  neighborhood   and   have   a   ing involved, was a success.  For  the  individual,
            good  grasp  of  what  is  happening  and  will  be   specific  memories  will   fade,   but   each   has
            a good  source  of  information  as  well  as  help   grasped  a  more  meaningful  perspective   towards
            for  RMP  and  SHO  in  the  future.  The  students   the field of medicine, that disease  is  a  symptom
            were  actively  involved  throughout   the   summer   of  the  environment  and  the  life-style  of  the
            and  should  definitely  return  next   summer   if   v
            not before.                                           patient.
              C. West  Side  Action  Center  was  the  site  of                               LisA WILSON,
            the SHO  office,  though  no  students  worked  ex-                              Area Coordinator,
            clusively with the center. Just how it  relates  to                               Denver Project.
            the community is difficult  to  evaluate;  opinions
            were highly variable.
              D. Inner-City Parish  is  run  by  the  very  en-   B. The Health Care System-East Denver
            ergetic  Reverend   Beech   with   much   volunteer   1. The  Present  System  of  Health  Care  for  the
            help. It is  a  remarkably  well-organized  program        Poor
            for  the  neighborhood;  perhaps   too   structured     There  are  two  primary  facilities  of   health
            to force the students to  develop  their  own  cre-   care for the 40,000 persons in the east side  area;
            ative approaches. But,  as  elsewhere,  many  hands   the  East  Side  Neighborhood  Health  Center   and
            are needed to help. This is a good  source  of  in-   Denver General Hospital.

            20


                                                   SUMMER 1968
       The  Health  Center  can  care   for   the   "physi-     2. The Most Pressing  Health  Care  Needs  of  the
       cal, mental and  dental  needs  of  the.  patients."      Poor
       Like everything  else,  there  are  likes  and  dis-     A.  The  problem  of  "personalized  care"   deals
       likes about this center. On the positive  side,  one     with the unfriendly nature  of  urban  areas  com-
       student  commented  that,   "This   facility   makes     pared to friendly rural areas. Since  most  people
       a gallant effort  to  give  excellent  medical  care     are from rural areas or at least  extended  family
       on a rather  personal  basis."  The  criticisms  are     situations  where  relationships  are  much   more
       concerned  mainly  with  the  amount   of   time   a     informal, it might benefit  these  people  if  the
       person  must  take  to  be  seen  and  to  have  his     hospitals were less formal.
       medical prescriptions filled.                            B.  A  better  communication  system   should   be
        Transportation   to   the   center   is    arranged     established. This  would  involve  things  as  (1)
       through the use of buses.  There  is  one  group  of     informing more  people  about  what  is  available
       buses that costs 60  cents  for  a  round  trip  and     at the center and  Denver  General  Hospital;  (2)
       another group  that  is  free  of  charge.  However,     community  residents  becoming  more  educated  in
       one  student  felt  that  not  enough  people   knew     the functioning of  the  medical  facilities;  (3)
       about  the  free  ones  to  take  proper   advantage     making information on  birth  control  and  vener-
       of  them,  while  another  felt  they   were   doing     eal disease more  available;  (4)  educating  per-
       an "excellent job," as all one  had  to  do  was  to     sons  in  the  health  professions  to  understand
       call them and they would pick the person up.             better the culture of the people  they  are  work-
        Denver  General  Hospital  was  not   looked   upon     ing with;. (5) orienting  poverty  people  to  the
       in as favorable  a  light  as  the  center  and  was     importance  of  keeping  appointments;   (6)   es-
       used mostly  for  emergencies  or  when  the  center     tab-lishing  community  boards  to  take  part  in
       could not handle a  specific  illness.  Besides  the     decisions which effect their relationship  to  the
       long waiting lines there,  the  staff,  particularly     health facilities.
       the administrators, was very "impersonal     I   and
                                                                C.  "The  circumstances  which  have   gone   into
       cold"  to  the  patients  whose  preexisting   fears     producing  the  negative  attitude  toward  Denver
       of  hospitals  were  already   great.   Denver   Gen
                                                                General Hospital  must  be  corrected."  "Attempts
       eral Hospital is also rather  difficult  to  get  to     should  be  made  to  make  Denver  General   Hos-
       when one is without a car.  This  adds  to  its  un-     pital  more  adequate  to  the  community."   This
       popularity with the poor in this area.                   would  involve  such  things  as   the   community
        One student felt that in spite  of  the  goals  and     board mentioned above.
       attempts  by  the  center  to  create  a   favorable
       image,  it  is  being  seen  by  many  people  as  a     3.  Bureaucratic  Probleras   Which   Hinder   the
       "little DGH."  If  this  negative  trend  continues,       Usefulness of  the  Present  Facilities  to  the
       it, too, will become a  place  to  which  one  comes       Poor
       only in emergencies.                                     A  major  problem  here  identified  by  four   of
         Folk  medical  practices   have   been   mentioned     the six students is the "lack  of  communieatioif'
       by several  students  as  being  a  part  of  health     among  agencies.  In  connection  with  this   the
       care for the poor,  but  they  are  used  mainly  in     overlapping functions of agencies  and  the  often
       unambiguous  and  nonserious   cases.   Because   of     confusing picture of  who  can  do  what  and  for
       this, they are not  seen  as  a  threat  to  helping     whom is the picture often presented to  the  poor.
       the poor when they are  sick,  as  they  do  seek  a     Agencies  seem  to  constantly   refer   community
       doctor when  the  illness  becomes  threatening.  In     residents  to  other  agencies,  giving  them  the
       fact, the practices could be a good  thing  if  they     proverbial "run around"  or  as  one  student  put
       keep those patients who are less  ill  from  length-     it, "Nobody takes a  stand  or  wants  to  make  a
       ening the  waiting  lines  at-the  clinic  and  hos-     commitment of any kind."
       Pital. This is not praising  ignorance,  but  rather     The  lack  of  agency  communication   and   their
       looking at the useful  implications  of  the  litent     overlapping and  referral  oriented  natures  have
       functions  of  folk  medicine  given   the   crowded     not only confused the poor  but  made  them  skep-
       hospital situation.                                      tical of coming to any agencies at all.  In  addi-
                                                                                                                 21


                                           COLORADO STUDENT HEALTH PROJECT
            tion,  agencies  often  are  involved  in  a   competi-    ing  lines  and/or  the  hiring  of  more  people  to
            tion-  for  "cases"  and  "work  at   cross   purposes"    fill prescriptions.
            to  one  another.  The  latter  is  due  perhaps  to  a    5.  Waiting   rooms   should   be   made   more   at-
            lack  of  clearly  defined  agency   goals,   and   the    tractive.
            desire  to  "do  well"  so  that  the  agency  can   be    6.  The   health   education   programs   should   be
            recognized as a good thin                                  increased.
                                        9-
              One  student   suggested   that   bureaucracies   are    7.  A   geriatrics   clinic   "where   doctors   have
            too interested  in  maintaining  the  status  quo,  and    more time to  listen  to  old  people"  was  seen  as
            for  them  to  feel  that  change  should  occur  would    an overt need.
            be  an  admission  on   their   part   that   something    8.  At  least  one  other  health  center  is  needed
            was amiss  . . . . .. Innovation    involves     stepping  to serve  the  poor  As  the  one  available  is  not
            on  toes  because  someone  is  not   doing   his   job    large enough to handle the volume of people.
            well," and this  is  demonstrated  by  the   need   for    9.   Communitk   residents   should    become    more
            change.                                                    involved in decisionmaking capacities.
              A   problem   connected   to   the   above   involves    B.  Alteration   of   the   neighborhood   represent-
            the  large  number  of   people   who   come   to   the    ative program. Two suggestions were offered:
            homes  of  the  poor  trying  to  "help   them."   Just         1.   The   program   should   be   expanded   so
            think,  a  family  that  has  a   neighborhood   repre-       that  there  will   be   more   "reps"   who   can
            sentative from  the  action  center,  a  social  worker       reach   more   people.
            from  welfare,  a  social  worker   from   the   health         2.   One   "multipurpose    neighborhood    rep-
            center,  a  teacher  or  parent   program   aide   from       resentative"  should  be  used   who   knows   the
            Head  Start  (or  both),  and  a  child   welfare   so-       people  and  who   could   refer   them   to   the
            cial  worker  coming  to  its  home  can   get   mighty       various  agencies  in  an  attempt  to   eliminate
            confused  if  all  these  independent  agencies   start       all  the  other  persons  from  all  the  agencies
            trying to solve the same problems.                            bothering  the   poor.
            4.  Concrete   Proposals   for   Better   Health   Care    5.  Cultural  Problems  of  the  Poor   as   Problems
                  Programs                                                for Medical Care
               A.  More  "personalized"   health   care   for   the     A.  All  six  students  mention  that   folk   medi-
            poor.                                                      cal practices are a  eult ural   problem   for   proper
               1.  At  the  health  center,   the   following   are    medical  care.  One  student   felt   it   played   a
            suggested:                                                 giminor  role,  if  any"  while  another  said,  "The
                    a.  Patients  should  see   the   same   doctor    use  of  folk  medicine  plays  an   important   part
                  whenever  he  comes  to  the  clinic.   Like.pri-    in health care. It is  often  used  rather  than  ac-
                  vate  practice,  the  doctor  should   know   the    tual medical treatment'"
                  patient's  name  and   something   of   the   na-     B. A  distrust  of  white  physicians,  and  a  dis-
                  ture  and   history   of   the   patient's   com-    trust  and   fear   of   Denver   General   Hospital.
                  plaints.                                              C.  Most  persons  are  not  oriented   to   preven-
                    b.   Personnel   in   contact   with   patients    tive health care,  and  many  will  wait  until  they
                  should  -be  out  of  uniform  and  wear   gireg-    are quite ill before seeing a doctor. While  this  is
                  ular, common civies" with name tags.                 in part a function of their  value  for  health  care
               2.  A  @definite  need  exists  at  Denver   General    and their definitions of what is illness, it is  also
             Hospital to treat  the  poor  like  people  and  elim-    linked to  their  distrust  of  physicians  and  hos-
             inate those long waiting lines.                           pitals mentioned in B above.
                3.  There  should  be   some   doctors   or   other      D.  One  student  felt  that   "a   major   problem
             qualified  personnel  who  can  make   house   visits.    for  medical  care  is  that  of  broken  homes   and
                4.  A  home  delivery  system   for   prescriptions    mothers   for   whom   children   are   mostly   bio-
             might be  instituted  to  help  eliminate  long  wait-    logical events."

              22


                                                  SUMMER 1968
      B.    The    Health    Care    System-West    Denver    C. The need  to  improve  image  of  Denver  Gen-
                                                             eral  Hospital.  "Thru  fear  and  rumor,   it   is
      1.  The  Present  System  of  Health  Care  for  the   looked upon by some people as a slau            r-
         Poor                                                house."
       There  are  three  main  facilities   serving   the    D. Need for  more  health  facilities-i.e.,  more
      west  side  of  Denver.  One   is   Denver   General   clinics, doctors and nurses.
      Hospital  which  has  been   discussed   under   the    E.  Community  residents  must  learn   to   keep
                                                             appointments and come  in  before  they  are  seri-
      section  on  the  east  side.  The  two  others  are   ously ill.
      Mariposa  and  West  Side  Health   Centers.   These           And  when  they  do  keep  their   appoint-
      centers  are   concerned   with   "checkups,   minor   ments, they should not be forced to  wait  so  long
      illnesses  and  injuries,  chronic  manageable  dis-   to see the doctors.
      eases,  immunizations,  dental  work,  lab  studies,    F.  A  better  understanding  of  the   poor   by
      and  drugs  and   nutritional   guidance."   Another   Denver   General   Hospital   staff   should   know
      student  stated,  "the  West  Side   Health   Center   about the  values  and  attitudes  of  people  they
      provides   comprehensive   care,   including    pre-   serve  and  should  be  tolerant  and   empathetic.
      natal, maternal and infant,  adult,  dental,  social   Again  community  residents  should  be  more   in-
      service, et  cetera.  .  .  .  The  Mariposa  Health   volved in  decisionmaking  roles  and  there  is  a
      Station is a smaller  facility  providing  prenatal,   need for staff conferences on "social  rather  than
      maternal and infant  care,  routine  lab  work,  but   purely medical issues."
      no pharmacy."                                          . G.  Need  for  more  neighborhood  family  health
       Family  health   counselors,   who   are   usually    counselors.  These  people  should  be  trained  to
      residents  of  the  neighborhood,   makes   "rounds"   deal with the  total  problems  of  the  family  as
      to peoples' homes  encouraging  use  of  the  health   sort of a  multipurpose  worker.  These  counselors
      station and center,  and  try  to  mediate  problems   could be useful in getting more people to  use  the
      in  keeping  appointments,   getting   prescriptions   clinics,  through   a   trust   and   understanding
      filled, et cetera. In addition, there is the  Denver   which they could elicit from the people.
      Visiting  Nurse  Service  which  has  nurses   mak-
      ing home visits as  well  as  helping  to  @ff  the    3.  Bureaucratic   Problems   Which   Hinder   the
      health centers.                                            Usefulness of the Present  Facilities  to  the
        These agencies are free, except  for  small  min-       Poor
      imal  payments  from  those  who  can  afford   it.     A.   Denver   General   Hospital   administration
      And,  "Medications  are  provided  free  of  charge    has not responded to the needs  of  the  poor.  It
      to the patients at the clinic at the conclusion  of    seems to be a structure that fears change.
      a visit with the doctor."                               B.  The  inconvenience  of  "forms."  Often   the
       I A point which  several  students  felt  was  im-    fear of having to fill out many  forms  is  enough
      Portant was the emphasis  by  the  clinics  on  the    to keep the poor away.
      keeping of appointments. Over  50  percent  of  the     C.  Lack   of   organizational   cooperation   in
      people do not keep  their  appointments  but  there    sending  many  different  people  into  homes  for
      are always enough  people  around  the  clinics  to    followup. Called  by  one  student  a  "fragmenta-
      keep the doctors very well occupied.                   tion of services.'@'
                                                              D. The problem  of  long  waits  to  be  seen  at
      2. The Most  Pressing  Health  Care  Needs  of  the    the  hospital  and  rudeness  of  the  clerks  and
          Poor                                               some nurses help intensify the difficulties  here.
        A. There  is  a  great  need  for  informing  the    A
      People about the clinics  and  when  to  use  them.    4.  Concrete  Proposals  for  Better  Health  Care
      The orientation  to  health  should  be  more  pre-        Programs
      veiltively oriented, and residents should  be  made     A.  The   employment   of   neighborhood   people
      aware of clinies availability.                         to act as  health  representatives  in  their  own
        B. Need for  transportation  to  the  clinic  and    neighborhood.  These  people  could  "provide  in-
      babysitters while parents go to the clinics.           formation  about  the  neighboihood's  health  fa-
                                                                                                             23


                                              SIV@VA'.ZXlJ%J 0 L U.LJJ2'L'4 L
              cilities  and  programs  to   the   people   of   the    in  making  all  decisions  which  will  effect   ti
              neighborhood"  who  in  turn  could  relate  to   the    services provided by the clinic.
              representative how     things   were   working    for      H.  A  reduction  of  the  number  of  people  wl-
              them. In connection with  this  could  be  an  oppor-    visit area  homes  seems  necessary.  This  could  I
              tunity  program  for  qualified  people   from   pov-    accomplished   through   more   agency    cooperatic
              erty areas to  receive  training  and  education  for    and organization of activities.
              participation in the  health  fields,  i.e.,  techni-      I.  Health  clinics  should  be  kept   open   evt
              cians,  nurses,  and   doctors.   Vertical   programs    nings  so  that  working  people   may   find   thei
              must  be  established  in  health  training  schools.    more available.
                 B.  An   adequate   transportation   system   from      J.   An   "emergency"   food   bank   created    b
              homes to  the  clinics  and  hospitals  must  be  in-    food   chain   donations   would    alleviate    man
              troduced.  Also  an   emergency   system   would   be    acute crises. This is a difficult situation  because
              most beneficial.                                         people must  be  taught  to  budget,  but  it  is  a
                 C.  A  preregistration  program  at   the   clinic    most impossible  to  provide  adequate  food,  clot]
              for  all  poverty   area   people   is   recommended.    ing, and shelter on a welfare check.
              This  would  replace  registering  only   after   one    5.   CulturalI'IProblems  of  the  Poor   as   Proble-ni
              becomes ill and is in no  position  to  find  out  if        for Medical Care
              he is eligible or  not.  A  preventive  type  program
              could  be  worked  into  this  scheme  by   providing      A.  The  non-time  orientation  of  the  poor   wE
              annual  or  semiannual  examination  for   all   reg-    again  seen  as  a  problem.  The  absence   of   th
              istered people@ Since the  people  realize  the  need    value for being at  a  certain  place  at  a  certai
              for medical  care  when  ill,  perhaps  a  value  for    hour  causes   difficulty   in   appointment   makin
              prevention  could   be   begun   by   such   a   pre-    and keeping.
              registration program  for  all  Deoi)le  irrespective      B.  The  value  of  preventive  medicine   is   nc
              of their present physical condition.                     strongly  established  among  the  poor   for   the-
                 D.   An   accurate   appointment   system   should    seem to use the clinic  only  when  quite  ill.  Thi
              be  introduced  by  Denver   General   Hospital   in-    is especially true of the males.
              stead of telling all people to  be  there  at  either      C.  Many  community  residents  have   the   belie
              9 a.m. or 1 p.m.  and  then  forcing  them  to  wait.    that "if it's free  (the  medical  care)  it  is  n,
              A  corollary  to  this  would  be  a  system  of  ap-    good, it's second rate." This helps propa
              pointment  reminders  for  the   people,   especially    double standard of health care.
              just prior to  the  date  of  a  long  term  appoint-      D.  The  low  socioeconomic  status  of  the  poo:
              ment.                                                    presents  problems   itself,   regarding   nutrition
                 E. There is a  great  need  for  educational  pro-    sanitation, clothing, et cetera.
              grams for medical staff  people  in  the  culture  of      E. Some  people  have  the  attitude  toward  i  I
              poverty.                                                 ness that  you  just  bear  with  it.  "For  example
                 F.   Health   education   programs   for   poverty    one lady suffered from severe  joint  pain,  think.,
              residents  in  such  areas  as  health  care  values,    she has arthritis, but won't go to the doctor,  an(-
              birth control, first aid, glue sniffing,  alcoholism,    she happens to be one of the  few  people  who  likE
              drug pro  blems, TB,  tetanus,  et  cetera,  must  be    Denver General Hospital."
              increased.                                                 F. There seems  to  be  a  fear  on  the  part  ol
                 G.  A  committee  of  area  residents  sfiould  be    the  poor  of  uniforms   and   professionalism-lan-
              implemented  to  work  with  the  clinics  and   help    guage, mannerisms, et cetera.

              24


                                                              Chapter 2

                                                             The Student
                                                               Reports


                                                COLORADO STUDENT HEALTH k'-UU.)@U'JL'
                 The papers in this  chapter  convey  a  spectrum              SOME ASPECTS OF COMMUNITY
               of individual experiences and  philosophies  rele-                           ORGANIZATION
               vant  to  the  involvement  of   SHO,   DRMP,   or
               any  predominantly  white  group  in  ghetto  com-            Webster     defines  community  as   a   "body   of
               munities. They express a  deep  sense  of  urgency           people  having  common  organization  or  interests
               and frustration.  This  cannot  be  taken  lightly           or living in the same place  under  the  same  laws
               in view of the  social  disorganization  witnessed           and  regulations."  On  the  west  side  of  Denver
               firsthand by these students, and  the  realization           the latter part of this definition is  most  appli-
               of our  own  impotence  in  confronting  even  the           cable as the area is notable for  its'lack  of  or-
               smallest of problems in a 10 week period.                    ganization. The residents of the area are just  be-
                 A recurrent theme here, as  in  other  parts  of           ginning to get together  to  discuss  the  problems
               the report, is that we can justify  our  existence           of common interest, an  activity  which  will  lead
               in ghetto areas  only  by  demonstrating  concrete           to a more  structured  community.  At  the  present
               changes  produced  as  a  direct  result  of   our           there is, on the whole,  little  communication  be-
               presence. This may  be  a  shortsighted  point-of-           tween  neighbors  about  matters  of   concern   to
               view. Ultimate justification  for  these  projects           the entire community. The basic  unit  is  that  of
               may lie  in  future  changes  in-the  health  care           the family rather than that of a  block  or  neigh-
               system based  on  the  insights,  personal  growth           borhood.
               and   firm   commitments   established   now    as             It is difficult to introduce the concept  of  or-
               health  professional  students.  These  are   pre-           ganization  for  the  purpose  of  bringing   about
               sented below....                                             desired  reforms  because  this  has   never   been
                 Ida  Jean  Newton  is  a  Junior  at  Women's   Medical    done  here,  and  people  must  be  convinced  that
               College of Philadelphia who worked with the  Mariposa        they have the power to change things.
               Health Station on Denver's west  side.  The  paper  deals      The problems which  an  outsider  with  ideas  of
               with  problems  relevant   to   community   organization:    community  organization   dancing   in   his   head
               defining a "community";  identifying  its  problems  from    faces when he begins work  on  the  west  side  are
               both  community  residents  and  community  service  cen-
               ters; and assembling community people  to  discuss  these    many. How does  one  actually  identify  the  prob-
               problems. A basic axiom  in  our  attempts  at  community    lems  of  the  community   rather   than   starting
               organization is alluded to in the  last  paragraph:  That    work on a  project  which  one  feels  needs  doing
               meaningful change  must  be  initiated  and  carried  out    but in which the  neighborhood  is  not  especially
               by the people whom it affects. The  question  of  whether    interested. It takes quite a bit of  talking,  both
               SHO  should  even  be  involved  with   community   orga-    to  the  members  of  the  community  and  to   the
               nizing projects is dealt with at length in chapter 4.        power  structure  which  purports   to   be   work-
                 Ida Jean  mentions  the  methods  used  by  SHP  in  an    ing  in  the  interests  of  the  community.   This
               attempt to improve conditions  of  a  neighborhood  pool.    method is very slow  and  unless  one  has  already
               The  situation.  was  described  more  fully  by   Steven    established a rapport with  the  people,  one  runs
               Berman:                                                      the risk of being  very  politely  yes'd  to  death
                   A very real medical problem was recognized  by  't'ne    on all  actions  proposed.  Organizing  the  people
                   high school interns who complain94  about  the  state
                   of  the  neighborhood  swimming  pool.  Some  of  the    around one's  own  goals  may  be  riiore  fruitful
                   problems  included  abundant  quantities   of   glass    if one has been able to ascertain who  the  leaders
                   and trash in and around the  ppol,  no  soap  in  the    are who are both closest  to  the  members  of  the
                   showers, and a  faulty  chlorine  system.  The  Mari-    community  and  respected   by   them.   This   re-
                   posa clinic  sponsored  a  community  meeting  during    quires time spent  around  agencies  listening  and
                   health week on  the  pool  problem  and  invited  the    watching who is  listened  to.  The  summer  worker
                   dir6ctor of  Parks  and  Recreation  to  attend.  The    can then do the leg work  for  projects  for  which
                   important feature of the  pool  controversy  was  the    the busier agency members do not have time.
                   insight  certain  members  of  the  community,  espe-
                                                                              The people of the  community,  of  course,  play
                   cially the high school interns, acquired in  the  im-
                                                                            the most vital  role  in  identifying  which  prob-
                   portance  of  documenting  a  problem  and  confront-
                   ing the establishment through  political  and  direct    lems are  the  most  acute  and  in  organizing  to
                                                                            solve them. How does one m
                   channels in order to get action.                                                          eet  the  members  of

               26


                                                            SUMMER 1968
         the  community?  For  the  purposes  of   community            munity  are  planned,  the  people  themselves  will
         organization, it is probably best to be  affiliated            begin to initiate positive action.
         with one  of  the  local  agencies  which  is  well
         liked rather  than,  say,  meeting  people  in  the                                          IDA JEAN NEWTON.
         park. For instance, being able to say one  is  from
         the Mariposa Clinic opens many doors.                           Jim Pachl, a second year  law  student  at  Berkeley,  was
          After  one  has  both  informed   and   been   in-            placed with the West  Side  Action  Center  in  Denver.  As
         formed  by  the  community   about   problems   and            in the last paper,  these  excerpts  again  deal  with  the
         actions being taken to solve  them,  there  is  the            frustrations  of  defining  and  relating  to  given  "com-
         difficulty of actually getting people  together  to            Tunities."  The  role  of  SHO  in  bringing  people   from
         discuss possible solutions.  They  are  not  accus-            these areas together  with  local  agencies  is  mentioned.
                                                                        This has been a most productive  and  effective  aspect  of
         tomed  to  and  probably  do  not  like  to  attend            many  of  the   projects   this   summer-particularly   re-
         meetings,  and  have  a  tendency  not  W  show  up            garding  health  care  facilities  and  health  care  "con-
         when  one  is  arranged.  This  may  be  solved  by            sumers." Much  concern  has  been  expressed  in  our  dis-
                                                                  --    cussions as  to  whether  "agencies,"  as  suggested  here,
         several  reminders  and  providing   transportation            should be in our base of operations. This is dealt with  in
         even to  those  who  live  very  near.  Also,  what            other parts of this report.
         form  is  the  meeting  to  take?  Should   it   be
         large  and  advertised  by  posters  which  may  or
         may not be read or  should  it  be  composed  of  a                 HOW CAN I DO SOMETHING?
         small group of  friends  and  relatives  who  will,              If you  are  going  to  work  for  a   summer   i@
         hopefully, later spread the message around?                    a "poverty  area,"  you  will  ask   this   question
           Both   methods   of   getting   members   of   the           often.  Hopefully,  my   comments,   based   on   10
         community  together  have  been  used  to   discuss            weeks in  the  west  side  in  Denver,  will  be  of
         two of  our  summer  projects  -  (1)  The  problem            assistance.
         of  uncleaned  swimming   pools   in   the   ghetto              To work  on  the  west  side  you  must  know  the
         area; (2)  setting  up  a  cooperative  store.  The            people. The blood is  a  mixture  of  Spanish,  Mex-
         necessity  of  improvement  in  both  these   areas            ican,  American  Indian,  and  Anglo.  They  are   a
         was  discovered  by  talking  to  members  of   the            people  unique  to  New  Mexico  and  Colorado   who
         community  and  the  power  structure.  People   in            are  searching  for   an   identity-Spanish,   Mexi-
         Positions  of  authority  with  knowledge  and  in-            can,  or  something  different.  "Spanish"  is   the
         fluence in these  areas  were  found  and  meetings            safest  name,  but  some  prefer  "Mexican."  Better
         were scheduled. In the case of the  pool,  official
         notification was posted at the various age          ncies;     yet,  don't  use  labels.  These  people  are   much
         People  went'door  to  door  to  inform  the   com-            like  anybody  else.   They   are   individuals-many
                                                                        are  intelligent,  some  aren't;   some   are   fine
         munity.  Rides  werl-  offered  and   people   were            fathers,  others  beat  their  wives  and  children;
         reminded  again  the  same  evening.  This  brought            some  are  hard-working,  some  are  lazy.  And  all
         the  desired  result  of  having  people  from  the            are different from each other.
         neighborhood  attend  a  meeting  with  city  Offl-              Words are  all  important  in  college,  but  they
         cials. An earlier  attempt,  in  which  transporta-            don't  mean  much  in  west   Denver.   Many   agen-
         tion was not offered, failed.                                  cies,  "militants,"  and  others  have  made   prom-
           A  meeting  for  the  co-op  store  was   planned            ises and broken most  of  them.  Few  will  serious-
         on a smaller  se-ale  with  a  nucleus  of  friends            ly  listen  to  anyone  with  an  idea.  "Why  waste
         and  family  of  people  in  the  neighborhood  and            time" is their idea.  It  is  said  that  people  on
         some interested officials. The store had ear                   the west side  and  in  other  "poverty  areas"  are
         been discussed in smaller groups in peol                       apathetic. This  is  inaccurate.  The  young  people
                                                                        with  steady  jobs-the  potential   leaders,   leave
         homes.  The  s6cond  attempt,   when   rides   were            the  west  side  because  there  are  better  p  ces
         offered proved a success.                                                                                 in   the   west
                                                                        to raise families. Many people
            If  these  projects,succeed  in  attaining  their           side   have   too    many    personal    worne@large
         goals, and others of vital  interest  to  the  com-            families,   intermittent   employment,   debts,   et
                                                                                                                                 27


                                                COLORADO STUDENT HEALTH k'.KL)Jn%al
                                                                an             be in the absence of the Student Health Project."  He  exam-
                  cetera. Many don't feel that anything c                                                                        munit@
                                                                                ines our roles as "patient advocates" and corn
                  done or don't know how to do it.
                                                                                organizers, and  concludes  that  in  some  instances  wc
                  Knowing    the     people     (wherever     you     are)
                                                                                were useful in these capacities.
                  won't   change   anything-it's   merely   a    prerequi-
                  site  to  do  anything.  Before  you  can  do  anything,
                  you  must  learn  what  is  going  on,  who  is  capable              A QUESTION OF NEED
                  and  who  isn't,  and  what  are   the   genuine   prob-
                                                                                A few weeks ago  I  was  asked  by  a  doctor  whc
                  lems and  issues.  Do  this  at  the  beginning  of  the      has considerable interest in the activities of thE
                  summer   so   that   you   have   time   to   accomplish      Student Health Project if I thought  there  was  q
                  something.  Don't  jump   to   conclusions   about   in-      need for such a project here  in  Denver.  He  pui
                  dividuals  and  issues;  you  will  make   a   fool   of      some emphasis on  the  word  need  in  the  phras-
                  yourself. Remember that the interests of                   a@y ing of his question, which  meant  that  I  woulO,
                  community    are     divided-single     teenagers     ao      have to do some deeper thinking  than  was  usual-
                  not  have  the  same  prob  ems  as  parents  of   large      ly  required  in  answering  questions  about  thE
                  families.                                                     proj ect.
                  You  should   work   with   people   in   the   agencies      Does  Denver  need  the  Student  Health  Project'
                  and  in  the  community  who  are   capable   of   help-      The issue of need is one which is related  to  thE
                  ing  the  community.   You   can't   do   much   without
                                                                                stated  purposes  of  the  project,  these  being:
                  them   and   someone   must   carry    on    when    you                                                   e
                                                                                (1) service to the community,     and    (2)     ducat
                  leave.  You  may   find   capable   persons   who   know      I -
                  the  community  but   don't   know   the   system,   and      ing ourselves  about  the  problems  in  the  com-
                  persons  in  agencies   who   know   the   system,   but      munities in  which  we  work.  But  it  is  not  E
                                                                                word used often, if  at  all,  in  justifying  oui
                  not  the  community.   Get   these   persons   together;      presence  in  Denver  for  the  summer   of   1968
                  they  will  be  much  more  effective.  You  can   teach
                                                                                My first impression on  arriving  in  Denver  wa,,
                  a  little  about  the  working  Of   the   system,   but
                                                                                that the system of health  care  delivery  is  re-
                  YOU   don't   know   much   yourself.   Be    wary    of
                                                                                markably  advanced  and   well   organized,   com-
                  feuding  factions   in   the   agencies   and   in   the      pared  to  Detroit  where  I  came  from.  I   has
                  community.
                                                                                brought with  me  some  vague  ideas  about  work-
                  I  have  found   that   the   "good   people"   in   the
                  agencies  and  in  the   community   don't   have   much      ing on development of facilities along the  line,,
                                                                                of neighborhood clinics. But the  prior  existence
                  time.  The  agency  people   are   swamped   with   day-      of  the  Neighborhood  Health  Centers  and   Sta.
                  to-day  work   and   the   potential   community   lead-
                                                                                tions indicated that the  city  had  already  madE
                  ers  hold  jobs  and  care  for  their  families.  Maybe
                                                                                the  commitment  to  such  facilities.  The   neee
                  these  persons   have   some   "pet"   projects   whicii
                                                                                in this particular area, then, no  longer  existed
                  they  don't  have  time  to  begin.   Maybe   you   have
                  an idea  that  people  like,  but  don't  have  time  to      and it became necessary  to  identify  some  othei
                                                                                problems  for  which  the  project  was   'needed.
                  initiate.  Health  science  students   could   lay   the       After a  short  time  on  the  west  side,  whict
                  groundwork,   get   the   information,   do   the   leg-      is  composed  mainly  of   Spanish-Americans,   ii
                  work,   and   leave   something   for   somebody    else      was seen  that  one  kind  of  need  was  that  ol
                  to continue.                                                  personal concern  for  individuals,  families,  oi
                                                                                small groups. It  is  a  near  certainty  that  n(
                                                                                one on  the  west  side  would  have  perished  ir
                                                     JAMES                 PACHL.
                                                                                the  absence  of  the  Student   Health   Project.
                                                                                What is less certain is that the several  individ-
                   Jerry  Yucht,   a   sophomore   medical   student   at   Wayne uals and families who were  directly  assisted  b3
                  State  University  in  Detroit,  poses  questions  which  might project  members  would  have   managed   to   gei
                  serve as an introduction to  the  discussion  of  our  role  in through some difficult situations  as  quickly  oi
                  '4ghett,oty  conmnunities  presented  in  chapter  4.  He  sug-
                  gests here that  the  "needs"  for  the  project  were  largely efficiently. People were helped  in  getting  med-
                  our own, in  terms  of  self-education.  "It  is  a  near  cer- ical assistance, helped  in  moving,  taken  shop-
                  tainty,that no  one  on  the  west  side  would  have  perished ping, and  helped  with  legal  problems  in  man3

                  28


                                                   SUMMER 1968
       cases  by  project  members.  But  was   this   sort   better idea of what we  were  doing  in  their  com-
       of  need  justification  enough  for  our  presence?   munities,  as  well.  The  problems  we  have   been
       is   this   evidence   of   community   need   great -exposed  to  may  be  even  more  trying  than   that
       enough  to  bring  30   students,   most   of   them   of  convincing  government   and   medical   profes-
       new  to   Denver,   into   minority   or   disadvan-   sion  to  make  the  commitment   to   comprehensive
       taged  areas  of  the  city?  I  think  not,   since   community  health  care.  I   was   educated   about
       many  of  the   problems   dealt   with   by   proj-   the problems residents face  in  dealing  with  wel-
       ect   members   could   probably   be   handled   by   fare,  food  stamps,  prescriptions,  transportation
       community  people  trained  in  these  areas  or  by   and  a  myriad  of  problems  relating  directly  or
       existing agencies in  the  community,  if  they  had   indirectly to the use  of  health  care  in  Denver.
       adequate staff and the desire It  is  possible  that   To better deal with these kinds     of   issues   we
       this kind of  personal  service  could  be  provided   might  use  this   summer's   experience   to   call
       by others on  a  long  term,  continuing  basis;  in   on  only  those  agencies  which   we   have   found
       this capacity we have  served  to  fill  a  gap  be-   truly  responsive  to   community   needs   in   the
       tween  what  could  be  done  and  what   is   being   future.
       done. But in filling the  gap  we  have  gained  in-    The  real  need,  it  seems  to  me,  was  actually
       sights which  could  not  have  been  otherwise  ac-   ours,  not  the  community's.  We   needed   educat-
       quired.                                                ing, and I think that all of us  got  an  education.
        In addition to  services  rendered  to  individuals   It is a very real  possibility  that  what  we  have
       or groups, we helped in the initiation  of  projects   learned  this  summer  can  be  passed  on  to   our
       which  were  designed  to  involve  people  of   the   successors in-Denver, as  well  as  put  to  use  in
       community  on  a  continuing  basis  after  our  de-   our own cities. This bene-fit can be  multiplied  if
       parture.  The  two  swimming   pool   projects   are   we  follow  the  persistent  advice  of  our   black
       examples  of  this  kind  of  action.  The   problem   associates,  that  is,  "go  home  and  spread   the
       itself, in this  case  inferior  swimming  pools  in   word I"  With  the  knowledge  that  10  weeks  time
       project  areas,  was  not  necessarily   of   earth-   is not  enough  to  accomplish  much  of  any  great
       shaking   importance.   What   was   important   was   import in the  community,  we  can  work  for  local
       the  involvement  of  community  residents  in   the   Student  Health  Organizations  along  with   exist-
       solution of the  problem,  demonstrating  that  city   ing  community  agencies  and   organizations,   and
       agencies   will   respond   to   demands   made   by   be  more  effective.  The  summer   projects   could
       groups of the  poor  if  they  organize.  But  again   then  be  continuations   of   year-round   efforts,
       the question of need. Did  the  west  side  of  Den-   concentrating  manpower  and   energy   on   problem
       ver need the  Student  Health  Project  to  initiate   solving, as well as using  the  project  as  an  in-
       these  kinds  of  actions,  or  were  the   vehicles   the-field classroom in community organ    izing.
       already  present  in   the   community?   It   seems     The  most  pressing  needs  of  the  summer   were
       that in this area of the city  there  are  agencies,   ours, since we were  the  ones  to  whom  the  prob-
       such as  the  Action  Center,  which  could  provide   lems  were  alien.  Hopefully,  the  education   re-
       the impetus, but for reasons of lack  of  staff,  or   ceived this summer will  make  us  better.  equipped
       initiative,  or  cooperation   the   community   re-   to deal with needs as they  exist,  and  not  as  we
       mains  unorganized.  Again,  we  tried   to   supply   perceive  them.  It  was  necessary  for  us  to  be
       some  manpower  and  ideas  to  fill,  a  gap.   Un-   here this year in  order  to  deal  with  the  needs
       fortunately,  it  became  painfully  apparent   that   of the community next -year.
       10  weeks  was  not  enough  time  for   implementa-                                    JERRY YUCHT.
       tion  of  the   grandiose   schemes   some   of   us
       brought  to  Denver  to  solve  problems   real   or     Joe Bergquist is a junior medical student at  the  Uni-
       imagined.                                              versity  of  Colorado  who  spent  his  summer  ih  west
         We  might  have  been  more  effective  in   corn-   Denver.  He  again  examines  the  "need"   for   summer
       niunity organizing if  we  had  defined  our  izoals   projects, but here on a  more  intrapersonal  level.  He
       more specifically and  at  an  earlier  date;.  this   concludes, "I don't need the false satisfaction of doing
                                                              something for a person which  he  could  and  should  do
       might  have  resulted  in  our  interns   having   a   for himself."

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                                               COLORADO STUDENT HEALTH PROJECT
                  "WHAT CAN I DO FOR YOU?"                                   for  a  person  which  he  could  and  should  do   for
                                                                             himself.
                 I  spent  the   summer   of   1968   working   with   the
                 Student   Health   Organization   in    Denver.    Osten-                                     JOE BERGQUIST.
                 sibly,  we  were  to  work  in  the  poverty   areas   of
                 Denver   trying   (1)   to   understand   health    prob-
                                                                             Nancy  Adams  is  in  Social  Service   at   the   University
                 lems  of  the  area;  (2)  to  recognize   the   communi-   f Colorado Medical Center. . She   spent   the   summer    in
                 cations   problems    between    the    poverty    people   0
                                                                             Grand  Junction  and  Fruita   setting   up   an   "Aftercare
                 and  the  power   structure;   and   (3)   to   stimulate   Program"  for  patients  recently  discharged  from   psychi-
                 these   same   poverty   people   to    organize    them-   atric hospitals. This is  described  in  some  detail  below.
                 selves  into  a   community   body   which   would,   it,   She mentions, ". .  .the   fine   line   between   motivating
                                                                             people to act for  an  ostensibly  good  cause,  and  pushing
                 self,  gain  desired  health  services  for   its   area.   people into  something  you  are  convinced  is  good."  This
                 Most  of  the   first   month   was   spent   trying   to   became an issue  of  frustration  to  many  of  the  students
                                                                             and  should  be  of  great  concern  to  any  group  planning
                 understand  the  existing   conditions   of   the   area,   "community  based  projects."  It  might  be   construed   as
                 which,   in   my   case,   was    predominantly    a    Span- an argument for expending a  great  deal  of  initial  effort
                 ish-American   area    served    by    Mariposa    Health   toward just  talking  to  community  residents  and  in  this
                 Station.  It  should  be  noted  that  to  truly   under-   way  becoming  attuned  -to  their  problems.  However,   she
                                                                             states  that  the  first  3  weeks  in  Grand  unction   were
                 stand  the  problems,  one  should   probably   live   or   ,pent "...  like  dogs  chasing  their  tails-madly  circling
                 at least work  in  the  area  he  is  studying  for  sev-   and finding no  direction....  inexcusable."  Still,  in  the
                 eral   months   which   for   me   was   impossible.   It   period  of  10  weeks  Nancy  developed  a   well-constructed
                            I                                      .         Iprogram which  will  continue  in  her  absence.  This  ques-
                 did not  take  long  for  the  bad  side  of  the  esTaD-   tion  of  structured  versus  unstructured   situations   was
                 lisbrnent to raise its  ugly,  deaf,  blind,  and  ignor-   a subject of much  debate  in  the  planning  stages  of  the
                 ant  head.  One  would  have   to   be   almost   totally   project.  A  logistic  issue  finally  settled  the   matter;
                 impervious  to   external   stimuli   to   fail   to   recog- although  the  grant  proposal   had   been   in   Washington
                                                                             since February, final  funding  came  on  the  first  day  of
                 nize  the  desire  by  the   establishment   to   attempt   orientation. To offer our  presence  and  then  not  be  able
                 to  maintain  its  role  as  the   father   or   perhaps.   to  follow  through  would  be  another  case  in  the   com-
                 benefactor  of  the  poor.  The  attitude  I   ran   into   munities' files of promises not kept. In  addition  to  this,
                                                                             it was felt that much of  the  time  in  the  first  year  of
                 time  and  again  was  what  I  can  do  for  you.   This   these  projects  must  necessarily  be  spent  in   "learning
                 attitude  is  one  of  the  very  concepts  which   guar-   the communities."  A  major  point  here  is  that  the  com-
                 antees  that  the  people  in  the   ghettos   will   re-   m'nications   which   we   have   established   this   summer
                                                                             must  be  continually  built  upon  during  the  year.   This
                 main  in  the  ghettos.  A  further  extension  Of   this   would provide at  least  a  sense  of  direction  for  future
                 attitude  is   the   objection   to   "letting   ignorant   projects. This point was discussed in  our  final  evaluation
                 people   run   their   own   lives   and   handle   their   'Ission:
                                                                                   The only point  that  I  am  trying  to  bring  out  is
                 own problems."                                                    that I think  you  have  to  decide  once  you  are  in
                  Frustration  became  the   rule,   not   an   occasional         the community, not before, what  its  real  needs  are.
                 happening.  Projects  are  not  set  up   in   a   month.         I don't  think  you  can  go  in  and  say  we  have  a
                 Friends  are  not   made   quickly   among   people   who         project  in  mind  where  we  could  analyze  the  user
                                                                                   of the  neighborhood  health  centers  as  compared  to
                 have  been  shot  down  for  so   many   years   by   the         the nonusers, and  we  are  going  to  devote  all  our
                 so-called I.iberals.                                        not   energies to  that.  I  think  we  have  to  go  in  and
                                     In fact, some people will
                                                                                   find  out  from  the  connnunity  what   the   problems
                 accept  friendship,   no   matter   what.   Some   people
                                                                                   are and what the conununity thinks.
                 may   say   friendshi   is   not   important.   It    is.
                                       p
                 Believe  me.  To  me  one   major   aspect   of   friend-
                                                                                               AN IMPRESSION
                 ship  is  the  necessity  for  letting  my   friends   do
                 for  themselves.  I  don't  believe  a  friend   is   one         The  first  3  weeks  in   Grand   Junction   were
                 who  will  not   allow   a   person   to   develop   self     mainly  ones  of  frustrated  confusion.  Skip,   Jeff
                 pride   through    personal    achievement.    I    don't     and  I  were  like  dogs  chasing  their   tails-Madly
                 need  the   false   satisfaction   of   doing   something     circling  and  finding  no  direction.  We  began   to

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                                                      SUMMER 1968
       follow  each  other  around-a   real   trailing   syn-   the  same  neighborhood  center.  So,  by   a   simple
       drome   which   produced   three   people    anxiously   rationalization, I decided  I  could  be  more  effec-
       peering  in  corners  for  places  and  ways  to   get   tive   working   alone   and   with   mental   health.
       involved.   Thus,   the   most   important   criticism   Besides, it is the field I in'.-end to enter and  it's
       I can make of this project is its  lack  of  organiza-   health related.
       tion  before  bringing  people  into  the   community.     The  after-care  program  here  was   terribly   in-
       I realize time was  limited  in  being  able  to  pre-   adequate  for  ex-mental  patients.  The  only   half-
       pare  for  this  project,  but  in  the  short  amount   hearted  attempt  made  at   rehabilitation   was   to
       of time we  had  to  spend  in  the  areas,  to  waste   herd  them  in  weekly  for   a   crafts   class   and
       a good  third  of  that  was  inexcusable.  Sure,  the   "ladies  from   the   community"   would   serve   re-
       idea for us to  come  into  the  community  to  learn,   freshments  before  they  were   herded   back   home.
       to  create  our  own  jobs,  sounds  good  in  theory,   Lovely!  Most  of  them  had  retained  the   institu-
       but   may   lead   nowhere,   depending    upon    the   tional style of life,  which  is  basically  antilife,
       community    and/or    the     individual.     Project   and   continued   to    be    completely    withdrawn.
       people must realize  that  lack  of  structure  so  as   Many   lived   in   foster   homes   whose   operators
       to allow room to  move,  to  tap  all  that  potential   encouraged  this  due  to  their   own   psychological
       creativity,  is  not  and  should  not   be   mutually   needs.  The  result   was   a   zombi-ish   atmosphere
       exclusive  with  having  definite,  structured   plans   that  was  just  too  tempting  for  many   of   those
       foi- action. It took us  3  weeks  of  relative  inac-   who  wished  to  withdraw  from   the   living,   real
       tivity to discover  that  Grand  Junction  is  a  very   world,  which  may  not  be  such  a  bad  idea   with
       conservative, "don't  rock  the  boat"  type  of  com-   America in its present condition.
       munity. But, is it  necessary  t(>  take  3  weeks  to     But   not   working   under   that   assumption,   I
       learn a lesson as  basic  to  a  small  rural  commun-   set  out  to  see  if  aftercare  could  be   changed.
       ity as that? So  the  alternative  is  simple.  Rather   And  here  came  my  first  real  lesson-there  is   a
       than  getting  vague  promises  from  kindly   people,   very  fine  line   between   encouraging   and   moti-
       such   as   a   welfare   director,   which    quickly   vating people to act for  an  ostensibly  good  cause,
       evaporated  into,  "We're  very   busy   this   summer   and  in  pushing  people  into   something   you   are
       with the  budget,"  et  cetera,  get  specific  things   convinced  is  good.  In  wishin  to  convince  othe.rs
                                                                                              9
       which  each  student  can  be   involved   with.   The   of this, you stand  the  chance  of  alienating  them.
       student  could  spend  as  much  time  with  that   as   It takes a  sort  of  sixth  sense  to  know  when  to
       he  likes  and  still  have   ample   time   remaining   approach  a  person  and  how  to  approach   him   on
       to  exercise  his  own  creativity  in  other   areas.   his  own,  individual  level,  and  make  him   accept
       Now, as  I've  said,  my  first  3  weeks  were  frus-   your way of thinking. It  takes  time  and  I'm  still
       trating, boring, purposeless. Basically,  I  felt  un-   learning,  but  this  seems  to  be  the  essence   of
       essential,  and  that  wounds  one's  ego,  but   per-   getting  things  changed.  It  was  essential  that  I
       haps a necessary lesson.                                 not  alienate  the  foster  home  runners   for   they
         Then,  I  stumbled   quite   by   accident   on   to   were  the  ones   'responsible   for   getting   their
       the   Mental   Health   Association.   These   people,   people  out  and  involved.   My   initial   hostility
       the  executive  director  of  the  Mesa  County   Men-   against  one  foster  mother  who  babied  her  people
       tal  Health  Association,  and  the  psychiatric   so-   and  encouraged   them   to   be   totally   dependent
       cial  worker  who  is  the  liaison   person   between   upon  her,  had  to  be  hidden,  for  I  needed   her
       Pueblo  State  Hospital   and   the   western   slope,   help. (I never did  get  it,  to  the  extent  that  I
       were  in  marked  contrast  to  most  others   I   had   had  envisioned.)  The   second   lesson   I   learned
       spoken  to  in   Grand   Junction.   Their   attitudes   was  that  maintaining   high   ideals   while   being
       were  the  reverse  of   keeping   the   status   quo.   involved  is  unlikely  and  may  be  more   detrimen-
       They  were   eager   to   change   and   improve   and   tal than helpful.
       have  new  ideas.  How  could  I  pass  up  an  oppor-      Setting  up  programs  was  a   unique   experience
       tunity to work  with  them?  .  .  .  especially  when   for  me.  Major  support   came   from   the   Mental'
       Skip's,  Jeff's,  and  my  jobs  tended   to   overlap   Health  Association  and  from  a   zealous,   reform-
       when  we  worked  with   the   same   people   through   ing  type   of   woman   who   had   been   a   mental

                                                                                                                   31


                                            COLORADO STUDENT HEALTH PROJECT
          patient herself. She and I  spent  time  contacting           being "more like holding actions than definite  solutions."
          the  ex-mental  patients  in  Grand  Junction   and           Thi.s is in contrast to the next. paper where the idea  that
          Fruita  and  I  started  weekly  meetings  in  both           such activities are important  parts  of  our  function  is
                                                                        developed. Charles is  a  junior  medical  student  at  the
          places. The goal of this type of group is  to  pro-           University of Colorado.
          vide a place for companionship  and  social  inter-
          action and  to  motivate  them  to  take  increased
          amounts  of  responsibility  for  themselves.   The               SHP-A CRITICAL EXAMINATION
          group  was   theirs.   They   decided   what   they              The  purpose  of  this  evaluation,   presumably,
          wanted to  do  (it  was  mostly  recreational)  an@           is to  examine  the  values  of  the  1968  Colorado
          I tried to be as -nondirective as possible,  though           Student Health  Project.  In  order  to  term  it  a
          I  offered  suggestions  when  I  felt  they   were           success or failure, it is necessary to look  at  the
          needed. The  Fruita  group  went  so  well  that  I           original goals  of  the  project  and  to  determine
          opened a  biweekly  canteen  program  in  the  rec-
          reation center donated by a priest.                           whether  or  not  they  were  reached  by  the   end
           These  groups  and  canteen  programs   will   be            of the summer.  This  task  is  made  doubly  diffi-
          continued after I'm  gone.  Plans  are  being  made           cult by the fact that  these  original  goals  were,
          to get directors and volunteers. Mesa                  ege    at least abstract or  unclear  ones  and,  at  most,
          provides  great  potential  for  volunteers   which           nonexistent ones. All was  not  lost,  however,  for
          has not been tapped.  In  working  with  a  similar           in the course  of  the  summer  certain  goals  were
          group in Boulder,  we  found  college  youth  could           at least approached, if not  attained.  Others  were
                                                                        recognized which  had  little  hope  of  attainment.
          add  a  good  deal  of  warmth  and   enthusiasm'to
                                                                        The latter were more numerous.
          a group such as this. I  met  with  several  people
          from the faculty  and  they  were  eager  to  begin              In discussing each of these goals  and  the  suC7
          recruiting in their  classes  for  volunteers.  The           cess that each enjoyed,  I  must  confine  my  eval-
          canteen program will  hopefully  be  the  precursor           uation  to  my  own  experience  and  not  that   of
          of  a  day-care  program  when  the  Mental  Health           the project as a whole.  I  see  five  goals  worthy
          Center is built in Grand  Junction.  They  hope  to           of discussion. The  first  of  these  was  the  edu-
                                                                        cation of both myself  and  the  middle  class  com-
          have the funding approved next year.
            It has been gratifying  that  I  began  something           munity.  The  former  has  been  rather   successful
          which will  be  continued.  The  aftercare  program           and the  latter  I  think  rather  unsuccessful.  My
          would  have  been  revamped  anyway,  but  the  op-           own  education  has  been  not  so   much   in   the
          portunity  to  develop  something  myself  provided           reality  of  poverty  (although,  what   I   already
          a  good  learning  experience.  And  what   I   did           knew  of  poverty  has  been  indeed  brutally   ex-
          learn was mostly about myself.                                emplified this  summer)  but  more  in  the  culture
                                                                        of the  Spanish-American  people,  a  culture  which
                                                                        I feel is analagpus to        that   of   the   American
                                              NANCY ADAms.              Negro  20  years  ago.  That  is,  a  culture  char-
                                                                        acterized   by    subordinance,    passivity,    and
           Charles  Holt',s  placement  was   with   Denver's   West    apathy. A  culture  not  lacking  in  heritage,  but
          Side Action Center. The  paper  examines  the  success  of    in pride of that heritage.  This  is  changing  with
          the project with respect to (1) education of    . ourselves   the Negro,  and  presumably  will  change  with  the
          and the middle class  conuniinity,  (2)  conununity  orga-    Spanish-American given time.
          -nization, (3) improvement of health care  for  the  poor,       The  education  of  the  middle  class  community
          (4) individual crisis solving,  and  (5)  the  development    has not gone so well.  A  notable  example  is  that
          of the high school intern program. As in the  last  paper,
          he mentions the frustrations of a relatively unstrue  ured    of  the  American  Cancer  Society.   The   American
          situation. The discussions of  the  projecVs  encou  iters    Cancer Society  came  into  the  Chicano  and  black
          with  the  American  Cancer  Society  and  the  conclusion    communities  of  Denver  this  summer  with  a  pro-
          that "perhaps our job is, as our black  friends  have  re-    irram  of  education  about  cervical  cancer,  fol-
          peatedly told us, in spreading the word to the          ite
                                                                        [owed  by  free  clinics  to  give  Pap  smears.  We
          middle class community"  will  be  a  major  consideration
          in  planning  next  year's  project.  The  aspect  of  the    offered the advice  that  they  should  enlist  paid
          project concerning crisis solving is criticised  here'  as    neighborhood  people  to   distribute   the   educa-

          32


                                                           SUMMER 1968

       tional   information   throughout   the   community@          sonnel  improvements  that  should   be   made,   or
       an  idea  about   which   they   originally   showed          to suggest  to  the  people  receiving  this  health
       much  enthusiasm,  even  to  the  point   of   vague          care.   that   they   demand   these   improvements.
       commitment.  They  later  claimed  that   they   had          Which of  these  courses  to  follow  obviously  de-
       no  funds  for  this  purpose  and  were   therefore          pends  upon  the  circumstances  of  the  particular
       unable  to  meet  this  commitment.  However,   they          situation;  after  considering   the   circumstances
       would be able to enlist  the  aid  of  middle  class          surrounding the pool,  we  chose  the  latter  meth-
       housewives to  canvass  the  poverty  areas  to  try          od. So in this case, at least, the  goal  of  health
       to  convince  the  local  black  and  Chicano  women          care  improvement  is  contingent   upon   attaining
       to  have  a  yearly  Pap  smear.  This  copout   un-          the  previous  goal   of   community   organization.
       fortunately  (but  predictably)  alienated  most  of          This latter goal was  successful  and  I  think  the
       the   community   workers   with   whom   they   al-          former will be too.
       ready  had  contact,  including  this  one.  It   is             A fourth  goal  was  the  solution  of  individual
       places like  this  where  I  think  we  can  do  the          crises.  The  instances  in  which  I  was  able  to
       most  good.  The  cancer  people  can't  learn  from          help  were  successful,  but  they  seemed   to   be
       the  poor  community  because  not  only  are   they          more like  holding  actions  than  definitive  solu-
       on a different wave-length,  but  they  aren't  even          tions. As a result, I felt less  effective  in  this
       in the same ball  park.  And  while  we,  hopefully,          capacity  and  spent  more  time  working  on   col-
       aren't  on  the  cancer  people's   wavelength,   we          lective projects than individual ones.
       are from their side of the  tracks  and  regrettably             The fifth goal was to stimulate our   1
       speak  the  same  language.  So,  perhaps  our   job          school interns to continue in school  and  per  iaps
       is, as our black friends have repeatedly told us              into health careers. This  goal  has,  in  my  esti-
       in spreading the word  to  the  white  middle  class          mation,  been  the  most  successful  one   of   the
       community.                                                    summer. Several of  the  interns  have  been  "stim-
         The   second   goal   was   that   of    community          ulated" I  think,  and  are  anxious  to  go  on  to
       organization.   We   have   been   moderately   suc-          college.  We  are  presently  in  the   process   of
       cessful in this effort. I  say  moderately  success-          trying  to  obtain  scholarship  funds   for   them.
       ful  because  several  early  attempts   at   having          But  beyond  this,  and  perhaps   even   more   im-
       community  meetings  to   discuss   this   or   that          portant  to  me,  is  the  rapport  we  have  estab-
       problem failed  dismally,  while  the  last  attempt          lished with these kids. One  of  the  most  valuable
       was  pretty  successful.  This  last   meeting   was          relationships,that  I  personally  established  this
       to  discuss  the  health  problems  at  a  neighbor-          summer was  with  the  intern  that  I  worked  most
       hood  swimming  pool.   Many   neighborhood   people          closely with. Most importantly, I  feel  that  these
       presented  grievances  about  the  pool   facilities          young  people  are  really  the  only  hope  of  the
       and  management,  which  were   loyally,   but   not          poor community.
       justifiably, defended by a director of  the  Depart-
       ment  of  Parks  and  Recreation.  A  committee   of                                             CHMMEs HOLT.
       interested citizens was formed to  carry  the  prob-
       lem further. They  did  so,  and  the  city  cooper-
       ated  by  granting  many  of  their  requests.  This            Steven Berman  is  a  sophcanore  at  Temple  University
       to me was one of the  high  points  of  the  sum@e@.          Medical School. In his paper he  discusses  the  community
                                                                     service and self-educational aspect  of  the  project.  He
         The third goal,  and  presumably  that  at  wiiicn          points out the importance of becoming  analytical  of  the
       this entire project  was  aimed,  was  the  improve-          directions we are taking and  suggests  methods  for  this
       ment of health care for the poor.  It  is  paradoxi-          analysis with regard to his ow-.i placement, the  Mariposa
       cal that this is  the  goal  that  we  are  probably          Health  Station  on  Denver's  west  side.  He  finds  the
                                                                     role of individual crisis solving quite  relevant;  it  is
       least able to achieve.  This  is  true  'because  as          seen as  the  first  step  toward  developing  "individual
       niere medical, students  we  have  no  authority  to          power"  which  can  then  be  mobilized   into   community
       meaningfully  participate  in  the  health  care  of          action. This role can biso  take  responsibilty  from  the
       the people  we  are  here  to  serve.  What  we  can          very  competent  community  aides  whom  he   found,   and
                                                                     allow them to devote more  time  to  organizing  which  is
       do is to either suggest to the existing health  per-          certainly more their legitimate function  than  ours.  Al-

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                                          COLORADO STUDENT HEALTH PROJECT

         though the Mariposa Health  Station  was  found  to  be   help  create  or  revitalize   community   orga-niza-
         an ideal placement, he advocates using caution in work-   tions, which expand  the  power  of  the  individual.
         ing with the community  agencies  before  learning  the     The   Neighborhood   Health   Station    and    the
         community's perceptions of them.                          Mexican-American     family     health     counselors
                                                                   provide  a  good  avenue   for   stimulating   change
                A QUESTION OF RELEVANCE                            in an individual's life style.  Bonds  of  trust  are
           I    worked    at    the    Mariposa    Neighborhood    built  between  patient,  family  health   counselor,
                                                                   and  doctor  through  which  the   patient   can   be
         Health  Station  on  Denver's  west  side,  which   is
         predojninantly    Mexican-American.    This    station    taught to cope  with  all  of  his  problems  better-
                                                                   not  just  "medical  ones."  I  worked  with   family
         enjoys  a  very  good  relationship  with   the   com-    health  counselors  and  developed   a   good   rela-
         munity.  Larry  Sena,  a  high  school   intern,   and    , .
         VI   Madrano   and   Rose   Uruste,   family    iealth    tionsiiip with two families.  I  also  tried  to  ob-
         counselors,  helped  me  greatly  by  patient  y   ex-    tain a realistic overall  view  of  the  role  inter-
         plaining  how  the  neighborhood  people   pe   -ceive    action between  the  clinic  (especially  the  health
         their  problems.  They  allowed  me   to   make   home    counselor) and the community.
         visits  with  them   and   introduced   me   to   many     There  is  an  important  role   the   student   can
                                                                   play  which   many   during   the   summer   rejected
         people in the community.  I  was  thus  able  to  dis-    as "band-aid solutions." It  falls  in  the  area  of
         tinguish  between   problems   created   by   my   in-    comprehensive  medicine   which   I   call   "holding
         tellectualizing  and  the  real  problems  of  import-    action."  It  concerns   people   who   are   totally
         ance to people on the west side.                          helpless and  realistically  unable  to  develop  the
           As  a.  first  year  medical  student   I   realized    power  to  function  adequately  in  society.   Since
         that  my  "service"  to  the   community   would   not    these  individuals  can  never   assume   an   active
         involve   direct   treatment.   If   my   contribution    role, one  is  actually  involved  in  providing  in-
         were  to  be  medical  it  would   have   to   involve    stitutional  type   care.   Such   families   consume
         other   areas   of   comprehensive   medicine,   -pre-    @  great  deal  of  the  family  health   counselor's
         vention  and  rehabilitation.  It  is   important   to    time  and  energy.   The   health   science   student
         recognize that the  patient  has  a  passive  role  in    can  substitute  for   the   counselor   with   these
         the treatment  phase,  but  an  active  role  in  both    families  during  the  summer  and  free  the   coun-
         prevention  and  rehabilitation.   The   active   role    selor  to  devote  more  time  to  those  Nvho   have
         can  only  be  assumed  when  the  individual   devel-    .1
         ops  the  power  necessary  to  control  his  environ-    ttie ability to change their life styles. Indirectly,
         ment  to  some  extent.  Many  low   income   individ-    SHO  can  provide  a  great  service  to   the   com-
                                                                   munity in this manner.
         uals  are  forced  into  a  "passive'.'  existence  as
         most  decisions  which   concern   their   lives   are     The  Student  Health  Project  can   also   be   the
                                                                   most  important   educational   experience   of   any
         made  in  the  end   by   others   such   as   welfare    health science school  career.  It  can  provide  the
         workers, creditors,  nurses,  et  cetera.  Their  pas-    student  with  the  opportunity   of   dealing   with
         sive,  crisis-to-crisis  style  of  living   must   be    the   most   crucial   problem   American    medicine
         broken  in  some  manner  and  the   individual   must    faces  today-how  to  deliver  good  health  care  to
         gradually   make   some   of   the   decisions   which    inhabitants  of  low  income  areas.  In   order   to
         affect his life. In this way  he  can  gain  power  in    approach  the  problem,  the  student  must   develop
         his  environment  and  learn  to  budget  his   money,    the means to  observe  accurately  as  well  as  par-
         provi'de   adequate   nourishment   for    his    family  ticipate in the normal life style of  the  poor.  But
         and develop work habits.                                  how  can  a  student  in  2   months   understand   a
          Prevention  does  not  concern  only   the   individ-    basically  foreign  life  style  and  community?  The
         ual  but  the   entire   community,   and   therefore,
         the  community   must   become   an   active   organi-    most important  thing  is  to  live  in  the  commun-
         zation.rather  than  a  group  of   fragmented,   pas-    ity.  One  can  then  walk  to  work  to   obtain   a
                                                                   feeling  for  the   physical   layout   and   natural
         sive   recipients.   SHO   should   strive   to   help
         "passive"  individuals  break   their   .   crisis-to-    boundaries  of  the  community  and   most   import-:
         crisis life style, to assume  active  roles  qnd  also    ant  become  known  to  the  residents.  One   should

         34


                                                    SUMMER 1968
       shop  in  the  area  and  become  acquainted   with   dant exposure to both  kinds  of  people.  Only  the
       local merchants  and  their  attitudes.  Learn  how   one who  communicates  his  concern  for  other  hu-
       the  different  local  agencies  are  perceived  by   man beings is accepted  on  the  west  side.  Honest
       people not affiliated with a given  agency.  It  is   communication  of  feelings  in   a   manner   which
       important  to  be  certain  of  the  image  of   an   can be understood  and  respected  is  an  art,  and
       agency  in  the  community  before  one  associates   one who can relate to people in this way  is  recog-
       himself in any way with that agency.                  nized as a brother. I  believe  that  too  much  em-
         There  are  many  questions  relevant  to  health   phasis in  medical  education  is  being  placed  on
       care delivery  which  can  only  be  answered  when   becoming   "do-gooders"    and    "brain    pickers"
       the life style of the people served by  the  clinic   relative  to  learning  to  relate  to   others   as
       is  understood.  How  many  meals   are   eaten   a   "brothers."  The  realization  of  this   inadequacy
       day?  What  are  the   common   measuring   devices   in our medical education  has  led  'me  to  believe
       used in the home?  i.e.,  a  teaspoon  of  medicine   there is a need  for  similar  experiences  in  com-
       may  mean  a  tablespoon.  What  emotions  do  uni-   munity  medicine  to  be  incorporated  into   medi-
       forms  and  white  coats  generate  in  the  people   cal school curriculum.
       of the  community?  What  are  the  barriers  which
       exist  between  the  health  professional  and  pa-                                 STEVEN BERMAN.
       tient   which   prevent    meaningful    communica-
       tion? How  important  is  it  to  always  have  the     Steven Feig is a sophomore student at the  University
       same doctor-"your doctor?"                            of Maryland School of Medicine. Through  his  placement
         A  good  example  of  how   a   phenomenon   com-   with the East Side Action  Center  he  was  exposed  to
       mon  to  the  poverty  area  has  practical   medi-   many aspects of the black-white communications  barrier
       cal  importance   is   the   relationship   between   mentioned above. Excerpts from his paper  amplify  this
       "Mother's   Day"    and    medical    appointments.   problem.
       This   phenomenon   recognized   by   the    family
       health counselors relates a  high  rate  of  missed     "WHAT WE HAVE HERE IS FAILURE
       appointments to  the  days  surrounding  the  arri-               TO COMMUNICATE"
       val of ADC  checks.  Just  prior  to  the  day  the
       check  arrives  (Mbther's  Day)  the   men   return     ... Unfortunately, little effort in  the  area  of
       home to try  to  obtain  part  of  the  check.  The   direct  communication  is  being  made.  In  a   re-
       women  being  very  lonely  for  companionship   in   cent incident, a Parks and Recreation Com
       many cases accept the man's presence and a            missioner  of  Denver  stated  that  he   had   been
                                                        P-   looking for 12 years to find qualified  black  life-
       Pointments   become   unimportant   or   forgotten.   guards to staff  an  area  pool.  He  even  had  an-
       I  observed  this  same  phenomenon  when  I   dis-   nouncements  made  over  the  public  address   sys-
       covered that the  local  dancing  club  always  had   tem  of  the  predominantly   black   high   school.
       its  biggest  day  the  weekend  closely  following   However, no one  applied  for  the  jobs.  The  stu-
       the  ADC  check  and   the   men   were   obviously   dents,  knowing  the  "system,"  really  didn't  be-
       trying.to hustle money from the women.                lieve that they  would  be  hired.  They  had  heard
         A Physician should  not  merely  be  a  technolo-   promises before.  It  was  not  until  we  organized
       gist and scientist but an  artist  as  well.  These   a  group  of  poverty  mothers  who  were  concerned
       three sides of the  medical  profession  have  been   about the city's  lack  of  concern'in  keeping  the
       identified  in  slightly  different  ways  by   the   ghetto pool clean that  the  difficulty  in  finding
       people  of  the  west  side.  The  technologist  is   black  lifeguards  was  brought  to  the   attention
       labeled a  "do-gooder,"  one  who  undertakes  cer-   of area residents'. Within a week, a list  of  qual-
       tain tasks without  taking  the  time  to  discover   ified  black  lifeguards  was   presented   to   the
       their implications or if, in fact,  they  have  any   Parks  and  Recreation   Commissioner.   In   short,
       value at all. The scientist is the aloof,  detached   it was only a matter of contacting  the  people  in-
       observer  who  has  become  known   as   a   "brain   volved.  But,  the  commissioner  and  his   depart-
       Picker" exploiting the  poor  without  any  concern   ment  never  thought  of  it.  After   the   meeting
           their  lives.  Th'e  community  has  had  abun-   some of the tension was  out  of  the  air-the  city

                                                                                                               35


                                             c                                 H PROJECT
                                              OLORADO STUDENT HEALT
            had a better feeling  of  the  people's  needs  and         toward  the  eradication  of  the  foundation  sup-
            the residents came to  understand  that  the  city,         porting poverty.
            too, has problems.
             Sometimes,  the  "establishment"   does   go   out                                              STEVEN FEIG.
            of its way  to  communicate  with  the  Negro  com-
            munity.  They  seek  out  Negroes   for   the   Bi-          Marylou Buyse is    a  junior  medical  student  at  Wom-
            Racial  Committees   and   Civil   Rights   Commis-         en's  Medical  College  of  Philadelphia,  who  worked  on
            sions. And  if  there  is  any  pressing  community         the west  side  of  Denver.  Most  of  the  projects  this
            problem  involving  black  people,  they  look  for         summer were developed  as  loose  affiliations  with  com-
            a  Negro  with  whom  to  speak  about  the  situa-         mu@i@y  agencies.  Here,  Marylou   presents   a   project
            tic,n.  Thus,  they  make  two  mistakes  in  their         moaei  of  problem  rather  than  site  orientation.   She
                                                                        worked  directly  with  the  residents  of  a   community,
            efforts for a  dialogue-both  of  which  are  fatal         alling on numerous  agencies  only  where  they  could  be
            to the course at hand. The first  mistake  is  that         expedient in  the  problem  solving.  This  same  type  of
            it is the white  power  structure  that  picks  the         project was discussed  in  the  final  evaluation  session
            Negro to represent  "his  people."  In  this  e-aca         as follows:
                                                                   -t       I think that what  we  are  talking  about  is  places
            the blacks haven't even  received  the  benefit  of             to work with, not places to  work  in.  I  think  that
            a  democracy  to  pick  their  representatives  for             is one of the things that has come out, we  should  be
            negotiations  involving  themselves.  Most   often,             working with, not working  in  or  under....  I  think
            the Negroes picked  to  represent  the  black  com-             we should organize around  issues  rather  than  agen-
                                                                            cies. It may take I or 2 weeks to identify  the  prob-
            munity are those with ideas similar  to  the  ideas             lems,  those  which  may  have   changed   or   arisen
            of  the  "establishment."  The  white   man   picks             during  the  year.  After  we  have  identified  these
            people who tell him  what  he  wants  to  hear  in-             problems,  we  should  regroup  and  work  around  is-
            stead of what  actually  exists.  While  the  white             sues. If you take one issue, you might  have  to  deal
            man is patting himself on the  back  for  his  pro-             with all the agencies in the area  on  it.  We  should
            gressive, benevolent attitude in instituting  these             be coordinating the agencies;  there  should  be  some
                                                                            kind of link and also be a continuity.
            dialogues and for  making  great  inroads  in  race           Marylou also discusses the physical  immobility  of  the
            relations, the  town  explodes  around  him,  erod-         "west side" as well as the subsequent exploitation of  its
            ing some of his power. He is dumbfounded.                   residents-particularly regarding  food  pricing.  The  es-
             The  other  mistake,  perhaps  even  more  easily          tablishment  of  a  cooperative  grocery  store  seemed  a
                                                                    1,  reasonable solution to this problem. At the time  of  this
            made 'is the exclusion of  black  people  from  aii         writing, the West  Side  Action  Center  has  set  up  the
            dialogues  that  do  not  involve  them   directly.
                                                                        organizational  framework  for  the  co-op  and  is  using
            Black  people  know  that  they  are  never  called         students from the  University  of  Denver  as  researchers
            upon to offer their opinion  on  things  that  con-         of information for obtaining funds.  They  plan  for  most
            cern the whole city and not  specifically  Negroes.         of -the money to come from  the  Small  Business  Associa-
                                                                        tion and, for this  reason,  have  to  call  themselves  a
            They  know  that  their  opinions  are  not  needed         Corporation, although the co-op will be  of  and  for  the
            or  wanted   and   consequently,   they'are   again         community. They expect to. be  able  -to  train  community
            made to feel alienated in their  own  home  ci+,t7,         people as clerks and managers  so  that  they  can  obtain
                                                                @.y ,   jobs in other stores. Presently, a credit union  has  been
            This, too, contributes  to  the  upheavals  in  our         established on the west side and is.  proving  successful.
            cities today.
             It mig  lit be said that one of  the  most  pricing        "WHEN     IT     COMES     TO     FOOD      STORES,
            needs of the  American  society  today  is  an  en-             THE SITUATION IS PARTICULARLY
            compassing  exchange   of   information   involving                             ACUTE . . ."
            all-its segments  so  that  each  can  better  come             The west side of Denver  is  the  most  isolated
            to  know  and  understand  the  needs   and   prob-         section of the city. Enclosed  by  its  boundaries,
            lems of  the  other.  We  need  to  communicate  so         its people are natural  targets  for  exploitation,
            that we can be acculturated  enough  to  live  with         deprivation, and neglect. This  is'evident  in  the
            one another and  so  that  we  can  be  enlightened         noninclusion of the west side in the  Model  Cities
            enough to see the causes of  the  existing  poverty         Program. Its isolation is intensified by  the  lack
            culture.  This  would  then  enable  us   to   work         of mobility of most of  the  residents,  few  cars,

            36


                                                          SUMMER 1968
         little  money,  and  large  families.  All   of   these    tion  to  the  problem.  The  establishment  of   such
         things  tend  to  keep  west  siders   in   their   own    a  cooperative   store   is   even   more   attractive
         area. With this  in  mind  as  one  walks  the  streets    when it is seen  as  a  source  of  jobs  for  men  in
         and  goes  into  various  shops,  most  of  which  tend    the area, as a @ite for job training  and  a  business
         to be  concentrated  on  or  near  Santa  Fe,  it  soon    that  will  keep  money  on  the  west  side  and  re-
         becomes  apparent  that  many   of   these   businesses    turn profits  to  the  shareholders.  The  cooperative
         are  owned   and   operated   by   Anglos,   not   west    can also serve  as  a  bridge  to  the  community  or-
         siders.  Certainly  there  are  some   businesses   run    ganization  so  badly  needed   on   the   west   side
         by  west  siders,  but  the  fact  that  there   aren't    (so  they  can  exert  enough  pressure   on   organi-
         more  indicates  that  something  is  amiss.  It  seems    zations  like  Model  Cities  and  not  be  overlooked
         that the Anglos come  over  to  their  stores  or  jobs    again).  If  successful,  the  cooperative  would  not
         on  the  west  side,  make  their   money,   and   then    only  serve  as  an  additional   source   of   income
         take  it  back  with  them.  When  it  comes  to   food    for west  siders,  but  also  would  be  a  source  of
         stores, the  situation  is  particularly  acute.  There    community  pride,  a  pride   in   their   accomplish-
         are only a  few  small  grocery  stores  in  the  area,    ment. We have talked to people in               commun-
         no    large    supermarkets    (Safeway    moved    and    ity  about  the  cooperative   and   have,   for   the
         does  not  plan  to  return).  The   stores   that   do    most part, found th    em  to  be   enthusiastic.   Our
         exist  are  not  only  mostly  An  o  run  (this   just    meetings   with    them    and    community    leaders
                                         . 91
         helps  you  look  for  exploitation),  but  are   small    have  likewise   made   the   cooperative   a   likely
         and  dirty,  poorly  run  and  have  high  prices   and    prospect, one that  is  possible  but  at  this  stage
         low  quality  meat   and   produce.   When   you   dis-    presents  obstacles.  To  get  it  going,   enthusiasm
         cuss  the  shopping  situation   with   the   neighbor-    must  be  maintained   and   more   community   people
         hood  women,  you  discover  they   are   pretty   much    must  be  interested  in  the  cooperative   and   in-
         confined  to  their  home  area.  They   did   complain    vesting in it. A  source  of  funds  must  be  secured
         about  such   things   as   shortchanging,   especially    to  start  this  endeavor.  And  then   someone   from
         when  the  children  were  sent  to  the  store  (which    the  community  must   be   found   who   is   willing
         they  very  often  are),  and  the   favoritism   shown    to  organize  and  get  the  co-op  going.  These  are
         by  the  grocers  to   some   customers,   i.e.,   some    admittedly  formidable   obstacles,   our   work   for
         people  get  charged  more  than   others.   (This   is    the summer  is  over,  and  while  we  have  tried  to
         easy to  do  since  most  items  are  not  marked  with    lay   some   groundwork   and   spark   interest    in
         prices.)  I  have  been  in  the  neighborhood   stores    the co-op, it is  now  up  to  the  west  siders.  The
         and   done   comparison   pricing   and    evaluations.    co-op is completely in their hands.
         The  prices  are  quite  high  and  can   often   fluc-
         tuate  @even  on  @ple  items.   For   instance,   milk                                    MARYLou BuysE.
         is  60  cents  per  half  gallon,  while  elsewhere  in
         Denver,   the   prices   range   from   43   cents   at
         Safeway,  to  49'cents  in  a  small  store.  Meat   is     Marcia Looney is a fourth year student at  the  Francis
         not only  very  high,  but  generally  of  fairly  poor    Payne  Bolton  School  of  Nursing  in  Cleveland.  Many
         quality  and  reportedly  can  be   just   laden   with    of her efforts this summer involved attempts to est  is
         fat.  You  can  often  find  bad  meat  under   a   top    a  "community  board"  to  mediate  complaints  and  be-
                                                             -      come involved in the decisionmaking of  a  general  hos-
         fresh layer in  a  package.  So,  for  all  these  rea-
                                                                    pital in Denver. She gives examples  of  -the  community
         sons,  some  change  in  the  shoppink   situation   is    residents' perceptions of this facility.
         obviously  needed  and   wanted.   When   all   factors     Many  large  city  hospitals  throughout  the   country
         are  considered,  i.e.,   the   relative   competition,    have been ineffectual in responding to the needs of  in-
         the  lack  of  opportunity  for  the   people   to   do    digent health  care  consumers.  These  consumers  often
                                                                    onfuse the health care received with  the  mechanics  of
         much  shopping  out  of  the  area,  the  lack   of   a    cfilling out numerous confusing forms, extremely -long
         large,   good   supermarket   and   the    unlikelihood    waits before seeing anyone, clinic systems  lacking  ap-
         that   any   large   chain   supermarket   would   move    pointment systems, the disrespect shown them by  certain
         into  the  west  side,  the  idea  of  establishing   a    hospital personnel, et cetera . . . On the  other  hand,
                                                                    hospit@l administrators often -  ignore  the  consumers'
         consumers'  cooperative  seems  to  be  a  good   solu-    feelings about these mechanics.

                                                                                                                          37


                                                     COLORADO STUDENT HEALTH PROJECT
                                        of the SHP    in chapter  4  is  that     said,   "You   feel   poor   just   sitting   here."    One
                    A criticism voiced
                  our  community  orientation  has     directed   us   toward                                           "Tumor       Clinic."
                                                                                  cliiiic has the reassuring title of
                  dealing with the end products of  the  health  care  system
                                                                                  I  sat  for  4  hours  with  the  two  patients  I   accom-
                  rather  than  stimulating  basic  changes  in  health  care
                  institutions. Marcia's acivities are a  first  step  toward     panied.  The  wait  is  due  to  the   fact   that   every-
                  this latter type of involvement.                                one  who  is  to  be  seen  in  the  morning  is  told   to
                    SHO speaks of its  role  in  terms  of  patient  advocacy     come  in  at  8:30  a.m.,   and   everyone   to   be   seen
                  and maintaining  the  principles  that  health  care  is  a
                                                                                  in  the  afternoon  is  told  to  come  in  at  I  p.m.  As
                  basic human right  and  that  all  people  have  the  right
                                                                                  we  sat  for  the  4  hours,  not  one   nurse   approached
                  to self-determination. If we  do  have  a  role  in  ghetto
                  communities, it might be  in  extensions  of  the  type  of     a  patient,  other  than  to  tell  him  that  the   doctor
                  project mentioned here.  Setting  up  community  boards  is     was  ready   to   see   him.   When   the   patients   were
                  only one way in which we can  use  our  leverage  with  our     finally  seen   by   the   doctors,   the   physical   care
                  own health care institutions, still acting as patient advo-     seemed good and thorough, however.
                  cates. Other areas of involvement  might  include  insuring
                                                                                    It   seems   that    this    hospital    could    greatly
                  that  paramedical  employees  come  from  the  ronnnunities
                  served, and that our -schools  put  out  more  health  pro-     heig'nten   its   community   image    if    it    improved
                  fessio-nals  from  minority  groups.  Only  in  these  ways     upon   two   things:   (1)   If   waiting   time   in   the
                  can health consumers feel that the  facilities  are  really     emergency    room,    clinics,     and     pharmacy     was
                  theirs and begin to relate to them in a positive  way.  The
                                                                                  shortened,   and   (2)   if   the    staff,    particularly
                  implications  of  these  measures  to  better  health  care
                                                                                  the    administrators,    developed    a    more     sympa-
                  delivery are obvious. This whole  question  is  dealt  with
                  in more detail in chapter 4.                                    thetic   and   helpful   attitude   toward    the    people
                                                                                  they serve.
                                                                                    When  the  new  hospital  is  built,   the   clinic   ap-
                     PROFILE OF A GENERAL HOSPITAL
                                                                                  pointment    system    will    be    changed.     Computers
                                                                                  are   being   used   to   set   up   hourly   appointments.
                    A   large,   red   building   of   unimpressive    archi-
                                                                                  However,   according   to    a    sociologist    associated
                  tecture  sits   on   the   periphery   of   Denver's   west
                  side.  Sometime  in  1969  the  area  is  to   be   blessed     with  the   hospital,   the   clinic   problem   could   be
                  with   a   new   building    which    should    be    quite     alleviated    now    if    organization    was    improved.
                                                                                  He  stated  that   an   efficiency   expert   drew   up   a
                  beautiful.  But  a  building,  after  all,   is   only   to
                                                                                  report   on   the   outpatient   department    and    found
                  contain  an  operation.   And   the   operation   of   this
                                                                                  that with  organization  of  the  staff  's  use  of  time,
                  hospital  seems  to  leave   something   to   be   desired.
                    It  is  one  of  the  most  hated   and   feared   insti-     there  would  be  no  need  for   the   long   waits.   Re-
                                                                                  portedly,   the   hospital's   administration   will    not
                  tutions  in  the  city   of   Denver.   Many   people   say
                                                                                  make this report public.
                  they  would  not  go  there  even  if  they   were   dying.
                                                                                    Reports    from    the    community    of     malpractice
                  Stories    abound    of    the     atrocities     committed
                                                                                  and   poor   judgment   by   doctors   is   a   very   hard
                  there.  One  may  hear  tales  of  a  girl  who   lost   an
                  eye   because   of   slow   service   in   the    emergency     thing   to   prove.   Professional   ethics   would   stand
                  room;  of  a  boy  who  lost  the  tip  of   a   nzer   be-     in  the  way  of   any   validation   of   those   charged.
                                                                                  It  is  also  more  probable   that   these   feelings   in
                  cause    grafting    was    not    performed     promptly-,     the  community  ar-ci  more  a  result  of  lack  of   ade-
                  of  people  dying  and  being  left  in  their   beds   all
                                                                                  quate  explanation  to  the  patient   of   his   diagnosis
                  day  to  be  finally  dumped   in   a   sack   and   carted
                                                        "dirty       Mexican"     ancL   treatment   in    terminology    he    can    under-
                  out.; of a woman being called a                                 stand.   The   patient   misunderstands   what    can    be
                  by someone -in the collections department.                      done  for  him  and  what  is  being  done,   and,   as   a
                    One   of   the   biggest   complaints   concerns    wait-
                                                                                  result,  feels  he  has  not   received   adequate   treat-
                  ing,   especially   in   the   clinics,   emergency   room,
                                                                                  ment.
                  and   the   pharmacy.   I   attended   the    clinic    one
                                                                                    It  is  my  feeling  that  the  staff  needs   education,
                  day   with   two   patients   whose    appointments    were
                                                                                  and   that   regular   staff    conferences    should    be
                  for 1 p.m. The  inside  of  this  ins  "Itution  is  paint-
                  ed   in   gloomy,   hospital   green.   The   clinics   are     arranged,   probably   through    the    Social    Services
                  squeezed-  into  two   hallways.   There   is   one   wait-     Department.    This     same     department     has     ar-
                  ing   room   consisting   of   several   rows   of    hard,     ranged    such    conferences    at    Colorado     General
                  straight-backed    wooden    benches.    As    one     lady     Hospital   where   a   group   of   fairly    verbal    ADC

                  38


                                                            SUMMER        1968
       mothers talked to the staff. In order to  try  and                The  last  paper  dealt  with  a  strictly   health   related
                                                                  om-   pr4Dject. The basic  question,  "How  is  my  project  related
       effect some change, we decided a health c                        to  health  and  medical  problems-"   has   been   asked   by
       Inittee  from  the  community  that   could   work               several  other  groups  during  the  summer.  It  was  brought
       with  the  administration  would   be   the   best               up   il our fnal session:
       solution. In this way, the  community  could  help                    Over  the  course  of  the  summer  I  have  come  around
       itself instead of us  doing  the  work  for  them.                    to  the  idea  that  the  SHO  should  be  more   concen-
       We  discovered  that  the  Model  Cities  Program,                    trated  with  "health"  problems,  and   if   there   are
       one of the most active  grass-root  organizations,                    not  enough  health  problems  in  these  areas  to  keep
                                                                             us  busy,  then  we  shouldn't  be  there.  This  is   my
       had  such  a   committee   already   formed.   The                    personal feeling. Certainly, there  are  lots  of  social
       idea of working with the  hospital  was  presented                    problems  to  be  dealt  with,  but  I  think  there  are
       to  them  and  they  were  most  enthusiastic.   A                    other  agencies  to  deal  with  them.  SHO  should  look
       meeting   between   SHO,   a   representative   of                    more seriously  toward  defining  health  a  little  more
                                                                             narrowly than we  did  this  summer  .  .  .  stress  the
       Model Cities, and a  representative  of  the  hos-                    importance of health  and  we  can  do  just  about  any-
       pital was arranged. The hospital's:  chief  admin-                    thing. Quite  a  few  people  at  my  placement  told  us
       istrator stated that he  would  be  glad  to  meet                    they were glad to have  us  there,  and  they  had  quite
       with Model  Cities  anytime  they  had  proposals.                    a few things  for  us  to  do  including  cleaning  up  a
       We informed  him  that  Model  Cities  could  work                    swimming  pool,  developing   a   co-op   grocery   store
       for the hospital, too, by  doing  studies  of  the                    . . . They  say  that  next  summer  they  are  expecting
                                                                             us and they  will  have  something  all  set  for  us  to
       community,  such  as,  why  people  fail  to  keep                    do when the  people  come  in-this  will  take  the  load
       appointments,  or  by  imparting  information   to                    off  them  and  get  something   done.   Should   we   be
       the  community  concerning  any  changes  in   the                    doing this? It is  better  than  nobody,  but  we  should
       hospital thus  improving  this  hospital's  public                    impress on the neighborhood centers       .and      action
       image.                                                                centers  that  we  are  a  health  organization  and   we
         Therefore, it is left up to Model  Cities  to  do                   would like to work with health problems.
       what they can. I think  they  have  the  potential                    The counter argument is stated by  Dr.  Bonnie
       to develop into a strong pressure  group.  I  feel               Camp in chapter 4.
       that pressure  will  be  necessary,  since  groups
       have  previously  presented  proposals  with  lack                    THE MAINSTREAM OF SUMMER@
       of results.  Model  Cities  is  a  new  committee,
       and  they  have  been  mostly  involved  thus  far                    Mainstream,  Inc.,  is  a  group  of  20  boy@
       in their own organization. But they  are  a  group               ages 13, 14  and  15,  who  formed  a  corporation
                                                                        for the purpose of doing  lawn  and  garden  work.
       of intelligent, enthusiastic people, who  seem  to               The boys all attend Cole  Junior  High  School  on
       have the ability  to  organize  the  community  to               I)enver's east side and, therefore, use  the  East
       bring pressure to bear on this institution.  Hope-               Side Action Center as a base  of  operations.  Our
       fully, SHO will  be  able  to  follow  up  on  the               roles with  Mainstream  consisted  of  advertising
       committee's activities  during  the  coming  sehod
       year.                                                            for  jobs  via  news  media-free  public            on   ra-
                                                                        dio, TV,  and  in  newspapers  was  easy  to  get-
                                                                        handling the requests for jobs as  they  came  in,
                                           MARCIA LOONEY.               taking the boys back and forth, to  their  work
                                                                        and supervising the  jobs,  keeping  the  power
                                                                        lawrlmowers and trucks  running,  handling  the
         Bill  Walker  is  a  sophomore  medical  student,  and   Joe   finances and helping the boys make up the  pay-
       Sprague, a third year  law  student  at  the  University,  of.   rolls every Friday.
       Colorado. Along  with  Joe's  wife,  Linda,  they  helped  co-
       ordinate Mainstream,  Inc.,  ".  .  .  a  group  of  20  boys-        One of the main problems in keeping the  or-
       ages  i3,  i4,  and  15,-who  formed  a  corporation  for  the   ganization running was that  of  operating  ex-
       Purpose  of  doing  lawn  and  garden   work,"   on   Denver's   penses. Three  power  lavnmowers  were  donated
       east  side.  The  paper  deals  with  many   implications   of   which were in a continual state  of  disrepair.
       this kind of  project,  wnong  them,  learning  the  attitudes
                                                                        The  corporation  purchased   two   new   power
       of  the  "white  middle  claW,   toward   these   youths   and         ers, and  Public  Service  Company  donated
       blacks  in  general,  while  at  -the  same  time  giving  the   mow
       boys       a glimpse of other life iityles."                     two pickup trucks  on  which  we  had  to  have
                                                                                                                                   39


                                                                     TH PROJECT
                                        COLORADO STUDENT HEAL
             mi,.ior repairs done  in  addition  to  purchasing   one  lesson   this   summer-that   you   sometimes
             insurance. Gas and oil  expenses  were  also  con-   have to invest money in order  to  make  money)  ;
                                          Federal   or    local   (3) an impo rtant part of the project  is  that  it
             siderable. Because we had no
             funding  for  the  project,  these  expenses  were   allows concerned white citizens to aid  the  Negro
             paid for out of  the  corporation's  earnings  and   community  in  a   meaningful   way-by   providing
             by selling some advertising  space  on  the  sides   jobs and  buying  advertising  from  the  corpora-
             of our trucks to local businesses.                   tion, supplying volunteers to take the  boys  out,
             The  boys  voted  to  keep  60  percent  of  their   and  donating  equipment.  We  met   many   middle
             earnings as salary, put 10  percent  into  savings   class  people  who  were  frankly  surprised  that
             which  was  to  be  matched  by  a  local  service   "those  people  are  willing  to  work."  We   met
             club, and use 30 percent for  operating  expenses.   others who  expected  the  teenagers  to  be  able
             However, to  boys  of  this  age,  30  percent  of   to  do  a  man's  job  because  they  were  black-
             what  they  made  seemed  somehow  less  than   $3   looking at them not  as  teenagers  but  as  "poor
             out of every $10 of  their  Friday  paychecks.  We   people who need  money  so  why  don't  they  work
             had  minor  complaints  at  the  beginning   which   for it."  Confrontations  with  these  people  may
             built up to a crescendo by the  end  of  the  sum-   or may  not  have  changed  their  viewpoints  but
             mer, but  we  could  find  no  other  way  to  pay   served to  make  us  more  acutely  aware  of  the
             for the expenses.                                    attitudes we are fighting  in  this  society.  For
             The  service  club  did  not   come   through   on   what it's  worth  some  people  were  very  inter-
             their promise to double the  10  percent  savings,   ested in the project,  invited  the  boys  in  for
             but we were fortunately able to  do  this  with  a   lemonade  and  cookies  and  solicited  jobs  from
             small excess left over in the  operating  expenses   their  neighbors.  From  the  boys'  viewpoint  it
             fund, so that the boys ended up  keeping  80  per-   gave them a glimpse of other life-styles.
             cent  and  spending  20  percent   for   expenses.    Mainstream  is  as  unrelated   to   health   and
             Ideally, the corporation will eventually  be  able   medical problems as  any  SHO  project  could  be.
             to cover all operating expenses  with  advertising   On the other hand, it is our viewpoint  that  com-
             money.  We  were  unable  to   this   summer   due   munity  health  has  to  encompass  many   aspects
             to delays in obtaining the trucks  and  the  signs   of life and  among  these  are  getting  jobs  and
             (which were also donated  to  us  by  Coca  Cola).   earning money. The boys  are  also  learning  val-
              Mainstream  will  continue  in  a   limited   way   uable lessons in how to deal  with  the  community
             during the school year  with  teachers  from  Cole   outside the ghetto, i.e., estimating jobs,  asking
             driving the trucks to jobs  after  school  and  on   for  their  money,   selling   advertising,   etc.
             weekends.  We  hope  to  have  Denver  Opportunity   Whether  or   not   Mainstream   could   ever   be
             fund us to hire  two  full-time  drivers  and  one   turned into any kind of activist  group  is  ques-
             full-time  secretary  for  next  summer.  With  an   tionable.  Boys  at  this  age  don't  have   many
             early'start on  selling  advertising,  new  equip-   interests beyond sports,  recreation,  and  spend-
             ment should be available by  the  time  school  is   ing money.  If  they  remain  together  as  a  co-
             out  and  Mainstream  should  be  able  to  expand   hesive group in the years  to  come,  they  coule,
             considerably both in the number  of  jobs  handled   very well branch out into activities  other  thar.
             and the. number of boys involved.                    just earning money. It is hoped that  we  will  b(
              The value of this project is  threefold:  (1)  It   able to follow on  into  high  school  those  boy@
             does the obvious thing  of  allowing  young  teen-   who  might  have  talents  and  interests   leanmi
             agers in need to earn money  at  a  time  when  it   toward  medical  or  paramedical  professions  anc-
             is extremely hard for them  to  get  jobs  of  any   possibly get them jobs in the medical center.
             kind; (2) it gives the boys practice  in  handling
                                                                                                BILL WALKER,
             their ovni business and making  their  own  finan-                                 JOE SPRAGUE,
             cial  decisions-something  which  was  done  to  a
             limited  extent  this  summer  and  which   should                                 LINDA   SPRAGUE.
             iricr eAge  as  time  goes  on  and  the  boys  gain   Marion von Buettner, a sophomore medical student a
             more  experience  (they  have  learned  at   least   the University of Colorado, worked with a number o

             40


                                                           SUMMER 1968
        elderly patients through  Denver's  East  Side  Neighbor-     he  was  drunk.  She  has  two  sons-one  on   east
        hood Health Center. She  suggests  the  need  for  imple-     coast and One on west coast,  but  neither  can  be
        nienting many  programs,  particularly  topical  to  RMP-     I
        better nursing  homes;  neighborhood  geriatric  clinics;     Dothered. This lady is practically  blind  and  has
        coordinate efforts "'to bring older people  together  for     great  difficulty  walking  because  of  arthritis.
        mutual entertainment and outings, the hiring  of  'quasi-     Because she cannot see  enough  to  write  or  rea@
        social workers' from among the elderly poor.                  or watch TV, she spends most  or  her  time  brood-
                                                                      ing,  mainly  over  her  aches  and   pains.   When
           AGING IN THE POOR COMMUNITY                                someone ]ends a  sympathetic  ear  and  gives  some
                                                                      advice  (even  if  totally   unprofessional)   that
           Aging  in  the  poor  community   is   accompanied         pain seems less and if  she  is  taken  out  for  a
        by  all  of  the   disadvantages   which   accompany          ride, the  pain  disappears  completely.  She  can-
        aging  anywhere-poor  health,   loss   of   physical          not resign  herself  to  a  nursing  home  as  long
        self-reliance, financial. difficulties, and  loneli-          as she can still crawl,  because  that  would  mean
        ness.  The  latter  two,  however,  are   compounded          giving up all independence.
        in  the  poor  community  for  the  obvious  reasons          The two  alternatives  for  people  such  as  these
        that  financial  difficulties  beset  all  ages-even          are to enter a  nursing  home  or  remain  at  home
        more so  the  elderly-and  that  the  isolation  and          under the care of visiting nurses,  visiting  home-
        loneliness of the elderly  poor  are  natural  prod-          makers and  social  workers.  The  sorry  story  of
        ucts  of  a  system  which  forces  one's  neighbors          many  nursing  homes  needs  not   be   reiterated.
        and children to spend  all  of  their  waking  hours          This is one crying  need:  More  and  better  nurs-
        scrounging for their own livings.                             ing  homes.   The   other   alternative-to   remain
          As cases in point,  consider  the  following  pro-,         home-finds  the  elderly   with   many   of   their
        files of  two  elderly  women  living  in  the  poor          daily needs taken care of by the  visiting  workers
        community:                                                    listed  above.  One  helpful  innovation  might  be
                                                                      a geriatrics clinic either within  or  without  the
        Case 1                                                        neighborhood  health  center.  Often  the   elderly
          Age   63,   never   married.    Ex-profession-prac-         are  well  taken  care  of  medically,  but  resent
        tical  nurse.  Worked  most  of  her  life  and  had          what they feel  is  a  rush-job  from  the  doctor.
        saved  some  money  but  several  years  of  illness          What  they  need  more  than  medicine  is  a  sym-
        ate up  her  financial  resources  and  put  her  on          pathetic  ear  and  this   takes   time-more   time
        crutches.  Now  on  welfare.   Budgets   her   money          than the average GP has to offer.
        well and is happy with the visits  of  the  visiting          The  problem  of  loneliness  and   isolation   re-
                                                                      quires, among  other  things,  a  more  coordinated
        nurse, the  health  aide,  and  the  homemaker.  But
        she is not  in  her  grave  yet  and  enjoys  things          effort to bring older people  together  for  mutual
        all  of  us  enjoy  like  window  shopping,  movies,          entertainment   and   outings.   Another   solution
        rides in the park, church  on  Sundays,  et  cetera.          might  be  to  hire   quasi-social   workers   from
        There is, however, no one  to  take  her.  She  nor-          among  the  elderly  poor  whose  sole  job   would
        mally  goes  out  only  on  Christmas  and  on   her          be to visit and socialize with other elderly  poor.
        birthday. The rest of  the  time  she  sits  in  her          A  monetary  impetus  and  an  "official  position"
        room and gets nervous.                                        may be all that is  needed  to  urge  some  of  the
                                                                      elderly  to  forget  their  own  troubles  and  pay
        Case '2                                                       some attention to their neighbors in need.
         Married  twice.  Buried  last   husband   8   years
        ago  and  hasn't  been  out  of  the  house   since.                               MARION VON BUETTNER.
        Would  love  to  go  see  her  husband's  grave   at
        least  once  a  year.  She   has   three   children.          Jeff Kluger, who is a second year  medical  student  at
        Daughter  has  been  married  twice  and  is  living          the Medical College of New York,  examines  the  health
                                                                      care  system  for  migrants  and  seasonal  workers  in
        with  a  third  man  now,  who  is   an   alcoholic.
                                                                      Fruits, where he worked along  with  @  Eva  Adler  and
        Daughter  never  comes   to   see   mother   because          Judy Lindauer. He mentions an  attitude  toward  health
        mother  threw  the  man  out  of  her   house   when          care which seemed prevalent in many of the rural place-

                                                                                                                          41


                                                COLORADO STUDENT HEALTH PROJECT
                 ments:  "There  were  no  health  problems  in  Fruita....      for in cash. One example of this that  I  encoun-
                 Fruits needed union  organizers  and  industrial  develop-      tered-Mrs.  V  who  could  not  work  because  of
                 ment, not  health  students!"  The  approaches  which  the      back trouble. She went to her  doctor  but  could
                 group took toward changing "the low  priority  on  health"      not afford the money for  the  medicine  he  pre-
                 are described. In addition they documented  the  need  for
                 a mobile clinic in the area to be run in conjunction  with      scribed, and when I left Fruita,  she  was  still
                 a Grand Junction hospital  and  cooperative  local  physi-      laid up, over a week since she visited the doctor.
                 cians'                                                          Unlike the tax-supported  hospitals  in  the  big
                 These students interviewed several families                     cities like Denver, the hospitals in  the  Fruita
                 they had  met  in  other  contexts  during  the  course  =
                 summer.  The  information  requested  was:  (1)   in   the      area are all private and charge for  every  serv-
                 event of a major illness or injury, how would  the  family      ice performed, from X-rays to  lab  work  to  bed
                 meet the costs of treatment;  (2)  Are  there  any  family      occupancy. If the poor person is -not on welfare's
                 members acutely ill at  the  present  time7  Under  treat-      medical  assistance  program,  which  requires  I
                 ment?; (3) What types of chronic illness are prese     @t?      vear of residence in the State, or if he  is  in-
                 Under treatment; (4)  Have  there  been  any  serious  in-      -
                 juries? Describe  problem  and  treatment;  (5)  Does  the      eligible  for  disability  or  Aid  to  Dependent
                 family  have  a  primary  physician?  Who7;  (6)   Is   it      Children  programs,   he   must   undertake   the
                 difficult to  obtain  medical  treatment?;  (7)  Does  the      debt of a hospital bill that is usually quite high     '
                 family  use  the  services  of  the   Health   Department?      One -neighborhood aide received a  bill  of  $700
                 Explain; (8) What does the. family  do  for  dental  ca!e?      from an osteopathic  hospital  for  an  appendee-
                 (9)  Does  the  family  have  an  up-to-date  immunization
                 schedule?; (10) In the event of a  medical  crisis,  where      tomy performed on her 9-year-old son. It  is  go-
                 would this family turn for  help?;  (11)  To  what  extent      ing to be a long time and  much  hardship  before
                 has illness progressed before the family sees a physician?      she pays off that bill.
                 A sponsoring  hospital  and  physicians  have  been  found      Although  the  Health   Department   does   offer
                 and funding is presently being sought. This mobile  clinic      some free medical clinics, they must  be  on  re-
                 should be in operation by next summer.
                                                                                 ferral from a.private physician.  And  then  they
                                RURAL HEALTH                                     are only diagnostic, with the cost  of  treatment
                                                                                 shouldered by the patient.  There  are  no  other
                                                                                 Clinics in the Fruita-Grand Junction area.
                 After spending  2  months  in  Fruita,  Colo.,  as
                                                                                 From  what  I  saw  this  summer,  there  is   no
                 part of the  Colorado  Student  Health  Project,  I
                                                                                 preventive medicine practiced by  the  poor,  es-
                 find  myself  overwhelmed  with   the   number   of
                 things I have learned about the  system  of  health             specially the Navajo migrant.  No  one  goes  for
                 care for the poor in rural areas  like  Fruita  and             a checkup., because  no  one  has  the  money  to
                                                                                 indulge in that sort of luxury. That goes for the
                 the life style of the rural poor as well  as  about
                                                                                 poor  person  on  Welfare's  Medical   Assistance
                 the agencies that contend to help them.
                                                                                 Program, old people on Medicare,  and  just  reg-
                  The system  of  health  care  for  the  poor  re-
                                                                                 ular poor people that do not fall into  any  pro-
                 volves  around  the  concept  of  crisis  medicine,              m, because  in  each  case  the'individual  must
                 that is, the poor person  sees  a  doctor  whe@  he
                                                                                 grar
                                                                                 foot the bill himself.
                 hurts badly  enough  so  that  he  cannot  worx  or
                                                                                 The life style  of  the  rural  poor  utilizes  a
                 cannot bear  the  discomfort  of  his  illness  any             hierarchy of importance  that  puts  health  very
                 longer. And then it is up to  the  charity  of  the
                                                                                 close to the bottom  when  there  is  no  medical
                 doctor as to how much  of  a  debt  the  poor  per-             crisis. Brushing one's teeth is  a  novelty  anc'
                 son has to incur because of  his  illness.  Fortu.-             having a checkup at the dentisVs  is  unheard  of
                 nately, many  of  the  doctors  and  osteopaths  in             The  children  of  the   Navajo   migrants   that
                 the Fruita  area  are  understanding  of  the  poor
                                                                                 have  worked  with  had  the  worst  teeth   that
                 man's  inability  to  pay  his  bill  and   usually             the  dental  hygienist  from  the  Health  Depart
                 allow him time to pay it off. But  there  are  some             ment had ever. seen.  While  the  need  certainl:
                 doctors  who  have  turned  people  over   to   the
                 credit bureau for not paying  bills  as  little  as             is there, and I gave two  sets  -of  toothbrushes
                 $6. Even though  the  poor  person  makes  it  over             and  an  adequate  supply  of  toothpaste  to  on
                 to the doctor, he cannot pay  for  the  drugs  that             family, the children never  brushed  their  teet)
                 the doctor prescribes because  they  must  be  paid             even once, I learned later  that  the  reason  wa

                 42


                                                              SUMMER 1968
          that I gave the brushes  to  the  mother  and  they           ents  of  these  children  were  beginning  to  put
          never got to the children.                                    some importance on  the  idea  of  preventive  med-
            When  we  came  to  one   of   the   neighborhood           icine and good health.
          centers  in  early  June  as  medical  and  nursing              Finally, our presence itself in Fruita as  health
          students, the coordinator  of  the  center  brashly           students,  visiting  many  indigent  families   and
          told us that  there  were  no  health  problems  in           inquiring  about  their  health,  working   closely
          Fruita, and that  Fruita  needed  union  organizers           with  the  aide  from   the   neighborhood   center
          and industrial development,  not  health  students.           on  health  referrals,  and  most  important,   be-
          People's  top  priorities  were  jobs,  money,  and           coming  known  and  liked   by   the   people   and
          food and  rent.  Health  was  a  luxury.  Very  few           children  in  the  community  helped  increase  the
          people  practiced  preventive  medicine  and   very           community's   knowledge   of   preventative   care.
          few  bothered  with   immunizations,   which   hap-           Hopefully,  the  new  health  perspective  that  we
          pened to be free at  a  Health  Department  clinic.           have helped to  establish  in  the  community  will
          No one bothered to come  to  the  center  on  Tues-           not fade in our absence.
          day afternoons,  the  time  when  a  Public  Health
          Nurse  came  to  answer  questions  on  health  and                                                JEPF KLUGER.
          make necessary health referrals. It  was  in  deal-
          ing with  this  low  priority  on  health  that  we
                                                                          Ken  McConnochie  is  a  second  year  medical   student
          had  our  biggest  and  most   rewarding   success.           at  Dartmouth  Medical  School.  He,  Mary   Jaegli,   and
          By  the  time  we  left  Fruita,  the  neighborhood           Nancy  Roland  worked   in   Palisade   and   Cli@n.   The
          center was as health conscious  as  job  conscious,           paper describes this group's  impressions  of  the  health
          and  many  kids  in  the  neighborhood  knew  about           care system in these areas, as well as  their  activities.
                                                                        The need for continuity of care for migrants is  stressed.
          germs  and  the  importance  of  immunizations   as           It is suggested that this might come  about  by  increased
          well as about stethoscopes,  heartbeats,  and  good           communication   between   groups   involved   in   migrant
          dental care.                                                  health, by providing  "traveling  records"  and  educating
           We  accomplished  this  in  three   ways.   First,           migrants concerning their importance.  The  mobile  clinic
          we held  health  education  classes  every  Tuesday           mentioned in the previous paper could  also  help  relieve
                                                                        the health manpower  shortage  in  these  communities,  as
          afternoon for the children  of  the  poor  families           they are all within a 10-mile radius  of  Grand  Junction.
          in Fruita, showing  films  of  various  aspects  Of           This is presently  being  investigated.  Ken  also  points
          good health  and  holding  discussion  groups.  One           out the heterogeneity  of  migrant  groups.  The  implica-
          of our best sessions consisted of  showing  a  film           tion is that no  generalizations  can  be  made  and  that
                                                                   s    need, must be dealt with individually.
          on the family  doctor  and  then  letting  the  kid
          hear their hearts beat  with  a  stethoscope,  tak-           SOME ASPECTS OF RURAL HEALTH
          ing  their  blood  pressure,   and   showing   them                          CARE DELIVERY
          what  an  otoscope  and   percussion   hammer   are
          used for. This particular class  helped  to  intro-           Palisade
          duce  the  concept  of  a  checkup  and   to   show            The  most  pressing  need  is  some  way  of   co-
          them there is nothing       to  be   afraid   of   when       ordinating  health  care  to  migrants   throughout
          they go to see a doctor,  which  was  the  case  as
          I observed with several of them.                              the  route  of  the  migrants.  This  would  insure
                                                                        continuity of care. Another  possibility  would  be
           Second,  we   started   an   immunization   progra@          an increase in local health care  staffs,  enabling
          getting over  60  kids  who  needed  a  variety  @i           the Public  Health  Nurses  to  make  rounds  with-
          immunizations   into   the   Health    Departinenvs
          immunization  clinic.  The  success  of  this  pro-           out  being  overburdened.  With  more   people,   a
                                                                        nurse  could  conceivably   visit   every   migrant
          grant as far'as our concern to establish  a  higher
                                                                        family. There is a  need  for  some  way  of  know-
          Priority,of health, was due to  the  fact  that  it           ing. where  migrants  are  throughout  the  summer.
          was  conceived  in  conjunction  with  a  Neighbor-           This would  help  get  information  to  the  people
          hood  Aide,  and  not  solely  by  the  SHO  group.           who need it. Also,  there  is  a  need  for  better
          In addition,  several  of  the  parents  came  with           broadcasting  of   information   to   the   migrant
          us, and the large turnout told  us  that  the  par-           about facilities available.

                                                                                                                                43


                                        COLORADO STUDENT HEALTH PROJECT
             The foremost  step  in  solving  the.health  care   they  do  not  understand.  Some  speak  little   or
             problems  of  a  mobile   population   would   be   no English.
             greater  cooperation  among  major   groups   in-
             volved in migrant health.  One  way  of  insuring   Clifton
             this could involve providin g  records  for  patients There is  need  for  a  GP  in  the  area  to  care
             to carry with them. Another  is  education  about   for local residents.  There  is  -need  for  general
             continuity of care and  the  importance  of  rec-   education  for  the  population  of   Clifton,   and
             ords.                                               possibly  need  for  another  Public  Health   Nurse
             Education could take  place  in  the  local  rec-   in the area.
             reation center which we helped  to  develop  this    Clifton  is  a  poverty  pocket  of  primarily  re-
             year  for  migrants  during  harvest.  These  ac-   tired  people.  Health  care  is  provided  by   the
             tivities were in the form  of  movies,  lectures,   two doctors  in  Palisade  and  the  Grand  Junction
             and pamphlets. We  sent  letters  to  growers  to   doctors. There  is  one  nurse  for  Clifton,  whose
             increase their knowledge of the facilities avail-   work  load  is  monstrous.  There  will  be  a  Com-
             able and provided 1)am-ohlets to the migrants  to   munity  action  center  which  intends   some   edu-
             inform  them  of  these  services  and  how  they   cation eventually. To  them,  this  is  smoking  and
             might best take  advantage  of  them.  The  addi-   drinking  lectures.  There  is  no  clinic.   Health
             tion of a Public. Health Nurse  who  would  work'   care is  purely  individual  and  there  is  no  re-
             in  Palisade  during  harvest  and  Clifton   the   cruiting.  These  people  are  the  invisible  poor.
             rest of the year would help -get better  coverage   It was not until the  end  of  the  summer  that  we
             of both areas.                                      became  aware  of  this  aspect  of  the   community
             A  plan  involving  the  cooperation  of  growers   both in  Clifton  and  Palisade.  It  deserves  fur-
             in registering all migrants  in  a  central  list   ther   exploration   and   concentration   in    the
             would help provide care to all.                     future.
             Because of the  diversity  of  the  migrant  pop-
             ulation, it is difficult to place any culture  or                            KFN MCCONNOCHIE.
             values on them. As to the winos, there is  highly
             individualistic feeling  among  the  group.  They
             will not ask for help until they really need  it.    Daniel Kraus is a second year student  at  the  Univer-
             Most  are  educated  Caucasians  who,  for   some   sity of Rochester Medical  Center.  He  was  one  of  the
                                                                 four health science students assigned to man  the  Sangre
             reason, have dropped out  of  society.  They  are   de Cristo Medical Unit in San  Luis.  Although  this  was
             hostile to any help "offered" and will come  only   the most clinically oriented of all  the  placements,  he
             on a take it or leave it basis.This  means  "soft   focuses on  the  welfare  system  rather  than  the  more
             sell."                                              narrowly defined health needs of the community.
             The  Negroes,   are   generally   from   Arkansas       PROSPECTS FOR TRUE WELFARE
             and are teenagers. They are fairly well  educated              IN COSTILLA COUNTY
             and eager to  learn  more.  They  generally  seem
             interested in health..                                From my daily log:
             The   Mexie-an-Americans   have   been    picking          July  18:  "Asked   Evan   M.   (Chama   Can-
             up our pamphlets. They  don't  seem  to  talk  as        yon) why his wife  and  child  didn't  come  to
             much as previous  groups.  They  travel  in  fam-        Well-Baby  Clinic;   said   his   battery   was
             ilies, generally. They  are  concerned  with  the        dead,  would  I  ask  around  town  for   some-
             welfare of their families.                               one  to  buy  his  homemade  fence   posts   so
             The  Indians  seem  to  be  the  least  receptive        he could pay  $15  for  a  new  battery  so  he
             group. They do not watch  the  films  as  do  all        could drive  his  pickup  into  town  and  earn
                                                                      a living."
             the other groups. They bring their children  with
                                                                        August   13:   "Told   Dave   S.   (LaValley)
             them, even to the fields. They do not  ask  ques-        that  he  was  ineligible  for  disability  for
             tions and seem suspicious of health officials al-        his  bad  hand  (though  his   alcohol-enlarged
             though they  do  cooperate.  It  may  be  because        liver  may  be  worth  something),  but   could

             44


                                                         SUMMER 1968
              get  100   percent   food   stamp   support   and   present  allocation   of   OEO   resources.   Surely,
              free  medical  care.  He  vowed  to  get  a   job   it  is  inconceivable  to  withdraw   support   where
              here or leave  his  wife  and  go  to  California   it already  has  been  given.  But  I  am  struck  by
              to make enough money to pay his bills."             the  ways  in  which   the   Government   is   acting
            Evan  and  Dave,  residents  of  two  of  the  most   at cross purposes.  For,  on  the  one  hand,  monies
         isolated  corners  of  the  San  Luis  Valley,  differ   are being spent  for  institutions  in  this  county,
         in  their  means  of  subsistence.  Evan   hunts   and   for the benefit of its  inhabitants,  while,  on  the
         sells elk in the  winter,  and  Dave  relies  on  full   other hand, little, if  anything,  is  being  consid-
         Government  handouts.   Nonetheless,   it   is   plain   ered  for  making  Costilla  County  a  more  desire-
         that   they   have   in   common    a    hand-to-mouth   able  place  for  youthful  people  to  continue  in-
         existence,  secure  against  starvation   today,   but   habiting.  On  the  contrary,  it  is  almost  as  if
         necessarily lacking a view into tomorrow.                the   CAP   opportunities   are   concentrating    on
           The  unincorporated  village  of   San   Luis,   the   arming  the  youth  for  success  "on  the  outside;"
         Costilla  County  Seat,  is   the   headquarters   for   in industries and  the  professions,  which  at  this
         the  regional  Welfare  Office   and   the   Community   point would be least likely to  settle  in  this  re-
         Action   Agency.   The   government    pursues    many   mote   expanse   of   sagebrush.    "Community    Ac-
         programs  here  which,  as  the   names   imply,   un-   tion"  might  more   accurately   be   renamed   "Ac-
         dertake  to  replace  deprivation  with  welfare   and   tion for Community Disintegration."
         inertia  with  action.  Basic  and   advanced   educa-    Was  it  purely   instinctual   revulsion   that   I
         tion; training  in  job  skills;  FHA  loans;  subsidy   felt  when  it  was  suggested  that  the  only  hope
         for  food;  and,  eventually  a  comprehensive  health   for  improving  this  county   would   be   to   move
         care program  in  the  valley;  all  these  and  other   those remaining citizens  out  of  the  valley?  Love
         well  intentioned  projects  are   operant   at   this   for one's  homeland  and  its  great  natural  beauty
         time.                                                    notwithstanding,   abandonment    is    neither    an
           Yet  Evan  and  Dave   and   many   more   residents   unprecedented  nor  an  inviable  solution   to   the
         of this county  are  being  overlooked  in  the  allo-   problem  here.  Lacking  an  economic  base,  a  com-
         cation   of   Federal   funds   for   OEO    programs.   munity has  no  reason  to  continue.  Given  greater
         These  are  perhaps   especially   important   people,   opportunities   born   elsewhere   of   technological
         heads  of  families  who  might   choose   to   remain   progress,  Costilla  County  shows   signs   of   be-
         in  the  county,  rather  than  move   away   at   the   coming a mammoth ghost town, i        n   much    the
         first opportunity, yet  still  quite  alone  in  their   same  way  that  the   old   mining   towns   decayed
         long term fight for survival.                            and died. It  requires  no  more  than  a  brief  in-
           For it is  unclear  that  under  the  best  of  con-   spection of  this  area  to  be  convinced  not  only
         ditions,  the  Federal  funds  would  be   acting   in   that without  water,  there  is  no  life,  but  that
         two   general   areas-one   which   we   would    term   without  industry,  there  is  no  prosperity.  In  a
         "stop  gap"  measures,  such   as   the   food   stamp   county  that  lost  50  percent  of  its   population
         Program,  and  the  other,  which  is  the  establish-   between 1950 and  1960,  it  is  folly  to  entertain
         nient of excellent institutions, such  as  the  Neigh-   hopes  that   private   enterprise   would   consider
         borhood Health Center concept.                           investing  in  any  plant  as   far   from   a   main
          These  more  lasting   efforts,   while   potentially   transportation route as this.
         significant   improvements   of   conditions   regard-    And  yet,  here  my  anger  is   backed   not   just
         less  of  the  prevailing  economic  conditions  of  a   by  instinct,  but  by  reason  as  well-the   desert
         region, will be  seriously  hampered  in  their  use'-   has been  made  to  bloom  in  the  past.  Where  en-
         fulness  unless  still  more  fundamental  steps   are   trepreneurs   were   unable   to   act,   governments
         taken.,   I   am   primarily   concerned   about   the   have  been  the  miracle  workers.  If  there  exists
         economic  future  of  Costilla  County  and  the   ap-   today  no  economic  base  in  the  county,   perhaps
         Parent   Federal   circumvention   of   this    entire   it is  the  responsibility  of  the  Federal  Govern-
                     expenditures   to   date.   Though    talk   ment to  create  such  a  base.  With  land  becoming
                        it  is  not  without  reason  that   we   even  scarcer  and  distances  less  prohibitive,  it
                      on   the   economic   wisdom    of    the   would  be  something  less  than  prophetic  for  the

                                                                                                                    45.


                                             COLORADO STUDENT HEALTH PROJECT
               Office of Economic Opportunity     to    appreciate   certain-so   a   13-year-old   kid   walking   home
                     tential of an area such as this. Is  it  nec-   from his piano lesson has a  fair  chance  of  get-
               the  po
                      to wait  until  Evan  gets  thrown  in  jail   ting  arrested  for  vagrancy  and  maybe  of  get-
               essary
               for poaching and  Dave  dies  of  cirrhosis  before   ting his head beat on.
               an  attractive  industry  moves  into  the   valley     I know a big dog on the east side  that  I  don't
               to  employ  them?  If  so,  perhaps  some   thought   even like  to  look  at  for  very  long-I  mean  I
               might be  given  to  the  altemative-the  evolution   only look at him sort  of  out  of  the  corner  of
               of an almost complete     Iwelfare       community.   my eye or with my  hands  over  my  eyes.  I  don't
               Even  if  the  Government  were  to  make   a   bad   think the people out in  South  Denver  could  even
               investment,  and  granted  its   wastefulness   and   do that. He's  awful  lookin.  The  thing  is  that
               inefficiency,  it  would  almost  certainly  repre-   people in South  Denver*  don't  have  to  look  at
               sent less of a total cost than to support  by  com-   that horrible giant dog enough.  I  mean  that  dog
               mon dole the population  it  might  otherwise  have   isn't very easy on the eyes.
               employed.  This  is  something  private  enterprise     Anyhow, the real  question  is  whether  the  big
               has not had  to  be  concerned  with.  A  reevalua-   dogs  on  the  east  side  aren't  really  MONSTERS
               tion  of  the  priorities  of  government  spending   FROM  THE  ID.  Something's   up   when   you   got
               might  do  well  to  consider  the  possibility  of   these  crazy  awful  looking  alien  dogs   around.
               taking  the  important  steps  which  the  reversal   These  dogs  come  from  somewhere  else  if   you.
               of the current trend in  Costilla  County  demands.   know what I  mean.  I  mean  they're  really  some-
                                                                     thing else. God, you oughta  look  at  em.  They're
                                           DANIEL J. KRAUS.          scary lookin mothers. It's pretty clear they  don't
                                                                     come   from   any   little   doggie   mommies-prob-
                                                                     ably  born  of  some  unspeakable  mental  process.
                Joe Sprague is a third year law  student  at  the  Uni- You know what I  think?  I  think  those  dogs  are
               versity of Colorado, who did extensive work with  Project some kind of SYMBOL!!
               Mainstream, welfare rights groups, and  various  families
                                          ide of Denver.
               with legal crises on the east s
                                                                     Just a Little Bit
               NOTES    FROM    THE    OVERGROUND    .     .     .     I don't want it all, just a little bit.
                                (EXCERPTS)                             if an  enormous  thing  like  the  United  States
                                                                     can introspect  and  really  wonder  (like  'geeze,
               Forbidden Planet                                      what is  goin.g on?), then it  can  find  an  answer.
                                                                     There's an answer. Uh  huh,  there  is  an  answer.
                  The east side has a lot of big  dogs.  If  some-
               body walks down  an  alley  you  can  hear  it  all     The answer  is  that  you  have  to  change.  The
               over town.  Those  big  dogs  yelling  their  heads   only trouble  with  that  is  that  nobody  in  the
               off,  turning  around  and  around,   and   hitting   history of  the  world  ever  changed  except  Mis-
               the fence like a rhino (sort of).                     ter  Scrooge  and  he   only   changed   into   Jim
                  They're funny dogs .      not just  routine  big   Backus.
               dogs' These dogs  are  sort  of  weird  (dig  those
               weird  dogs).  Their  heads  areconnected  in  many   Alors Que Passa
               cases to their bodies direct!                           Everybody   knows   that   human    conduct    is
                  Anyway,  what  kind  of  a  deal  is   it   when   mostly  incoherent  reflex'  and  if  it  has   any
               somebody  makes  you  live  in  a  place  and  then   meaning, it has to lie in   a slim  vein.  I'd  bet
               cuts you off so you can't  get  any  money  so  you   that personal mortality,    in fact,  is  the  only
               got  to  steal  everything  you   can   from   your   thing that counts,  and  given  our  terrible  per-
               neighbors and you all  have  to  go  out  and  find   ception that adds up to not  lying  to  ourselveIs.
               these alligatok-dogs and keep  them  in  your  back     It's lying that hangs up dissent  in  the  United
               yard to seare off the stealers. Oh yeah?              States. The  question  is  whether  lying  to  our-
                  It's sort of like everything else  around  here.   selves isnpt  a  fundamen;a  process.  The  questio
               Ten million vicious circles. The  police  are  ner-
                                                                       0 Denver's south side is a predominantly white upper middle
               vous  (maybe  at   best),   the   environment   un-   cl"s area.

               46


                                                  SUMMER 1968
        is  whether  anybody  with  any  interest  in  the    and  Dr.  Brothers  then  invited  me   to   watch
        process can reflect on  it  honestly.  The  night-    their surgery  and  tag  along  with  them.  There
        rnare is the unquestionable accurac'y of the  most    was nothing particularly  rural  about  their  new
        insanely radical voices around.                       clinic either, with lab technicians and phone  re-
        You  know  it's   not   them   bad   Russians-it's    ferrals to specialists in Grand Junction.
        not  those  weird,  hysterical  Chinese-it's   the    I  occasionally  tagged  along  with  the  Migrant
        personal devil, baby, on duty  all  the  time  and    Association nurse,  volunteered  to  help  her  do
        just iookin' for a home.  And  the  time  to  beat    Denver  Pediatric   Development   testing,   which
        that cat was day before yesterday.                    never panned out. I took quite  a  few  sick  kids
                                                              to  the  local  doctors  to   get   penicillin-and
                                       JOE SPRAGUE.           balloons.
                                                              At this point, I  was  beginning  to  get  desper-
        Norrnan  Chenven  is  a  junior  at  the  Downstate  Med- ate.  Particularly  so,  as  my  community  repre-
                                                              sentative   (intern)   was   a   Commanche   among
        ical Center in Brooklyn. He, along with his wife,  Dinah,
        and Jane Patterson, spent the  surnmer  in  Delta,  Colo. Navajos (traditionally bitter  enemies)  and  also
        The following  events  are  true,  only  the  names  have very "American." He had  less  ability  or  desire
        been changed to protect. . . .                        to communicate with  Navajos  than  1,  except  to
                                                              the  female  VISTA   Associates   with   whom   he
                 THE DELTA PROJECT                            established considerable rapport.
         The three of us moved  into  the  town  of  Delta    I was  relieved  of  the  burden  of  dragging  my
        without a shred of legitimacy. Luckily  for  Jane,    Indio" around by a  stroke  of  mutual  good  for-
        Joe Lawson of the school district  had  a  project    tune.   Adrian   was   accepted   by   HEP   (High
        ready to go  for  the  summer.  Jane  was  then  a    School Equivalency  Program)  and  he  left  on  3
        SHO  member   working   for   the   Joint   School    days  notice,  owing  me  wampum  to  the   extent
        District  50,  preparing  materials  for  a  grant    of $140, (more  than  enough  money  to  buy  Man-
        proposal that  the  school  system  hopes  to  put    hattan Island).  Since  this  Indio  was  an  all-
        into effect in the coming year. It deals with  the    American spendthrift, I  took  the  precaution  of
        Spanish  high  school  dropouts.  Thus,  Jane  was    having the  Great  White  Father  in  Denver  send
        a  SHO  member  doing  a  job  that   would   have    his check directly  to  me  when  it  was  issued,
        been salaried b the school district.  Fortunately,    approximately  5  weeks  too  late.   Adrian   was
                      y                                       thus  subjected  to  the  indignity  of  receiving
        the program should  be  a  very  valuable  one  to    $14.50  from  a  $180.00  paycheck   after   Unple
        the Spanish population in Delta.                      Sam and  the  Indian  Agent  (me)  did  our  work.
          Dinah, liking children, found  a  daily  7  a.m.    This is known as Indian giving.
        to 7 p.m. job  working  in  the  Day  Care  Center     In a  burst  of  unprecedented  energy  (probably
        run  by  the  Migrant   Association.   They   were
                                                              derived  from   despair),   Adrian,   two   Navajo
        short-handed and  welcomed  reliable  and  respon-    Vista Associates and I began to put up  a  basket-
        sible help since those qualities were  rare  among    ball goal  in  the  Holly  Sugar  labor  camp.  We
        others  stationed  in  Delta.  Thus,  Dinah,  like    finished it a  week  after  Adrian  had  left  and
        Jane .1 had also discovered  a  legitimate  actv'ty'  2 days before the Holly Sugar  labor  camp  closed
        Again it  was  in  the  capacity  of  a  volunteer       the season. To date, the only  people  to  play
        worker  for  an  established  organization.   Thi!    for
        job had a medical  slant  to  it;  taking  care  t    ball on that court are Ritzy  (Adrian's  14-;year-
                                                              old sister) and myself.
        kids, feeding  them,  and  bringing  them  in  for     With  the  departure  of   the   Navajo   migrant
        Physical exams with local physicians.                 workers,  I  redirected  my  inexhaustible  energy
          That left only myself high and  dry.  Dr.  Stark    and  multifaceted  talents  toward  the   Spanish-
        Was wonderful.  He  invited  me  to  the  hospital    American,  community  in  Delta.   Marching   for-
        to observe surgery and allowed  me  to  tag  along
        in his office for 10 days to  observe  his  "rural    ward  under  the  banner  of   SHO,   and   always
        -Practice." There was nothing  particularly  rural    bearing  in  mind  that   racial   discrimination,
        about it except,that he  was  a  G.P.  Dr.  Ronald    school segregaton, and  second  class  citizenship
                                                                                                               47


                                      COLORADO STUDENT HEALTH PROJECT
        must  be  fought  with  every  means   at   hand,   I     bling, and  the  decision  to  go  to  the  Migrant
        charged  into  the  community  as  a   salesman   for     Association  office  the  following  day  to   find
        the  Food  Stamp  Program  which   is   directed   by     out about  HEP.  One  of  the  kids  said  he  sure
        the   Department   of   Agriculture,   but   adminis-     would like to go to HEP, but  he  had  to  pay  off
        tered  by  welfare.   Three   Spanish   Vista   girls     his Mustang first (3 years to go).
        reluctantly  drove  me  around  for   a   few   days,     On  the  following  day,  Sid  Lucero   showed   up
        introducing  me  and  then   letting   me   give   my     because Mario picked him up, -,vhich was          a
        spiel.  "It  is  a  REAL  good  program.  .  .  ."  I     pleasant surprise  in  itself.  John  Montoya,  who
        visited  25  to  30  households  to   find   approxi-     had been  the  most  enthusiastic  about  going  to
        mately  five  families   that   qualified   for   the     HEP, was asleep and couldn't  be  roused  in  spite
        stamps,  and  only  two  families  willing  to   sign     of two phone calls. Sid  got  a  spiel  from  Frank
        with welfare for the program.                             Trujillo,  the  head  teacher  with   the   Migrant
        . It took me  seven  visits  to  the  Montoya  family     Association at  the  end  of  which  he  was  given
        to get them signed  up.  Also,  it  necessitated  the     an application, told to -fill it out, and soon stood
        chartering   of   the   Special   Food   Stamp   Loan     in mortal  peril  of  being  accepted  by  HEP.  He
        Corporation  of  Delta  which  extended   its   first     seemed  vaguely  uneasy  about  this  prospect  and
        loan  to  Mr.  Sam  Montoya  for  $10  on  July   20,     so we told him  that  he  would  have  a  month  to
        none of which will ever be seen again.                    think it over  before  he'd  have  to  go.  He  has
         The  Lopez   family   also   made   an   application     since gone to Utah.
        for a'loan  of  $10,  even  though  they  received  a     About  this  time,   the   great   depression   hit
        $200  ADC  check  on  the  day   that   food   stamps     Delta. The area director for the Migrant   .   Asso-
        were  being  sold.  The  president   and   board   of     ciation  on  the  western  slope  was   already   2
        directors  of  the  now  tottering  corporation  exe-     weeks  late  in  returning  from  his  vacation  in
        cuted a  dramatic  suicide  of  the  mind  by  diving     California.
        gracefully  out  of  the  third   floor   window   of     In the  director's  absence,  the  acting  director
        Renfrow's   Furniture   and   Appliance   Store    on     and  educational  supervisor  decided  that   early
        Main  Street.  The  Delta  Independent   noted   that     August  was  a  perfect  time  to  shut  down   the
        this  was  the  most  newsworthy   event   to   occur     Head  Start  and  the  Day  Care  Center  for   re-
        on.the  north  side  of  town  since   the   McCarthy     pairs  and  renovations  since  the   only   people
        gang  held  up  the  Farmers  and   Merchants   Trust     around  were  migrant   families;   everyone   else
        Corporation in 1893.                                      was  on  vacation.  So  one  Monday  morning  Dinah
         While   the   food    stamp    campaign    smoldered     found herself  temporarily  out  of  a  job  and  I
        with  only  sporadic  bursts  of  activity,  we   de-     was  tired  of  observing  surgery  at  the   Delta
        cided  to  attempt  to  interest  local  high  school     City Hospital. We went cherrypicking.
        dropouts  (whoops!  pushouts)  in   completing   high     Much  to  our  surprise,   we   found   nearly   50
        school,  joining  HEP  or  GED  programs,   or   get-     migrant  families  in  the   orchards,   for   some
        ting   job   training.   We   enthusiastically    ap-     reason  unknown   to   the   Migrant   Association.
        proached  Mario,  Mary  Valdez  (secretary   to   the     With  the  evident  embarrassment  of  being   pre-
        Migrant  Association   and   lifetime   resident   of     sented with 30 to 40  young  children  that  needed
        Delta)  ,  Lucy  Renfrow  (GED  teacher   and   life-     Head Start or  the  Day  Care  Center,  the  acting
        time  resident  of  a   neighboring   town),   Sally,     director  and  educational  supervisor  reluctantly
        Nancy,   and   Carol   (VISTAS,   Spanish    and    8     prepared to reopen the Day  Care  facilities.  Then
        months  in   Delta).   Mario   said   he   had   four     lightning struck from Denver.
        friends,   Mary   had   no   friends,   Lucy   didn't     The   Migrant   Association   auditor   had    dis-
        know  who  her   friends   were,   and   the   VISTAS     covered that  the  Head  Start  and  Infant  Educa-
        hadn!t  known  that  there  were  any   pushouts   in     tion  branches  of  the  Migrant  Association   had
        Delta.                                                    exhausted  its  money  for  the  year,   with   the
          Consequently,   we    had    our    meeting    with     largest rush  of  migrants  not  yet  arrived.  The
        Mario's four friends. The joyous occas     ion   con-     two Migrant  Association  nurses  and  all  of  the
        sisted  of  two  packs  of  Coors,  1  hour  of  mum-     teachers were fired with 2 days  notice  and  with-


                                                   SUMMER 1968
       out being paid  for  hundreds  of  hours  of  over-     Other than  this  burst  of  activity,  the  Delta
       time  pay  that  they  had.  earned.  And  so   the    recession had lasted for  11/2  weeks  before  Jane
       Migrant  Association   Child   Care   Program   was    came to  the  rescue,  offering  salvation  in  the
       closed down for  good,  due  to  poor  fiscal  man-    form of a census  of  the  Spanish  population  for
       agement,  as  well  as  an  overabundance  of   mi-    the school district. Thus,  in  the  nadir  of  our
       grant children.                                        despair  and  desperation,  we  charged  into   our
        The  two  nurses  asked  me  to   follow   up   on    new found project.  All  our  goal-oriented,  bour-
       four kids who  were  in  need  of  referrals  to  a    geois middle  class  hangups  welled  to  the  sur-
       pediatric diagnostic clinic. The earliest  appoint-    face. Here was a job that could be    '   completed
       ment  possible,  according  to  the  Public  Health    by  the  end  of  the  summer  and  also  could  be
       Nurse, was in February.                                put in a book.
        During  orientation  week  Dr.  Jordan  said  that     The  census  turned  out  to  be  a  SHO  worker's
       if we found any kids that  needed  pediatric  care,    dream.  Meeting  the  community,  getting  to  know
       he  would   make   arrangements   in   Denver   for    our  community,  et  cetera.  Also,   we   got   an
       them. So I  called  Dr.  Jordan  and  was  referred    occasional piece of pie and milk.
       to Dr' Boyd who talked  to  me  as  if  I  were  one    However,  as  we  got  to   know   our   community
       of those  enthusiastic  SHO  kids.  From  our  con-    in  more  depth,  we  were  stricken  with   dismay
       versation, I gather that  he  knew  all  about  us.    and  despair  as  we  discovered   that   many   of
       He then gave me a list of  protocol  procedures  to    Delta's  Spanish  population  were   middle   class
       follow before  turning  to  the  Denver  Children's
       Clinic. I  struck  pure  gold  when  I  called  the    in both  aspiration  and  attainment.  As  we  went
       fourth name  on  the  list-Dr.  Nelson  Scott  from    from door to  door,  it  became  increasingly  evi-
       Grand  Junction.  He  cancelled  two  luncheon  en-    dent that revolution would  never  come  in  Delta.
       gagements in  order  to  see  the  kids,  which  is    This is entirely in keeping with the  character  of
       just  what  I  envisioned  SHO  to  be  all  about.    the town. It  gets  no  snow  in  winter,  no  rain
       What better way to  eliminate  the  fat  cat  image    in summer, and in case  of  nuclear  holocaust,  it
       of the American physician.  Dr.  Scott  has  agreed    has  been  projected  by  competent   meterologists
       to follow the case of one of these  children  which    that the  whole  thing  will  pass  Delta  by,  in-
       may result in transferring  the  child  to  another    cluding the fallout.
       family  because  of  neglect.  Another  child  will
       be placed in a special school  for  retarded  chil-
       dren. A third child will  be  placed  under  vigil-                               NORMAN CHENVFN.
       ance for a bad rheumatic heart.


                                                                Chapter 3

                                                               The Interns


                                         COLORADO STUDENT HEALTH PROJECT
                                                                                      local  -Lyan-g leaders to  a black
                                                                            ranged from         udent of a predominantly
          The   development   of   a    g'high    school    interre         militant$ to the head st
                                program    was    one    of     the
          biomedical careers                  arant       proposal.         black high school-              turned but to
          three objectives of the original                                  The Denver intern program                 of the
                                 s   in   former   student   health                               etured        because
          Like similar PrOgran"                                   p         be the most highly stru
                    it  consisted  of  hiring   high   school   ag-                          owup    and    the    many OPPor-
          projects,                               in    which    we         possibilities Of fOll              pectrum  Of
          ,students from the    conununities                      ems       tunities  to  demonstrate a  full  s
          would be working     to    sensitize    us    to    PrObl         health careers. Each week the entire Denver
                  areas  and  for  us   to   acquaint   them   with                                             e of health
          in  their                                               bio-      grou   would tour a different typ
          the possibilities and realities of entering                       p .              ate weeks the interns would
          medical  careers.   A   corollary   to   the   biomedical         facility On altern         z seminars on their
                                              ging    these    stu-         be responsible for conductin-
          careers program was encoura                        ements         communities, and the health science students for
          dents to enter college, and finding pla('                         arranging proLrams on health careerst college
          and financial aid for them.                                       admissions, et cetera. @
            The    proposal    stated    this     rationale     for the     The interns conducted their own meeting at
          program:                                ities         and         the final evaluation session. They presented five
                  people    from    ethnic    minor                         major   recommendations   to   the   group.
                  poverty     groups     are     grossly     under-                                                   t  epr@-
                                                       professions.         (1) The need fo'r Increased minoriY 'r
                  epresented in the health                                                                       ority
                  r                                                         sentation: They felt   at more min
                  This   disproportion   reflects    limited    em-         should be represented on the project-b          in-
                  ployment    and    obstructed    career    oppor-         terns and health science 'students.   heir ra-
                               ch     aggravate     the      social                             They were at home in the
                  tunities whi                         professions.         tionale was s    e.          em far better than
                  is   on  of  the  health
                  olati                                                     communities,   und
                         science     students     training      and         we, and  would  be    on(         ed     by   POB'-
                                    -Dron&ing             disadvau-
                  working  with                                             tive action and ha   d b         V.
                  taged youth can raise as            ons,      in-         (2)    The    need               C'i
                  crease    self     confidence     and     provide                                         int
                  career-relevant   experience.   in   the    light         Throughout  the  S                   in the 1  oup.
                                                  sorganiza-                because  they  lacked    autonomy
                  of   contemporary    social    di                         They had  no  say  in      anning of the - oiect,
                  ti  in   the   United   States   and   the   lim-         they were  not  pres(                      ientation
                            f   -      g      health      manPOwerp
                      olls 0  existin
                                                  becomes         a         meetings,   and   Mal
                  this    new    career     element                         jected   during   the
                  crucial   bridge   between   the   health    pro-
                    ssions    and    the     disadvantaged     com-         were   selected'becai   this   autc
                  fe                                                        The  interns  felt
                  munity.                                                     tive  values:  T  ey   could   he
                                                        were            found POSI.
                          d  students     in     Denver                     year'.%,               basis  of  t
                  I                         d      Youth      Corps       and                                                 mg
                  throul the Neighborhoo    Centers.     Those     in     the which                      ed  t]
                  the N             referred     to     us      by      VISTA the ye.,             then Pr
                  rural             as    the    local    school     systems. ity for               and.    provid    nthe year.
                  voiun                               for          selection. uity I
                  Th                 d standards      ' '
                  eri                                 e Droblems           to They
                  The   rural   areas   Posed    uniqu- -                   need i
                                                  uld   be         difficult,
                  the program.      Followup       wo                       uton
                  an(  the   areas   )rovided   few                       fora                          o. should
                                                                            They
                    ing   the   interns   a    full                         slogs aT                     repor
                       opportunities.    For     th                                                     media
                                                              inter         in own ii               to
                              who   not    only    show
                  w  sought                                                                         equal basi
                                                                            and negoti
                  the  project  and   their   communities,   but   who   also                            direct
                                                        eers.         interns science               eet
                  were  oriented   toward   college   car                                                                        le:
                  in   the   Denver   projects   represented   more   of    a                              es sn           of their
                                                                                                        because a
                  cross    section     of     their     communities:     They The interi         that


                                                  SUMMER 1968
       program   was   concerned   with   biomedical   ca-   been  the  enrollment  of  three  interns,  who  had
       reers, they  should  have  more  time  to  work  in   not before considered a college  career,  as  fresh-
       health facilities with health  professionals.  They   men at  the  University  of  Colorado.
       suggested that this  was  the  only  way  for  them    At  the  end  of  the  summer  the   interns   were
       to  make  their  career  plans  more  concrete.  In   all asked  to  write  evaluations  of  the  project.
       addition  they  wished  to  work  on  projects   in   These papers reflect many of the   attitudes     and
       other are"  than  their  own;  exchange  rural  for   criticisms  discussed  above.  They  are   presented
       urban  placements  and  get  out  into  white  com-   largely  unedited.  Selected  papers  and   excerpts
       munities.                                             are included.
        (4)  Selection   p@ties   for   future   projects:
       The  interns  proposed  that  they  be  given   top    This  summer  I   worked   with   SHO.   The   pur-
       priority next year if they.desired  to  work  again   pose  of  this  employment  is  that   the   medical
       because  they  already  knew   the   problems   and
                                                             students I work with  are  not  familiar  with  this
       could provide continuity throughout the year.         community. Since I grew @ up  in  this  district,  I
        (5)  The  project  next  year:  Most  of  the  in-   should  know  more  about  it   than   the   medical
       terns  encouraged  SHO  to  return  to  their  com-   students.   Through   the   summer    we    attended
       munities.  They  did  offer   certain   suggestions   many meetings with staff of Denver Gen
       for changes in  the  program,  however.  They  felt   Hospital,  Parks  and   Recreation,   Denver   Hous-
       that it should be their job to  find  the  problems   ing Authority and other government posts.          e
       and  outline  the  power   structures   responsible   results of the meeting  fr@m  the  staff  of  Denver
       for  dealing  with  these   problems   before   the   General Hospital were,     :why were the  I   people
       project,started. In this way they  could  eliminate
       the initial frustrations felt  by  all  members  of   not  using  the  local  health  stations?"  Some  of
       the  SHP.  They  also  noted  that  "SHO  took   up   the answers: (1) PeolDle were not familiar
       too many projects that couldn't  be  done  in  that   what  was  available,  and  (2)   Fear   of   social
       period. If you are  going  to  take  up  a  project   harrassment.
                                                               The meeting with Parks and Recreation            s
       it should  be  something.that  could  be  continued   to  better  a  neighborhood  park-the  main   recre-
       through  the  winter,  or   something   that   just   ational spot for children,  teenagers,  and  adults.
       pertains to the summer. If you take up  a  project,
       and you start it and then  let  people  down.  they   A problem was the     swimming pool. The           ol
       arIe: not zoing to trust  you  next  year.  @rt  with had a  rough  cemented  bottom,  it  was  unpainted,
       the  little  roblems  and  work  up  to   the   big   contained broken glass and other debris,           d
       ones.ts                                               the  shower   rooms   were   not   adequat@no   like
        This  report  reflects  a  great  deal  of  growth   other  community  pools.  The   projec
                7
       on the part of  the  interns  during  their  summer   was improvements in the pool,
       e   ience  It   demonstrates   an   externalization   court,  an  unused'tennis   court,   a
         probl   s which many     Iof   them   had   consid
                                                         -   baseball team,  and  other  recreatioi
           personal  before.  Their  statements  are   all     A great help on this project was
       quite positive, their commitments  to  future  !in-
        olvement  and   their   constructive   ideas   ior   Center, one of the  sta-,ions  of  SHO             er
       alterations  in  the  program.  At  the  same  time   Housing Authority,         lo house  :         I the
                          an  intense  feeling  of   frus-   chronically  deprived  people,  A  loc           do-
                            the   inadequ   es   of   this   nated food, supplies, Clothing, and help
                                          aci
                                                             needy. A local health clinic, whose  i
                       ar   the  failure  of  SHO  to  put
       @a      I     existing   ghetto   conditions.   The   health counselors would  -oo  into  tt
                     they  have  stressed  are   concerned   root out the problems,   als    helped
                                                             residential stations a  @@s pp@r
                        aspects of the projiect.  This  is
                      health science students,   :we   can   munity. How we                   d
                  o    educiation....                        to the peoples' a                 I
              po  ive   outcome   of   the   program   has   organization. D@
                                                                                                                53


                                         COLORADO STUDENT HEALTH PROJECT
          probably  prove  that  the   community   is   organized    high"  sniffing  glue.  They  also  were   doing   well
          as of this date.                                           with their other group.
                                                                     My   last   and   probably   my   best   project    was
                                       LAWRENCE: SENA,               a  report  on  "brown  history."  I   was   told   that
                                       West Denver.                  there  was  going   to   be   a   meeting   on   'brown
                                                                     history"  and  my   supervisor   wanted   me   to   get
                                                                     this  meeting  ready.  First  of  all,  I  started  ob-
          I   first   learned   about   SHO    (Student    Health    taining    information    about    my    subject:    om
          Organization)   through   some   friends    who    were
                                                                     books  and  other  printed  pamphlets.  I   also   made
          employed   by   this    organization.    Asking    what
          their i                                                    a trip  to  the  "Crusade@for  justice".  office.  Here
               ob   was,   they   explained.   From   what   they    T -1
          told  me  I  was  impressed  and  went  to  see   about    iL  Talked  to  a  man  about  where  I   could     ain
          an  opening.  When  talking  to  one  of   the   health    the  best  information  on   this   subject.   He   ave
                                                                     me  names  of  books  where  I  could   find   e   sub-
          students,  I  told  her  what  my  qualifications  were    ject and told  me  where  to  find  the  books.  For  2
          and  they  met  standards.  Then  I   was   interviewed .
          by  the  director:and  was  hired.  I   started   work-    weeKs   I   studied   the   history   of   the   "brown
          ing right off  with  one  of  the  interns.  The  proj-    people."  When  the  meeting@  began,  I   started   my
          ect  was  to  hel  better  the   Lincoln   Park   Swim-    talk.  After  a  short  time  talking,  I  was   halted
                        p                                            by questions. The answers to these qu                 I
          ming  pool.  We  started  by   asking   questions   and    gave   started   a   whores   new    talks ver      r-
          talking to  the  staff  of  the  pool.  Our  next  step
          was   interviewing   other   public   swimming    pools    esting   one.   Mainly,   this   was   "black   people"
                                                                     arguing against the     "Mexican       people,"     ly
          in the city.  By  this  we  found  that  pools  in  the
          Minority  area  were  the  worst  in  the  city,   such    on  which   is   making   more   progress   and
          'as  bottoms  were  not  painted  on  the  pools,   not     This  was   not   all   that   we   accomplish p   but
                      -  poor  fa  ities  in  the  locker   rooms    in my opinion, the mo   interesting. I did
          enough                cil                                  tion trips we took, su     a  a  trip  to   Rid
          -these a e just  a  few  of  the  poor  examples.  Our,    Hospital   where   in     @ and retarded           dren
          next  step  was  lettinir  the  community  know   about    were boarded. We al       :went   to    Colorado    ni-
          it.  Then  we  arranged  a  meeting.  People   in   the    versity and toured I                     We           d
          community  raised  havoc  to   the   manager   of   the    Fort Logan, another                           and    we
          pool, its  staff,  and  administration  of  the  public
                                                                I    visited Craig Rehabill                   1%         ey
          Pools.     er  the  meeting,  everyone-  in  the   pool    help  the   crippled.                         s     Of
          and park area saw much improvement.                        the  iDlaces  we   we                   an
           We  held  a  meeting  about  children  in   the   west
          ide  area  sniffing  glue.  These  children  ranged  in    the atmosphere      v
             fro     11  to  15.  At  this  meeting  we  arranged    meetings   with    th                  eni
          that       in   people   would   work   with    certain    Hospital  and   ha                     Th-
          children.  Jerry  and  I   teamed   up   together   and    SHO.    We    had,                    West
                                                                     Center.  These   E
          worked        the  two  brothers,  and  we   went   and    time I worked
          visited        home.   When   we   talked   to    their    them very in                       ducatii
          mother,    e  found  out  that  they  had  been   worx-
                                                                     opinion in the St              I  have   v
          Ing wi     another   group.   The    mother    informed    feel Iliad an intere        and     succes
          us  that  they  worked   some   days   and   on   other
          days  went  to   the.   museum,   to   the   park,   et                                        GARY
          etera. And  she  told  us  if  we  wanted  to  see  and
                                   t                                                                       West De
          talk to the two., for us  to  return  at  five  in  the
          evening.  I  returned  myself   several   times.   When
                         the   boys   alone,   they   were   more      This    sumi                 me from my regular
                              information     mainly      because    realm   of  WI                ed in(
                           and  probably  thought   I   did   the    type of  .9til                    da3
                          From  the  talks   I   had   with   the    July 1  at  -m               first in                 I
                           out   they   had   stopped    "getting    would    be    wor              The

          li4


                                                      SUMMER 1968
        we  would  be  doing  was  extremely  cloudy   to   me      the clinic not to be  overlooked,  but  rather  given
        from  the  beginning  because  I  was  used  to  work-      a second look. Joann and I made personal       gains.
        ing physically  and  not  in  the  sense  of  applying      To   elaborate   on   my   feelings   about   another
        myself to this job.                                         SHO project, I said  before  I  strongly  favor  such
         July  1  also  marked  the  first  meeting   of   our      a  project  because  with  this  year's  project  the
        group;  from  that  point  it  was  decided  that   we      seeds were only planted.  So  if  you  want  to  har-
        would  man  the  Sangre   De   Cristo   Medical   Unit      vest your total results, you  will  have  to  make  a
        since there  were  going  to  be  no  nurses  for  the      place for  another  project.  If  you  should  decide
        SHO  appointed  doctor.   From   this   time   on   we      to  bring  another  project  down  next  year,   here
        were   engaged   in   familiarizing   ourselves   with      are  a  few  suggestions  derived  through  our   own
        the clinic and the specifies  of  our  jobs.  We  then      experiences  that  may  be  helpful:   (1)   Have   a
        proceeded  to  set  up  a  schedule   by   which   the      group  (student)  leader,  one  who  is  truly   rec-
        clinic  would  be  manned  and  still  provide  for  a      ognized by all; (2) The  first  2  weeks  should  be@
        team  to  be  out  in  the  community   learning   the      spent  learning  the  power  structure  ,   (3)   An-
        ways  of  the  place.  It  worked  very  well  because      8wering  the  questionnaire   to   one's   self   may
        the  people  of  San  Luis  have  always   looked   up      help  in  many  ways;  (4)  Possibly  for  each  per-
        to  medical  people.  This  has  provided  the   group      son  to  set  personal  goals;   (5)   Continue   Con
        with a  great  degree  of  acceptance  into  the  com-      La Famlia.
        munity.  This  has  primarily   been   our   line   of      Here  are  the  things  that  next   year's   project
        work all summer.                                            may  pursue:   (1)   Help   carry   out   -preventive
         I  feel  that  personally  I  gained  a  great   deal      medicine and  introduce  it  to  the  people,  simply
        in the sense that  this  job  has  boosted  or  rather      because  this  objective  will  not   be   completely
        raised  my  hopes  and  wants  of  going  into   medi-      reached  in  a  few  years  even  with  a   permanent
        cine.  I  learned  a  few  simple   basic   operations      doctor in the  area:  (2)  Setting  up  a  survey  of
        like  checking  patients  into   rooms,   and   taking      some  sort  which  may  help  people  Lret   insights
                                                 e,    respira
        their vital signs of temperature, puls               -      into the community, its problems and
        tion,  and  blood  pressure.  Some  days  even  taldng      (3)  Keeping  eyes  and  ea  oDen  to  any  @  fe  d-
        care  Of  the  reception  desk,   taking   hematocrits      back on this year's pr iect which would
                                                                                         Oi
        and giving  Tine  tests.  The  SHO  gains,  or  rather      vesting your crop.
        accomplishments.  in   my   eyes   are   as   follows:
                               services to people  and  filled                                 JOHN LA ComBE,
                        IV between the  last  doctor  and  the                                 San Luis.
                        (2)  May  well  have  set  the   stage
                      HO  project  which  I   favor   greatly.      I  worked  for  the  Student   Health   Project   for
                         to  a  greater  point  of   enligbun-      10 weeks and now  that  it  is  over,  I  feel  it  has
            t  for  the  grant  a  few  things  that  may  be'      - -
        helpful.                                                    been  an   experience.   r   me.   I   learned   many
                                                                    things which will          y  help  me  out  in   the
          Another  way   of   looking   at   what   this   SHv      future (I  hope).
        Project  accomplished  is  by  the  looking  at   what      I was asked to     wri     an   evaluation   on   the
        personal  goals  were  visibly   accomplished,   again -
                                                                    project but I really                what   @    say;,
        in  my  eyes,  by  each  member;  personal  gains  in-      what I mean is, that                we   were    sue-
        cluded-  Bob  liked  the  clinical   work   but   made
                                                                    cessful or  I  can't  say  we  were  not  because  we
        Some  exceptionally   good   followups;   Dan   basic-      were  used  as  flunkies  for  someone   else.   When
        ally  made  personal  gains;  Gail   setting   up   or      someone got an idea           wasn't    from     SHO,
         dding   ore encouragement to a referral          'Sys-     'they figured if th   co  d get SHO to pass
             to  make  im  ortant  patient  followups;   Sue's      th -
                         p                                          eir  little   pam                    material,,   all
           rk in  the  survey  overlaps  everybody  else's  by      they would do  is                      a
           ite  a  bit,  Rocky@trong  personal   gain,   moti-      credit. A lot  of                   that
                   90 to college  -and  he  made  it  a  point      was  a  group  Of               their d
             the  transportation  of  people   to   and   from      This is one  reak    I f    so unsure

                                                                                                                        55


                                         COLORADO STUDENT HEALTH PROJECT
          I  feel  that  I  haven't  done  much  for  the  com-   people in this ghetto area. These  extra  16  -Vvill-
          munity itself  -  it  seems  that  if  we  started  a   ing and able people are SHO.
          project, people in  agencies  would  often  say  this    SHO  is   the   Student   Health   Organization,   a
          is  not  needed  in  the  community.  I  don't   know   group  of  Health  Science  Students   from   differ-
          whether  the  people  didn"t  want  or   need   help,   ent  States  who  have  come  into  the  ghetto  area
          or if they  wanted  help  and  then  we  were  afraid   to  help  with  the  many,   many   community   prob-
          to get  something  started  and  be  let  down.  And,   lems.   Among   these   health   science    students,
          if they felt this way, I don't  blame  them.  I,  my-   there are high  school  interns.  The  interns  ,vere
          self, would be afraid  to  put  faith  in  a  program   hired  from  the  neighborhood  to  @  identify  thIe
          that will be in action  only  3  months.  I  feel  if   problems  to  the  health  sciencc-   students.   The
          there  was  more  time,  the  SHO  would  really   be   problems identified  were  social  and  health  prob-
          an active program.                                      lems. Their goal was  to  set  up  facilities  for  a
                                                                  health center.  However,  there  -a,as  one  here  in
                                          JAKE PINO,              the  west  side  of  Denver,  Colo.  Therefore,   our
                                          West Denver.            goals were  really  "social  goals,"  such  as  work-
                                                                  ing  with   family   problems   and   the   community
                                                                  problems. Some of the  @  problems  Nvere.  (1)  Get-
            In  working  with  the   Student   Health   Organi-   ting  a  Mexican  family  welfare   and   information
          zation this summer,  I  have  felt  that  I,  myself,   about the  health  center  and  movitilr  other  fam-
          didn't  accomplish  too  much.  On  the  whole   may-   ilies  and  obtaining  food  for  them;  (2)  Ge  ing
          be we did help out a little on  the  east  side,  but   a  youth  out  of  a  reformatory;  (3)  Showing  the
          it wasn't  enough  to  look  back  at  and  be  proud   younger  children  (age   10   to   14   years)   sex
          of. And I am  sure  I  speak  for  the  rest  of  the   education  movies  because   lack   of   communi   a-
          high  school  students  when  I  say  that  none   of   tion between them and the -Darents; (4) Sh
          us really got the full effect of our jobs  this  sum-   ing  teenagers  (age   15   to   20 years)
          mer. What I  mean  is  since  the  first  meeting  we   movies,  such  movies  were  on  di
          have  been  hearing  about  helping  our   community,   smoking,  et  cetera,  (5)  To  bet
          but so far,  we  haven't  done  too  much.  The  com-   pool, trying to make, a better
          @munity  seems  just  the  same.  The  only   way   I   ation facility for  the  people  in
          can see to better it or  make  it  a  success  is  to
                                                                  . What would have been accompli           ?  thi
          stick to  what  they  plan  to  do  besides  grabbing   the  swimming  pool,  but  we   didn't'
          at  something  big  and  failing,  and  just   giving   time  to  really  accomplish   anything
          up. I    ink  they  should  work  with   the   little   time  here.  People  i  the   communit3
          things, then  work  up  to  the  big  ones  and  take   terested.  There   were   many   things
          it  from  there.  If  things  keep  going  this  way,   have  accomplished  but   we   were      Of
          I @ think the project is going  to  be  a  flop.  But     The shortcoming        the program was tt
          if the project can stick  to  one  specific  program,   wasn't planned p       Orly.  I  felt  that  some   e
          I'm sure the ball can get  rolling  and  the  project   in the Action Center       uld have kno
          can be known throughout the differ        ent    com-   about     SHO, wh  it was there, et cetera
          munities  because  I'm   almost   sure   that   there   the health                  nts   could
          are a lot of  people  on  the  east  side  who  don't   hired  the  hi              rns and gone @t
          'know a thing  about  the  project  or  its  purpose.   right    away.               rtness of tim
                                                                  the  maj  ori-               th science
                                 VINCENT C. ROBINSON,             should     com                    and to the
                                 East Denver.                     And please-not@ so mai        meetings!
                                                                    My  impression  of  the   program   was   od,   but
             There are 23,000 people  in  the  ghetto  area  in   only one (or two) bad things. It was         od   be-
          the west side  in  Denver,  Colo.  in  the  midst  of   cause it helped a I      people  in  the  comm   ity.
                 23,000, there are  an  extra  16  willing  and   It helped me leam       o  t  health  and   educ   on
          able  peo  e  who  have  come  to  help  the   23,000   and  to  understand   e   people   in   the   commun-
                    Pi


                                                bummk;.K IU(ib

    ity. It helped me look into  my  future  as  far  as  crete and worthwhile  project  that  will  help  the
    school  and  to  90  on  to  college-to  be  someone  community.  For  instance,  our  project  of  clean-
    and help  the  people  in  the  ghettos.  Especially  ing  a  neighborhood  pool  was   very   worthwhile,
    the  younger  group  because   the   younger   group  but because of our  short  time  on  it,  we  didn't
    are going to develop  into  future  leaders  in  the  get to finish it and complete it. If we had  started
    community. I  want  to  inspire  them  to  do  some-  at the start of  the  summer,  I  believe  we  could
    thing  good  and  worthwhile  and  to  stay  in  the  have said  of  ourselves  that  we  of  the  SHO  of
    community  and  help  develop  it.  The   bad   part  the  east  side  had  helped  the   community   help
    was  that  we  were  short  of  time.  SHO   changed  themselves.
    my  feelings  toward  the  ghetto  because  I   felt
    people there didn't try, didn't  have  the  intelli-                               NORMAN      HARRis,
    gence, and they were  all  bad.  Yet,  I  found  out                               Ewt Denver.
    different,  because  I  never  realized  that   some
    people didn't know  about  their  rights,  how  hard
    some have tried, and  how  some  misuse  their  high    During the summer of       1968  I  worked  as  a
    intelligence.  There  are  many  intelligent,  kind,  student intern in SHO on     the east side. I  feel
    and happy  people  in  this  "ghetto  area."  Now  I  the group could have  been  better  if  it  had  had
    realize why they remain like that.                    a  better  understanding  of  what  it  was  to  ac-
      I  felt  that  -SHO  was  a   worthwhile   project  complish.   The    main    problem    was    getting
    andInow  that  the  health  science   students   are  started.  Some  had  great   ideas   but   when   it
    more familiar  with  these  problems;  I  hope  they  came to actually putting  them  to  work,  this  was
    reniai . or come back. I felt  there  was  a  short-  another  story.  One  of  ou  problems   (I   think)
    age, of funds  to  carry  on  certain  projects  that was how some of the peo        that  talked  to  us
    involved  actual  cash.  My  biggest   concern   is   kept comparing  and  tell!nLr  us  that  we  could
    more time. a  10 weeks is hardly adequate.            do what they  did  in  other  cities.  Maybe  this
                                                          was a mistake because  Denver  is  different  from
                        @ARET ANN LOVATO,                 other cities,  and  it  also  has  many  different
                        West Denver.                      problems.
                                                            I don't feel much can be  done  in  9  weeks.  I
                                                          think SHO should start        little  earlier  n
      I  learned  a  lot  about   my   community   this   year.  I  feel  we   accomplished   something    a
    summer.  I  found  out  how  people  of  the   com-   summer but it wasn't very      ch. When  we  first
    munity  look  n  outsiders.  I  believe  we  accom-   started  out,  we  were  not  cepted  by  the
           a lot. Our first couple of days  at  one  of   munity people right  away.  We  had  to  gain    ir
          's health stations, the  nurses  and  doctors   trust. Many  people  still  @don't  trust  us  a
    gave  me  the  mpression  that  we  weren't  needed
                                                          don't want  us  to  be  here.  However,  th@s   was
    and  were  in  wasting  their  and  our   time.   I
                                                          only a small  portion  of  the  i)eolDle.  We  fi
    also ink the organization  was  used  as  a  se-rv-                                   I  -
                                                          tried working  with  the  larger  problems  but  w
    ice   duct, ecause  we  were  used  as  free  labor
                                                          didn't  get  anywhere.   W   et p  with  an  awful
    more or less   do service for  the  health  center.
                        uld have  gone  into  the  com-
    I al  think                                           lot  of  criticism.   When   found out
                      sho
           more. I  feel  th@  place  we  were  needed.   couldn't   really   accomplish all
                                                                                                           d
    rn      the  community.  I  also  believe  that  we   wanted to with  the  larg4
            too  many  projects   and   found   ourself   take years to  do,  we  ,R
    too ung  uD  and  sOpping  on  projects  to  go  on   ones. This  was  better  b           c
    to   ers when they weren't finished.                  put our  fingers  on  sor,
      I think in order for the project  to  be  a  sue-   least this way  we  didn't
                  years  to   come   the   organization   up@ high and  then  disapp
                  a  goal  when   the   summer   starts   pened  so  many  times   t
                   it. This plan         e  very   con-   will  be  a  greater  help
                                 must b                                                              IC


                                       COLORADO STUDENT HEALTH PROJECT
        since it now has a better view of what  it  should   even fight with people just because I didn't  like
        be doing.                                            them.  Also,  when   we   w'ould want  to  go  to  a
                                                             dance and we didn't have  a  ride,  we'd  steal  a
                                   MARIE ARRINGTON,          car,  but  sometimes  I  would  get  caught  alone
                                  East Denver.               driving  it  or  with  my  friends.   My   friends
                                                             taught me  how  to  steal  and  drive  a  car.  We
                                                             would steal just  Chevy's.  because  they  had  an
           I felt that  the  Student  Health  Organization   ignition that you could start  with  the  turn  of
        was a good thing because it  had  a  lot  of  good   your wrist. One time  I  was  drunk  and  stole  a
        ideas for the community.  People  were  interested   car  and  ended  up  wrecking  it.  I  got   away,
        in  what  they  had  shown  to  them.  They   also   though.  I've  been  caught  twice  for   stealing
        helped the younger kids  out.  For  instance,  one   cars, but all because of  my  friends  influencing
        student helped a  family  from  Mexico  get  help.   me  and  letting  me  help  them  only  because  I
        He also  helped  another  family  move  closer  to   was  dumb,  or  should  I  say  I   wasn't   smart
        the  Neighborhood   Health   Center.   All   these   enough to think. This is how  I  grew  up  ...  If
        people appreciated it, too.  Because  when  I  was   I had another chance I'd  try  to  show  the  kids
        younger  I  never  had  an  opportunity  for  any-   that are growing  up  the  -wrong  way  the  right
        one to help me like they have  helped  the  people   way.  Through  SHO,  1  have  had  it  lucky  even
        here. When  I  was  younger,  I  was  bumming  the   that I got a job like I have  now.  It  helped  me
        streets  looking  for  something  to  do   because   understand   people   and   their   problems   and
        there was nothing to  do.  This  is  why  some  of   helped them get in the  right  road  to  a  better
        the kids today get into trouble. I  know,  because   and more convenient life. So  I  say  the  SHO  is
        I used to when I was younger, so  I  had  to  find   a  good  thing  for  me  and  the  community   and
        out my own  fun.  When  my  friends  and  I  would   hope they can come  back  next  year  because  our
        get money, we  would  spend  it  on  something  to   part of town can ALWAYS have help.
        "get  high  on."  My  friends  influenced  me   to
        smoke, steal, and to get  into  trouble.  I  would                                  Name withheld.

        58


                                                                                                                                        i@  @.

                                                                                                                                                                                                                                                                                                      Chapter 4

                                                                                                                                                                            i
                                                                                                                                                                                                                                                                                                 Perspectives

                 ,t @@ i@@ @@

                                                                                                                                                                                                                               I

                                                                                                        I
                                                                                                        I
                                                                                                        I

                                                                                                        i
                                                                                                        4

                                                                                    i

                   I


                                       COLORADO STUDENT HEALTH PROJECT
           The  final  evaluation  session  for  the  project   Robert Taylor Homes, or tried to  begin  a  health
           was held  at  the  University  of  Colorado  Medi-   clinic at Robert Taylor  Homes,  and  by  the  end
           cal Center. In addition  to  health  science  stu-   of the  summer,  all  that  we  had  succeeded  in
           dents and interns  from  the  project,  the  meet-   doing was to organize some  residents  into  some-
           ings were open to our  advisors,  members  of  the   thing that was called  the  Robert  Taylor  Health
           communities  where  we  worked,  members  of   the   Committee;   through   the   winter   SHO   people
           health care community and the press.                 were  working  with  people  with  this  committee
           It included  a  discussion  of  individual  place-   to try to get permission from the  City  Board  of
           ments, their assets and liabilities, successes and   Health to open  a  health  clinic  there.  It  was
           failures, as well  as  a  hard  retrospective  and   going to be a very modest kind  of  clinic,  doing
           prospective analysis of  Student  Health  Projects   mostly diagnostic work  and  feeding  people  into
           in general.                                          nearby  hospitals.   Finally,   about   half   way
           Peter  Bonavitch,  a  third   year   law   student   through June, the Board of Health  gave  its  per-
           at  the  University  of  Chicago,  who  has,  been   mission  to  open  up  this  clinic,  and  Student
           integrally involved in  both  Chicago  SHP'S,  de-   Health people  from  this  summerps  project  were
           livered the keynote  address  to  the  conference.   going to work to finally get the  clinic  set  up,
           He spoke of the  frustrations  of  SHO's  involve-   get equipment in and to get it  opened  up.  About
           ment in ghetto  communities  and  the  very  basic   2 weeks into the project,  the  clinic  was  about
           moral  questionability  of  such  involvement.  He   to open. It was going to open  on  a  Monday.  The
           suggested that we not  only  reexamine  our  pres-   Thursday before, we had  a  meeting  in  the  same
           ence in these communities, but  also  channel  the   church where the clinic  was  supposed  to  be  to
           experience  which  we   have   accumulated   there   discuss something entirely extraneous,  and  about
           into  more  productive  and  effective  roles.  We   eight  young  black  kids   from   the   community
           have  learned  much  from  the  communities  often   showed up at this meeting  because  they  saw  all
           at their expense;  we  have  learned  that  insti-   these white people going  into  their  church  and
           tutions are responsible  to  a  great  extent  for   they wanted to  know  what  was  going  on.  About
           existing problems in  the  ghettos.  It  is  these   half  way  through  the  meeting,  they  asked  us
           institutions which are truly  our  constituencies,   what  we  were  doing  there.  Some  people  tried
           where our ability to catalyze  changes  in  health   to  explain  what  SHO  was  and  explained   that
           care lies; in basic analysis of health care insti-   we were meeting in  that  church  because  it  was
           tutions,  specifically  our  own  health   science   where  the  Robert  Taylor  Clinic  was  going  to
           schools,  and  in  white  middle  class   communi-   be. They said,  "What  Robert  Taylor  Clinic?  We
           ties. . . .                                          live in Robert Taylor  Homes  and  we  don't  know
                                                                about any clinic." We  explained  that  we  had  a
                     NEW PERSPECTIVES                           health  committee  which  was  composed  of  resi-
                                                                dents in  the  community,  and  they  said,  "What
                                                                residents  in   the   community?"   We   mentioned
            The final state of several  SHO  projects  reaiiy   some names, and these  kids  didn't  know  any  of
           is confusion, division, and hopelessness  in  many
                                                                these  people-they  were  young  black  militants.
           ways. I will  just  try  to  communicate  that  to                        -would  like  to  meet   with
                                                                They said that they
           you.using Chicago as a model. I will start       oy  the  people  who  were  going  to  be  working  in
           telling you  the  story  of  what  happened  about   this clinic and find out what they were  going  to
           3  weeks  into  the  summer  project  in   Chicago   be doing. They asked  if  any  black  people  from
           this summer, and that which happened at R        b-  SHO were  going  to  be  working  at  the  clinic.
           ert Taylor  Homes.  Robert  Taylor  Homes  is  tne   @t happened that one of the girls  was  black  and
           world's largest high rise  urban  renewal  project
           for low income  people,  which  means  it  is  the   tne other five were white SHO people.
           world's largest vertical ghetto. There  are  about     They agreed on meeting  the  next  day  to  dis-
           27,000 black  people  who  are  housed  in  Robert   cuss how the clinic  was  going  to  be  run,  how
           Taylor Homes along about  30  blockg  of  Chicago.   it was going to be staffed, et cetera.  What  came
           Last  summer,  SHO  began  a  health   clinic   at   out of  that  meeting  was  an  edict  from  these

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                                                  SUMMER 1968

     black  kids  that  they  didn't  want   any   white   sponded by saying the health  clinic  is  something
     people running their  clinic,  that  they  had  had   that  is  needed  in  the  community.  It   doesn't
     enough; the essence  of  what  they  said  is  that   really  matter  Who  @ffs  the   clinic-it   is   a
     .they  had  enough  white  people  coming  in   and   health clinic and it  is  going  to  start  healing
     telling  them  how  to  run  their  own  community,   people and that is all  that  counts-white,  green,
     and if they were  going  to  have  a  clinic,  they   black, yellow, or whatever. Still, a third  faction
     wanted  it  to  be  staffed  by  black  people-they   said that it is really good that  this  thing  hap-
     wanted black people to  be  deciding  how  big  the   pened.  We  are  really  performing  our   function
     clinic was going to be  they  wanted  black  people   by acting  as  a  catalyst  to  the  community.  We
     to  decide  where  the  money   was   coming   from   go  into  the  community  with  our  white  middle-
     and  what  the  money  was  going   for,   and   no   class  selves  and  the   community   responds   by
     white  people  had  better  show  up  that  Monday.   throwing  us   out   and   organizing   itself@rga-
     if  they   came   Monday,   they   wouldn't   leave   nizing its own health clinic.
     again!                                                  This  stresses   the   importance   of   becoming
       There followed  a  long  series  of  negotiations   analytical and starting to  ask  some  basic  ques-
     back  and  forth.  After  about  another  week   or   tions about what SHO  wants  to  be  doing  in  the
     two,  the  SHO  people  agreed  that  they   really   communities,  and  beyond  that  what   SHO   wants
     didn't  have  any  legitimacy  running   the   Rob-   to be doing itself.  I  think  you  can  set  up  a
     ert Taylor Clinic, that they would  do  their  best   progression of the way  that  white  liberals  have
     to try to find black doctors, to try to find  black   seen their role in the  black  community.  I  think
     nurses to  run  the  clinic,  but  there  would  be   the first stage is that a white  liberal  tends  to
     no white  SHO  people  involved.  The  black  mili-   see  himself  as  the  savior  and  healer  in  the
     tant kids agreed that  they  would  also  do  their   community. I am talking  about  a  white,  liberal,
     part to find black doctors and  black  nurses.  The   medical student.  I  think  this  was  the  initial
     end of the story is that the clinic  is  being  run   idea  of  many  people  who   come   into   Student
     and operated  with  a  black  staff.  The  mothers,   Health  Projects.  They  see  themselves  as  going
     the  people  who  were   on   the   Robert   Taylor   into  the   community   and   fixing   things-going
     Health  Committee,  a   puppet   organization   for   to save the ghetto in 9 weeks. It takes  much  less
     SHO,  have  been  phased  out  of   the   operation   than 9 weeks to  realize  that  we  are  not  going
     to some extent and these black  militant  kids  are   to save the  community,  that  sometimes  the  com-
     having much more  of  the  say  of  what  is  going   munity doesn't  want  to  be  saved,  and  even  if
     on.                                                   it  does  that  we  don't  have  the  time  and  we
       The  whole  story  points  up   something   that.   don't  have  the  resources  and  we  really  don't
     is going to happen or  already  is  happening  more   have the skills to do it.
     and more  in  Chicago.  I  think  it  is  something     The second phase is that  we  feel  if  we  can't
     that will happen in Denver  also-at  least  in  the   save it, we can organize it,  and  pretty  soon  we
     black  communities.  In  these  conununities  there - begin to realize, especially  if  we  go  into  the
     is really an  upsurge  of  a  feeling  of  identity   communi  ties which are  beginning  to  feel  their
     which you are going to  start  running  into.  This   racial identities very strongly, not only  that  we
     raises  some  pretty  basic  questions  about  what   can't'organize it, but that  we  shouldn't  be  or-
     SHO should be  doing,  about  what  the  real  pur-   ganizing  it-we  are  white   and   the   community
     pose of SHO is. In  Chicago,  this  touched  off  a   is black. We can't do it  effectively.  because  of
     Crisis  within  the  organization   because   about   the hostilities that exist  in  the  community.  We
     one-third of  the  people  felt  that  these  black   should not be doing it-it's really  not  our  place
     kids were absolutely  right,  that  we  really  had   to do it. This is the kind  of  point-of-view  that
     no  legitimacy  in  the  community  and  that   SHO   SHO in Chicago is coming around to.
     should  really  have  never  gone  into  the   com-     The third stage is  that  SHO  should  be  acting
     munity in the -first place with this kind of  atti-   as a catalyst in the  community,  that  we  can  go
     tude-like  we  are  going  to  give   you   now   a   into  the  community  and  try  to  set   up   some
     health  clinic-lucky  you!  Another   faction   re-   kind  of  ongoing  program  and   hope   that   the


                                          COLORADO STUDENT HEALTH PROJECT
            community  will  respond   by   saying,   "No,   we    upper  class,  middle  class  community.  The  other
            want to  do  it  ourselves."  You  can  argue  that    type of constituency you can  talk  about  is  other
            that is a good role for SHO,  more  effective  than .  medical  students,  hospitals  and  health  institu-
            either of the other roles, that is,  going  in  and    tions, and just  the  institutions  in  our  society
            saying,  "We  know  what  is  best  for  you,   you    that provide health care to people.
            are not really  getting  any  place,  you  are  not     It is  a  premise  of  the  SHO  that  health  care
            really  very  far  advanced  politically.  We  have    is a  basic  human  right.  It  is  another  premise
            thought about  this  a  lot  and  decided  that  we    of  the  SHO  that  the  institutions  that  provide
            were going in  and  try  essentially  to  turn  you    health service should  be  organized  so  that  they
            off, try essentially to  mal,-e  you  mad  and  get    give  health  service  according  to  the'needs   of
            you  mad  enough  to  do  it  yourself."  There  is    the  people  and   not   according   to   how   much
            still a kind of condescension implicit in all this.    money  there  is  in  it  for  the  doctors  or  how
             If you  reject  all  the  three  that  I  mention,    much money there is  in  it  for  the  hospitals  or
            we can say  that  we  have  no  role  in  black  or    the  drug  industry.  The  obvious   question   fol-
            brown   communities,   that    those    communities    lows: Is the system  organized  to  give  that  kind
            have to resolve their own  political  crises,  they    of  health  care?  I  think  we  would  agree   that
            have to resolve their  own  identity  crises.  They    the answer would  have  to  be  "no."  It  is  orga-
            have  to  get  themselves  together  at  their  own    nized on the basis of fee for  service.  It  is  or-
            pace and  with  their  own  leaders  as  they  want    ganized  on  the  basis  of  what  the  doctor   can
            to. Or you can say, I am  available-I  as  a  medi-    get out of the patient.  The  patient  who  can  pay
            cal student, or a social work student,  or  a  den-    gets good medical  care,  some  of  the  best  medi-
            tal  student,  or  whatever,  have  certain  skills    cal  care  in  the  world.  The  patient  who  can't
            that I can offer to the  community,  certain  tech-    pay  often  gets  the  kind  of  medical  care  that
            nical  skills.  If  the  community  wants  to  come    you  can  get  in  any  underdeveloped  country   in
            to  me  and  ask  me,  I  will  be  happy  @  offer    the  world.  There  are  all  the  statistics,  like
            them, but  I  am  not  going  to  make  any  policy    Wo-odlawn,  a  community  in   South   Chicago   has
            decisions, nor  am  I  going  to  try  and  run  it    an  infant  mortality  rate  that  is  approximately
            for them. That is where we are at the  end  of  the    the  same  as  Nigeria's.  In  1963,  the   nonwhite
            project in Chicago.                                    child  (92  percent  Negro)   under   5   years   of
             Now  the  next  question   is   if   the   Student    age had  a  death  rate  twice  that  of  the  white
            Health  Organization  does   not   have   10   week    child.* In  1961,  the  United  States  ranked  15th
            summer  projects  that  go  into  ghetto   communi-    in infant mortality statistics,** all  of  which  is
            ties to perform basic services, then  what  is  the    intolerable for a nation that is  as  industrialized
            role of SHO? In order  to  answer  that  you  would    and  urbanized  and  highly  developed  as  we  are.
            have to think  about  what  kind  of  an  organiza-      The  welfare  medical  assistance   system   oper-
            tion SHO is and  you  would  have  to  think  about    ates not to give people the  best  possible  medical
            the people that SHO  gains  its  forces  from.  You    assistance, but  to  keep  them  from  starving  and
            would  have  to  face  up  to  the  fact  that  the    to keep them from  dying  in  the  streets.  Welfare
            medical students are  largely  an  affluent,  white    recipients  in  Chicago   are   shuttled   to   Cook
            middle class group.* The statiatic@'are  that  only    County Hospital  which  is  the  city  run  hospital
            15  percent  of  all  medical  students  come  from    and is a chaotic kind of mess of  a  hospital.  And,
            families whose income  is  less  than  $5,000,  and    I am  told,  that  Denver  General  Hospital  sounds
            14 percent come from  the  1  percent  of  families    very much like Cook County Hospital, an
            whose incomes are in excess of  $25,000  per  year.    welfare  patients  in  Denver  are  also  forced  to
            So you have to start asking who  is  the  constitu-    go  to  Denver  General  Hospital,  just  like  they
            ency of SHO?  There  are  two  types  of  constitu-    are  forced  in  a  slightly  more  subtle  way   in
            encies that you  can  talk  about-the  constituency    Chicago to go to Cook County Hospital.
            that  the  medical  students  form  from  a   white      We  had  better  start  talking  about  i  e   way

                                                                    *Health, Education, and Welfare Indicators, P.  29,  June  1965,
              Lasagna, lAuis. Life, Death and the Doctor, Alfred A..  Knopf, U.S. Department of Health, Education, and Welfare.
            New York. 1968.                                           Epidemiology, Vital Statistics Report, WHO 19, 4S4. 1966.

            62


     the medical schools recruit their students.  The            and constant source of ideas during the  development  of
     ,Way  medical   schools   set   up   their   curriculum.    this SHP. She speaks below  on  the  legitimacy  of  our
     We  have  to   talk   about   the   mechanics   of   the    involvement  in  ghetto  communities  in  terms  of  our
                                                                 personal growth and ultimately of  positive  effects  on
     niedical  school  system.  We   have   to   talk   about    the ommunity . . .
     the  reasons   the   medical   schools   discrim'M-al-.-
     against  black  people  in   admissions   policies.   We            COMMUNITY PRESENCE-A
     have  to  talk  about  the  way  that  medical   schools                    JUSTIFICATION
     exploit  interns   and   residents   by   paying   some-
     thing  like  $4,000  to  $5,000   a   year   for   doing      The  implication  in  much   of   the   discussion   I
     really  the  bulk  of   the   work   in   any   teaching    have  heard  is  that  if  one   were   really   dealing
     hospital.  We  have  to  talk   about   the   way   that    with  "health"   problems,   particularly   the   analy-
     hospitals   operate   in   their   admissions   policies    sis  of  health  care   institutions,   SHO   would   be
     and  in  their  staffing  policies.  This  is  the  kind    able   to   accomplish   more   and    students    would
     of  analysis  that   SHO   really   should   be   doing.    spend  less  time  in  frustrating,  useless   activity;
     SHO   should   be   dealing   with   the    institutions    or   the   alternative    argument    that    low-income
     that  it  knows  best   and   those   are   the   health    communities   don't   need   SHO   to   show   or   tell
     care  insitutions.  We   should   be   researching   the    them   anything.   My   remarks   are    addressed    to
     institutions  that  deliver   health   care   and   find    the idea  that  there  is  a  good  deal  that  SHO  can
     out  who   controls   them   and   find   out   why   we    accomplish  by   continuin   to   go   into   the   com-
                                                                                             9
     have   such   an   anachronistic   system   of    health    munities  both  in   personal   growth   to   the   Stu-
     care  delivery  in  the  United  States  and  find   out    dents and ultimately in returns to             e    com-
     where  the  health  establishment's   leverage   is   in    munity.
     the   Federal   Government,   in   the   Department   of      First  of  all,  at  least  one  Public  Health   Com-
     Health,   Education,   and   Welfare.   Who   are    the    mission  has  pointed  out  that  racism  is  the   num-
     people  that  really  make  the   decisions?   We   have    ber  one  health  problem   in   this   country   today.
     to  start  finding  out  where  we  can   get   at   the    If  you  are  not  talking  about  a  narrow  definition
     power  structure  so  that  we  can  begin   to   change    of  health,  that  is  fine.  But  a  narrow  definition
     it  and  how  we  can  change  the   whole   orientation    has  been  implied  in  much  of  the   criticism   that
     of  the  system.  It  really  amounts  to  turning   the    I  heard   yesterday,   in   much   of   what   everyone
     whole   system   upside   down,    because    what    we    has  been   saying   today,   and   apparently   implied
     are  asking  for,  if  we  really  believe  that  health    by  the  representative  from  RMP  in   what   he   had
     care  is  a  basic  human  right,  and  if  we   believe    to  say  about  funding.   Personally,   I   feel   that
     that  the  system  should  be  oriented  in  that   way,    for  you  to  adopt  a  narrow  definition   of   health
     is  to  completely  abolish   the   whole   fee   system    is  as  much  a  flight  from  the  real   problems   as
     philosophy.  We  ask  that  people   get   health   care    has  been  the  tradition  in  the  past.  Perhaps   one
     as  they  need  it-not  when  they  can  pay   for   it.    of  the  things  the  health  science   students   could
        If  we  can't  analyze   our-own   institutions   and    do a  little  more  effectively  would  be  to  acquaint
     how  they  relate   to   the   ghettos   what   possible    the  interns  with  some  of  the   things   that-   are
     legitimacy   can   we   have   in   these    communities    involved  in  a  broader  definition  of   health.   One
     at all? ...  None.  I  realize  that  most  of  -what  I    could  say,  why   is   racism   considered   the   num-
     have  said  has  been  directed  at   white   SHO   Stu-    ber  one  health   problem?   Well,   it   is   probably
     dents  and  white  professionals,  but   that   is   the    because  of  the  kind  of  information   contained   in
     bulk   of   medical   professionals   in   general   and    the   U.S.   Civil   Rights   Commission   Report,   the
     this  is  exactly  what  we  have  to  start   changing.    Kerner   Report,   and    the    Coleman    Report    on
                                                                 Education  in  the   United   States   and   on   racial
                                    PETM BONAVITCH.              isolation  in  the  public   schools.   You   can   call
                                                                 these  social  issues  or  racial  issues;  but  if  you
       A reply to'these remarks was  offered  by  Dr.  Bonnie    want to  bring  it  back  down  to  the  narrow  defini-
     Camp, a pediatrician at  Denver's  East  Side  Neighbor-    tion  of  health,'you  can  even  talk  about  how   you
     hood Health Center, physician for the San Luis  Project,    can   make   sure   people   keep   their   appointments

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                                       COLORADO STUDENT HEALTH PROJECT
           in a health clinic when  a  child  needs  continued    something  that  should  be  continued.  A  lot  of
           followup  care,  about  how  much  you   can   rely    effort  and  energy  should  be   directed   toward
           upon mothers to give medicine  to  their  children,    this;  and  if  nothing  else,  expand  your  intem
           and about the delivery of  health  care.  You  just    program  about  five  times.  So  if  you  want  to
           can't separate the problems of delivery  of  health    talk  about  a  program,  don't  worry   about   it
           care from these other  broader  problems.  I  think    not  being  relevant  to  a  narrow  definition  of
           if you want to confine yourself to a  narrow  defi-    health. Make it relevant  to  the  broader  problem
           nition of health  care,  you  might  as  well  flee    of delivering health care.
           back  to  biochemistry  and   microbiology,   anat-
           omy and physiology.  You  can  escape  the  broader                            BONNIE CAMP, M.D.
           problems which are the hard  things  to  deal  with
           and the things  that  will  tear  you  apart.  Emo-                  DISCUSSION
           tionally, I think that is what you  all  have  been
           faced with this summer....  the  fact  that  it  is    These  two  points  of  view   provided   the   nu-
           the social, the mental,  the  little  menial  tasks    cleus for an evaluation of our presence  in  ghetto
           that  make  delivery  of  health  care  in  a  poor    communities  and  the  future  direction  of   Stu-
           community a big  problem.  It  is  the  problem  of    dent  Health  projects.  Excerpts  from  this  dis-
           taking care of a  family  of  eight  children,  all    cussion are transcribed  below.  They  reflect  not
           of whom have a  different  kind  of  medical  prob-    only  the  frustrations  of  10  weeks  of  an  ex-
           lem,  a  mother  who  is  psychotic  and  a  father    tremely  intensive  involvement,   but   also   the
           who  is  in  a  penitentiary  for  having  molested    marked  personal  growth,  the  constant   reevalu-
           one of the little girls of the family. That is  the    ation  of  our  roles  as  individuals  and  future
           kind  of  problem  you  could  spend  your   Nvhole    health professionals, and new  directions  to  firm
           time with. . . .  just  trying  to  deal  with  one    commitments  made  over  the  course  of  the  sum-
           family like that. I feel very strongly about  this,    mer.  Few  answers  are   provided,   but   perhaps
           that the more you  cling  to  a  narrow  notion  of    the evolution of these ideas is a  necessary  first
           health, the further away  you  get  from  the  real    step-
           advances  of  even  having  SHO.  The   very   fact
           that  there  are  medical  students  who  are  con-        ON DEFINING A COMMUNITY
           cerned  with  other  problems  than  starting  IV's    Throughout   this   report   people    have    been
           and doing  gallbladder  operations  is  really  un-    referring  to  an  ostensibly  straight-forward  enI:-
           usual in the  history  of  medical  education.  And    tity:  "the   community."   SHO   has   classically
           as far as getting black  people  and  other  minor-                                    is
                                                                  thought of itself in  the  role  of  community  ad-
           ity people into these kinds  of  schools  and  edu-
           cation programs, you  may  be  interested  to  know    vocates." One of the greatest sources  of  frustra-
           that  the   Howard   University   School   of   Den    tion to all the  SHP's  has  been  the  problem  of
                                                             -    deciding who  are  truly  representative  of  these
           tistry  was  unable  to  admit  black  students  to    census  tracts,  these  "communities,"   in   which
           its freshman class last year because  of  the  lack    we have been  involved.  This  dilemma  arose  con-
           of applications.  So  they  have  70  white  fresh-    tinually over the course  of  the  summer:  In  the
           men in the school of dentistry. One  out  of  every    decisions  of  whether  or  not  we   should   work
           670 white people go into one of the health  science    with  agencies  which-  may   or   may   not   have
           fields; but only one out  of  every  5,000  Negroes    been  representative,  in  attempts  to   establish
           go into a health science field. It is  an  enormous
                                                                  a  community  board   for   Denver   General   Hos-
           problem to find  people  who  are  both  represent-
           ative of  their  patients  and  well-trained  in  a    pital  comprised  of  "representatives   from   the
           health care profession. The  impact  of  this  kind    community  ... . . .
                                                                   AUDIENCE:  In  your  talk  you   referred   to   a
           of problem is  not  something  you  are  likely  to    vague  entity,  "the  community."  WhAt   you   had
           recognize on the basis  of  any  10  week  personal    in mind were  militants,  those  eight  black  kids
           experience. However, I think that yo    ur  efforts    who came into  the  meeting.  They  are  the  lead-
           to  stimulate  in  health  science  professions  is    ers  and  spokesmen  of  the  community.  I'm   not

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                                                 SUMMER  1968
                 at   they   really    are    "the    community" with those  40-year-old  ladies.  Who  is  going  to
                 leaders   of    4'the    community."    I    am use the health clinic, the 22-year-old kids  or  the
                                           black           mili- 40-year-old ladies with six kids?
                  ith some of the things
          ti    done.   I   am    unimpressed    with    others. PETER   BONAVITCH:    There    are    two    commit-
          f    eight   kids   ever   confront    the    original ments really. One is the  commitment  to  the  prin-
          c     that you formed?                               ciple  of   community   control.   Another   commit-
          PETER   BONAVITCH:   Yes,   they    were    eventually ment is whether  you  agree  or  disagree  with  the
          forced  to  get  along  with  each  other.  There  was proposition that clinics or  institutions  in  black
          initial friction.                                    communities  should  be  controlled  by  the   black
          AUDIENCE:   Who   comprised    the    original    com- people  or  by  the  white  medical   establishment.
          nlittee ?                                            AUDIENCE:  We  are   talking   about   an   isolated
          PETER BONAVITCH: Eight mothers.                      small clinic, but  the  implications  are  obviously
          AUDIENCF,:   And   which   group   of    eight    best much  more  general.  This  is   a   problem   which
          represented  the   makeup   of   the   Robert   Taylor --nedical people are going  to  have  to  face  now.
          Homes?                                               There  will  always  be  one  segment,  the,  users-
          PETER  BONAVITCH:L  have  to  make  a   value        mothers  and  children;  they  are  going  to   want
          judgment  because  I   don't   even   know   what   it medical  care.  There  is  another   segment   which
          means   to   -represent   the   community.   I   don't is  not  looking  for  stop-gap  therapy   but   for
          know  what   community   legitimacy   is.   it   takes long  term  solutions.  These   long   range   goals
                                                               enecessita       e       MM
          a great deal of effort to find out  You            hav     te that th  co      unity    develop    itself
          to talk  to  people,  evaluate  the  kind  of  support without  white  intervention.  But   you   were   in
          these kids have in the community.  We           discov the  position  where  you   made   the   choice   by
          ered  that  there  seems  to  be   an   understructure either remaining there or withdrawing.
          to these kids in this particular case. And          there PETER   BONAVITCH:   My    personal    feeling    is
          is  more  sympathy  for  them  and  what   they   want that  SHO  should  not  put  itself  in  a  position
          to  do  than  for  the  original  mothers.  There   is where it has to make  that  kind  of  decision,  be-
          obviously  an  age   breakdown.   All   the   40-year- cause I feel that  SHO  as  an  organization  should
          old   mothers   don't   care   whether    they    have not be even the force  that  is  providing  resource
          white  students  or   black   students   manning   the help to  the  community;  that  it  should  be  pro-
          health  clinic.  They  want   a   health   clinic   in vided by some other health institution.
          Robert  Taylor   Homes.   But   the   militants,   who
          are  a  pretty  large  group,  want  black   staffing.   A QUESTION OF LEGITIMACY
          AUDIENCE:   But   ultimately   SHO   made   the    de-
          cision  for   Robert   Taylor   Homes   as   to   whom Because  of  the  problems  of  defining'the   com-
          their clinic was going to be run by.                 munities in which we  were  involved  and  our  sub-
          PETER   BONAVITCH:   No,   what   we   did   was    to sequent relationship to them, it was  felt  by  some
          pull  out.  That  is  right,  we  deserted  the   com- that we should  respond  only  to  the  requests  of
          munity  and  we  waited  for   the   community   which certain  segments  of  these  communities  for   our
          was running  its  own  health  clinic  to  decide  for presence.  In  this  way  just  whom  we   represent
          itself,  and  to  ask  us  to   give   them   whatever would  be  clear,  as  would  our  specific   roles.
          help we could.                                       Others felt that we  had  absolutely  no  legitimacy
          AUDIENCE:    IIt  is  a  very   false   assumption   to in   ghetto   communit.ies  bIecause   "that   kind   of
          state  that  27,000  people  in  Robert  Taylor  Homes-service  function  provides  a  safety  valve  which
          belong  to  the  community;  this  is   a   complement releases  some  of   the   pressures   which   might
          of  millions.  There  is  a  community  of  militants, operate otherwise  to  develop  an  effective  poli-
          and  there  is  a  community  of  other  people   with tical organization." . . .
                                                                 Just because there is  no  local  political  orga-
          community  interests.  What   you   did   was   accept
          the  most  vocal   group   as   the   community.   Who nization, political  awareness  or  militancy  in  a
          was                       ive    oup    there?     The community does  not  mean  that  it  makes  it  open
             the most representat       gr
          black  militants  wouldn't   have   anything   to   do to entry to any  white  liberal  who  Wan  "s  ;o  9
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                                            COLORADO STUDENT HEALTH PROJECT

          in and  save  the  place.  It  really  means  that  the    long  run  if  we  ask  them  to  come  into  the  com-
          community   is   open   to   exploitation.   It   means    munity  to  educate  them  to  our  ills."   The   com-
          that the  entrance  of  a  white  liberal  organization    munity  has  a  legitimate  feeling  that   they   have
          into  that   community   will   retard   its   develop-    been  studied  to  death.  If  they   don't   want   to
          ment,  because  that  kind  of  service  function  pro-    perform   the   function   of   educating   us,    they
          vides  a  safety  valve  which  releases  some  of  the    shouldn't have to.
          pressures   which   might    operate    otherwise    to
          develop an effective political organization.                    THE QUESTION           OF EXPOSURE
             1 think  you  have  to  go  beyond  what  is  merely
          educational   and   talk   about   what   is    morally      The  grant   proposal   for   this   project   stated
          right,  morally   sound.   Going   into   ghetto   com-    three major objectives:    service   to   the   commun-
          munities   is   highly   educational.   The    historic    ities,  the  development  of  a  high  school   intern-
          function  of  summer  projects   has   been   to   Pull    biomedical   careers   program,   and   self-education.
          medical  students  toward   some   kind   of   realiza-    In  the  previous  discussion  it  was   implied   that
          tion of the  ills  of  the  health  care  system.  This    our  own  education  comes  about   at   too   high   a
          is  a  very  efficient  way   of   accomplishing   that    price  to  the  community.  In  this  section   it   is
          task, but it is  done  at  a  very  high  cost  to  the    argued    that    individual     commitments     toward
          community.  At  some  point  we  have   to   take   the    changing the health care     system   in   the   future
          moral  stand  that  it  is  wrong  to   do   that.   It    can be made only on the      basis  of  this  type   of
          just isn't right  to  exploit  the  community  for  the    exposure  to  ghetto  areas  as  health  science   stu-
          sake   of   educating   medical    students-at    least    dents.  Those  sympathetic   with   this   view   argue
          for  an  organization  like  the   SHO   which   thinks    that  at  some  time  we  must  find  to  what   extent
          of itself in some  kind  of  moral  terms.  It  is  im-    we  are  capable  of   becoming   involved   with   pa-
          moral  because  there  is   a   kind   of   paternalism    tients   as   human   beings.   The    counter-argument
          involved  and  because  we   are   not   dealing   with    is  that  SHO  has  evolved  by  this  type   of   com-
          the  people  as  a  group,  we  deal   with   them   as    munity  involvement  to  the   point   where,   "people
          some   kind   of   pathological   specimen,   a    show    who   have   grown   up   with   SHO   have   developed
          case.                                                      theoretical   perspectives   about   their   own   lack
            I don't think it  is  true  that  the  average  medi-    of  legitimacy  in  exactly  the  things  that   caused
          cal   student   coming   into   the   community   would    them to 4 oin the  group  in  the  first  place."  This
          see  it  as  a  disease  entity  under  a   microscope-    faction  argues  that  it  is  not  necessary  to   re-
          something  removed.  In  fact  a   very   large   func-    peat  our  past  history  to  maintain   a   sense   of
          tion of SHO  is  to  have  its  people  relate  to  in-    involvement. . . .
          dividuals   in   the   community   as   human    beings     I  think  there  is  a  point  that  we  have  missed.
          and not just as clinical case presentations.               We   have   been   discussing   SHO's    presence    in
            I  think  that  your  coming  from   a   white   mid-    ghetto  communities  in   terms   of   medical   educa-
          dle  class  community  and  going  into  a  black  com-    tion.  In  medical  school  you  are  taught   not   to
          munity  and  trying  to  organize  it.   and   set   up    get  emotionally  involved   in   a   patient.   "Don't
          clinical facilities and things  of  this  nature  is  a    go  overboard  or  you   can   become   involved   with
          well   meaning   project.   But   coming   from   upper    every  patient!"  But  at  one   point   in   your'life
          middle  or  middle  class  white  families,  you  don't    you   must   become   emotionally   involved    in    a
          know  any  of  the   problems   of   the   ghetto   and    patient  as  a  total  individual.  Perhaps   something
          you  are   trying   to   impose   those   same   middle    good  will  come  out  of  a  2   month'stint   working
          class  values  which  you  hope  to  avoid  on   people    with  someone  on  a  medical  problem   out   of   the
          who don't want them.                                       clinic,  going  over  it  every  day,  and  trying   as
            It  is  for  the  community  to  judge   whether   or    hard  as  you  can   to   accomplish   whatever   goals
          not  they  want  our   presence,   and   the   judgment    you  have  set.  Through  this   you   can   begin   to
          we  are  asking  the  community  to  make   is,   "It's    understand-as  students,   or   as   residents   in   a
          going  to   be   good   for   medical   students,   and    hospital,  or   when   you   are   practicing-what   it
          therefore, it is  going  to  be  good  for  us  in  the    means  not  to  get  involved  with  a   patient.   You

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                                                SUMMER 1968
     aust see how far  you  can  allow  yourself  to  go.    schools.  This  might  be  interpreted  as  passing
                                           before      in    of  the  proverbial  "buck."  On  the  other  hand,
     f you have never become involved
     rour life, then I think that when  you  hear  people    our project  experience  has  clearly  demonstrated
     ,five this advice, you just have to find  out  where    that a great  many  of  the  problems  of  deliver-
     he  point  is  for  yourself.  This  project  is   a    ing health care  to  ghetto  areas  arise  from  an
     inique  opportunity  to  come  to  grasp  with  that    inexcusable   lack   of    communication    between
     .mportant  question  in   your   medical   education    health  care  "providers"  and   "users."   Perhaps
     ind your lives.                                         such service projects, if legitimate at all, should
     if   you   understand   the   inception   of    SHO,    be the function of  health  care  institiutions....
     these were the  people  involved  in  civil  rights;    The  question  we  have  asked   is:   Should   SHO
     they saw the conditions  first  hand,  and  that  is    be the institution  that  sensitizes  medical  stu-
     what  moved  them-not  reading  the   papers.   This    dents  to  the  problems  of  the  ghetto  in  this
     is why  these  projects  are  so  important  because    kind of direct  experimental  way?  I  don't  think
     reading the papers  you  don't  get  moved  as  much    it should. First, no one should  enter  these  com-
     as  you  do  working   in   the   communities.   The    munities until they are asked,  and  then  I  would
     motivation  to  change   the   system   comes   from    have the health systems of the institutions do  it.
     the experience we have all had.                         The  white   liberal   medical   student   has   no
     These  people   who   have   grown   up   with   SHO    role by himself or  as  a  member  of  SHO  in  the
     developed  theoretical   perspective   about   their    black  community  even  as   a   resource   person.
     own  lack  of  legitimacy  in  exactly  the   things    The resource people should  be  supplied  by  other
     that caused them to join  the  group  in  the  first    institutions,  and  other  institutions  should  be
     place. I don't feel  that  we  have  to  repeat  all    facing  that  dilemma.  SHO   should   not   thinl-
     our  prior  history  before   we   can   develop   a    of itself as some kind of  junior  hospital  or  as
     better  perspective.  I  don't  think   that   every    an organization  that  sets  up  junior  hospitals.
     person  has  to  live  through  the   whole   thing.    I  think  the  medical  school  and  the  hospitals
     Many of the  people  in  SHO,  many  of  the  active    which are  actually  in  the  ghetto  areas  should
     members,  are  people  who  have  not  gone  through    be dealing with  the  community  at  all  times  on
     the  whole  student   health   movement.   Some   of    some kind of equal basis.  The  institutions  them-
     the  people  in  the  project  this  summer   really    selves  should  be  developing  the  relationships,
     never had any  contact  before  with  that  kind  of    with  the  community,  and  asking  the   community
     sensitization, and yet  they  came  to  the  project    if they want medical students to come in.
     aware.  They  came  into  the  project   questioning    Another   point   we   mentioned   was   how    are
     its validity.                                           white liberal students to find  out  or  to  expose
      Some people  like  myself  had  to  be  exposed  to    themselves to the ghetto? I  think  the  answer  is
     this kind of experience.  I  came  out  of  it  with    that our health science  schools  have  to  provide
     a certain feeling. If I  hadn't  done  it-if  I  had    that.  SHO  should  not  be  expected  to  do  this
     read the paper  and  saw  it  on  TV,  it  would  be    since its goal is really to change the health  care
     very hard for me to  say  I  am  going  out  and  do    system.  We  should  not  be  expected  to  perform
     something.                                              this  kind  of  service   function.   The   medical
                                                             schools  themselves  should  expand   their   e-om-
                                                             munity  medicine  or  preventive   programs.   That
           THE ROLE OF HEALTH CARE
                                                             means that  the  medical  schools  themselves  must
                     INSTITUTIONS                            undergo  a  radical  change.  They  must  begin  to
       One  possible  solution  of  the  dilemma  of  the    negotiate on an  equal  basis  with  the  political
     urgent  need  for  self-education  and  SHO's   lack    powers in the community.
     of legitimacy in  ghetto  areas  as  a  group  would
     be  for  the  health  care  institutions  to  assume       THE FAULT, DEAR BRUTUS . . .
     whatever  roles  the  summer  projec+iz  have   ful-      If we have no  legitimate  role  in  ghetto  com-
     filled. This would mean  an  incorporation  of  such    munities,  we  must  define  new  perspectives  for
     activities into the  curriculum  of  health  science    our energies.                                               4ii


                                      COLORADO STUDENT HEALTH PROJECT
           We   are   constantly   being   told   by   our   black don't think it  warrants  going  back  again  next
           and  brown  associates,  particularly  the   militants, year. I think our job is on  the  outside  working
           that our role  should  be  in  spreading  the  word  to with the  white  community  in  general  and  spe-
           our  own  communities,   in   our   own   institutions. cifically with the  white  institutions  presently
           If  there  is  a  role  for  SHO  in  black  or   brown bxerting control over certain  aspects  of  ghetto
           communities  it  should  be   assumed   by   black   or dwellers lives.
           brown students....                                    There  is  a  faction  of  SHO  called  the  black
           SHO  has  among  its   interests,   not   only   chang- caucus. This group  consists  of  all  black  stu-
           ing the  health  care  system,  but  providing  a  more dents. There is a feeling  growing  in  the  black
           humane  education  for   medical   students   and   for caucus that their legitimate function is to  begin
           all   health   science   students.   There   are   many to look  for  black  students  to  work  with  the
           different  interests   involved.   Instead   of   work- community  organization  in   their   communities,
           ing  with   ghetto   communities,   we   should   enter to organize them around  the  problems  of  health
           the  white  communities  to  help   the   health   pro- care. Again, that all  rests  on  the  proposition
           grams  that  are  in  the  black   communities.   Those that  black  communities  are  the  constituencies
           white   communities,   our   own    communities,    are of the  black  students  and  the  white  students
           responsible   for   propagating   the   double   stand- are the constituents  of  the  white  communities,
           ard of health care.                                   %vhich is practically all of SHO.
           I   think   the   white   community   is   much    more I think that the  way  things  are  now  socially,
           nearly  the  constituent   or   the   source   of   the a black person going into ',-,he  black  community
           people  who  are  in  the   SHO.   If   we   have   any and aiding in  terms  of  the  educational  oppor-
           leverage,  it  is  in  the  white  communities.   There tunities and things  that  you  talk  about  would
           would  be  much  more  conflict,  much   more   hostil- be  more   understood   and   appreciated.   There
           ity  if  we  even  started  doing   anything   substan- wouldn't  be  a  development  of  hostilities   on
           tial  there,  because  that  would  mean  real  change. either side, and I think that you should  be  able
           If  I  learned  anything  this  summer   it   was   the to find some black people to  work  in  this  par-
           extent    of    prejudice    among    whites-even    my ticular project.
           own  parents,  aunts,  uncles,  friends....   For   in-
           stance,  we  came  to  this  old  man's  house,  and  I   A QUESTION OF LEGITIMACY
           happened  to  mention  that   after   we   had   scrub-            RECONSIDERED
           bed for 8  hours,  and  it  was  really  dirty  because Still,  arguments  remain  for  our  presence  in
           he was too debilitated to  clean  it  himself,  he  im- these communities based on  the  present  lack  of
           mediately   started   spitting   tobacco   again.    My involvement  of  other  institutions  in  assuming
           friends  started   saying,   "There,   you   see?   Now
           you  know,  'these  people'  want  equality,  but   are our  roles,  the  overwhelming   immediate   needs
                           if                                    of ghetto  dwellers  causing  organization  around
           just  plain  dirty.  I  think  we  should   take   high health issues to assume a low  priority,  and  the
           school  interns  into  the  white  community   and   go
                                                                 need for continuing the high  school  intern  pro-
           see  those  people,  make  them  see   they   are   in-
                                                                 gram, one of the  three  objectives  of  the  sum-
           dividual@no   better   or   worse   than    themselves. mer program as well as one of  its  most  success-
            The  essence  of  this  conversation   is   that   the
                                                                 ful aspects....
           problem  is  outside,  not  inside.  I  feel  the  same "What has SHO  tried  to  do?  Has  it  gone  in
           way  after  working  with   +.he   East   Side   Action and tried to organize the community?"
           Center,  where  we  sat   around   for   a   few   days "Yes, but we think that is a mistake."
           with  our  mouths  open,  trying  to  look  like  water "Well, they are  not  going  to  organize  them-
           fountains  and  stay  out   of   the   way.   We   then
                                                                 selves. Their  problems  seem  to  revolve  around
           jumped   into   a   project    called    Main    Stream just making  enough  money  to  live.  Under  such
           which  engulfed  us,  and  we   felt   like   we   were circumstances the  existing  conditions  will  re-
           doing  something  with  20  boys;  it  was  a   produc- main the same."
           tive  summer  for  them,  and   for   us   getting   to if our aim is  to  change  health  science  stu-
           know  the  community  at   the   same   time,   but   Idents, but at the same  time  begin  changing  the

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                                                   SUMMER 1968
     health  care  system,   then   we   might   send   new     The   agencies   cooperate   when    we're    around
     people in  to  help  the  communities.  Let  them  see   but then they do nothing.
     the  problems  first  hand.  You  are  not  going   to     Our  role  in  assuming  responsibility  for   these
     get  -new  recruits  to  come  around  and  work   for   agencies  and  our   influence   on   them   is   dis-
     a  summer  on  health  care  analysis,  because   they   cussed....
     don't understand it and they don't care!                   What  we  did  as  SHO's   was   to   be   dedicated
       One  of  the  objectives  of  the  high  school  in-   and  do  the  jobs  for  them.   The   Public   Health
     tern  program   was   to   put   individual   problems   Nurse  should   have   been   taking   care   of   two
     into  a  community   context.   Before   the   project   children whom I brought in fro
     these  kids  only  looked  upon  their  own   personal   The              Council   should   have   found   out
     problems;  they  didn't   realize   that   the   whole   about  a  migrant  family  for  whom  I   got   public
     community   was   affected   by   the    same    prob-   health forms for health care.                   should
     lems,  and  we  should   give   them   a   chance   to   have   been   handling   food   stamps,   they    were
     look  at  the  problem  as  social  rather  than  per-   trained to do it. I  took  care  of  food  stamps  my-
     sonal,  and  to  direct  their  own   efforts   toward   self.  I  went  around  from  family  to   family   to
     organizing.                                              try to get them in the food stamp program.
       Other   arguments   are   based   on   certain   in-     The   town   where   I   worked   has    an    ideal
     adequacies  of  community  agencies   and   our   role   setup in  terms  of  agencies  and  service  organiza-
     in   influencing   them.   A   sample   of    comments   tions   which   might   encounter    public    health.
     concerning  agencies  with  which   we   had   contact   They  are  willing   to   take   anyone.   There   are
     in all of the project areas is presented below. . .  ..  eight  Vistas,  plus  a  supervisor,  and  it   is   a
       The  agencies  don't  focus  on  health.  They   are   community  of  3,000.  It  has  all  these   resources
     interested  in  jobs,  money,  houses,  roads,  water:   there and the reasons  they  don't  function  is  that
     Health is the  last  interest.  I  think  that  a  re-   the people in the  organizations  are  lazy  or  don't
     orientation  toward  health  considerations   is   our   really care or are not dedicated.
     most valuable role.                                        After   our   10   week   presence,    the    Public
       I   don't   think   that   our   sanction   by   the   Health  Department  now   realizes   that   they   can
                  Center  is  a  sanction  from  the   com-   do  things  that  they   have   never   done   before.
     munity  because  I  don't  -think  that   the   people   They  now  have  the  first  rush  of  activity   they
     on  the  staff  are  really  representative   of   the   have  ever   seen;   they   now   know   what   public
     community.                                               health  means-more  than  waiting   for   the   people
                     has a lot to  offer  but  it  is  very   to  come  to  the  building  for   immunizations.   We
     defensive  about  letting  information  out   to   the   showed  them  that  60   children   would   come   for
     I                                       eir    aspira-   such  a  program  where  they  had  only   four   pre-
     community because it just raises th
           and   they    start    making    more    demands   viously.
     on  the  director,  and  he  just  doesn't  know  what     I think  that  this  is  the  most  important  thing
     'he is doing.                                            about  the  project.  It  really  doesn't  matter   if
       I   can't   evaluate   the   organizations   because   you  go  some  place  and  set   up   a   program   or
     they are not getting anything done.                      set up  a  clinic-those  are  just  additions  to  the
       The agencies  are  there  but  they  are  not  good.   structure   already   there.   Our   only   legitimate
     There  -was  only  one  agency  person  in  the  whole   function  is  going  places,and  opening  up  people's
     connnunity  with  whom   we   felt   really   comfort-
     able   and   he    was    a    Spanish-American    who   eyes,  making  them  more  aware  of  what   is   hap-
     understood  his  people's   problems.   He   was   the   pening   and   more   aware    of    themselves-people
     only person that we could talk to.                       in  Public  Health   Departments   and   Welfare   De-
       The               agency    has    a    hard    time   partments.  Then  when  we  leave  it  doesn't  matter
     getting  anything   done.   They   are   more   interr   whether  we  have  an  existing   program   there   or
     ested  in  rubbish  rules,  being  on  time  to  meet-   not,  because  we  have  made  some  effect.  on   the
           and    parliamentary    procedure,    than    in   structure.  To  affect  the  people  there  and   make
                  action.                                     them  aware  of  what  benefits  they  can   have   is

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                                          COLORADO STUDENT HEALTH PROJECT

           a  concrete  change-you  don't  have  to   leave   a   marginal  change,  and  you  know  the   amount   of
           monument behind.                                       change  you  accomplish  in  a  given  time,  it  is
                                                                  going to be greater for  this  kind  of  study  than
               THE CASE FOR INSTITUTIONAL                         it is for the summer projects.  Our  energies  could
                              ANALYSIS                            be  better  directed.  If  you  don't  do   anything
                                                                  else but get a few  more  students  to  come  around
             The point was  made  several  times  in  our  dis-   to realizing the  kind  of  health  crisis  that  we
           cussion that what  we  have  done  in  ghetto  areas   are  in,  then  we  really   accomplish   something.
           amounts   to   "band-aid   measures"   rather   than   The future of  the  health  care  profession  is  in
           gipreventive  cures."  We  have  been  dealing  with   the hands of present health students.
           the  end  product  of   the   health   care   system     The idea  of  research  really  burns  me  because
           rather than with  its  roots.  Our  work  is  easily   we will come  up  with  these  sophisticated  analy-
           ignored   by    the    medical    community    which   ses of just how things got the  way  they  are,  but
           largely passes us off as  "those  idealistic  kids."   will  that  make  any  difference  in  the  way   we
           Yet  it  is  the  unresponsiveness  of  the  medical   are going to'be  able  to  affect  things?  We  will
           communities  which  has   catalyzed   growing   stu-   come  up  with   some   real   nice   sophisticated,
           dent  involvement  in  preventive  measures   rather   understanding-  medical  students,  but  no  change.
           than  our  historical  concern  with  crisis   ther-     "Why   can't   we   develop    an    understanding
           apy....                                                that really attempts to  get  at  the  root  of  the
             We  are   posing   a   dilemma-we   shouldn't   go   problem?  If  the  root  of  the   problem   happens
           into  the  community,  but  the  only  way  we   can   to  be  that  a  particular  medical   establishment
           learn is to  go  into  the  community.  I  think  if   is a white racist  group,  then  that.is  one  thing
           we  started  working  within  the  power   structure   to document."
           in our own institutions and  if  we  ran  into  some     "What  happens  then?  Where  do   you   go   from
           of  the  dynamic  people  there,  we   might   start   there?" "You  use  the  media.  I  really  see  that
           getting  turned  on  just  as  much.   The   medical   as a kind of  educational  function  for  ourselves,
           power  structure  doesn't  pay  any   attention   to   the  medical  community  and   the   general   popu-
           our work  in  the  black  communities.  We  are  not   lation. This kind of  exposure  must  lead  to  pos-
           going to be labeled for that. But,  if  we  were  to   itive action."
           start  mixing  with  the  white  medical  establish-     I think it is naive  to  assume  any  expos6  that
           ment  we  might  have  a  chance  to   create   some   SHO could  write  of  any  institution  or  powerful
           change.                                                city hospital could do  anything  but  cause  a  de-
             We  have  been  observing  the  end  stage  of   a   fensive reaction.
           disease  process-we  have  been  working   in   com-     Maybe we  shouldn't  expect  anything  but  a  de-
           munities where you see  the  results  of  the  pres-   fensive reaction', but I think that is the  type  of
           ent  health  care  system.  We  have  been  abandon-   thing that we have to begin doing.
           ing the  place  where  we  have  leverage.  This  is        S.    came  up  with  the  kind  of  documenta-
           in  the  medical  schools  and  the  hospitals.   We   tion  we  have  been  talking  about,  and  if   the
           have been patching up  this  end  but  ignoring  the   corruption  and  the  kind  of  corporate  exploita-
           process itself. In a  way  we  have  been  retarding   tion is the kind of control that interests like  the
           the  development  of  the  people  who  would   like   medical  establishment   and   the   drug   industry
           to  change  things  in  the  affected   communities.   exert on the health profession,  and  is  really  as
           I  think  we  should  be  analyzing   the   existing   great as we think it  is,  then  that  is  something
           health care  institutions  and  change  them  beforeI  that needs to be  said  and  something  that  people
           they begin to affect these connnunities.               will be interested in.
             The problems of the black communities          are     We  agree  that,  with   the   kind   of   medical
           extremely well documented already.                     care that  is  being  made  available,  we  want  to
             Research of health care  institutions  is  a  more   change  that  system  where   we   have   the   best
           worthwhile  channel  for  our  energies  than  going   leverage.  This  is  in  the  medical  schools   and
           into the ghettos for 10 weeks.  If  you  talk  about   hospitals. If SHO has any power it is there.

           io


                                                    SUMMER 1968
             BRINGING IT ALL BACK HOME                        almost no mobility for licensed practical  nurses,
                                                              and they pay the hospital orderlies and  the  sub-
         The  transition  between  these  short   but   in-   professional  groups  almost   starvation   wages,
        tense  and   commiting   summer   experiences   and   not to mention the wages of the house @ff.
        reunion with our  health  schools  has  been  found     I do think that  it  is  a  legitimate  function
        painful. Many of  the  reasons  have  already  been   of SHO to begin to recruit  people,  and  I  think
        stated:   The   lack   of   communication   between   that SHO should  demand  that  it  be  a  function
        our  schools  and  the   communities   with   which   of the medical schools to begin  actively  to  re-
        we  have  been  involved;  the  immobility  of  our   cruit minority groups, out  of  high  school  into
        schools toward  dealing  with  the  problems  which   college, and out of college and into  the  medical
        we  have  seen.  Some   participants   have   dealt   schools. I see this as more of a pull of  SHO  and
        with this  transition  by  dropping  out  of  their   the  medical  schools  rather  than  any  kind  of
        respective school,. not unlike those  students  de-   push within the community.
        scribed  in  Kenniston's  book,  "The  Young  Radi-     Even  when  you  assemble  numbers   of   minor-
        cals-Notes   on   Committed   Youth."   The   opti-   ity  students  with  the  right  credentials,  few
        mistic alternative to this course is  the  role  Of   know  how  to  go  about  the  whole   application
        SHO  in  changing   our   institutions-living   our   process, which is a whole skill in itself.  It  is
        experiences, "bringing it all back home."             really only the big medical  schools,  the  fairly
          Once  we  know  something   that   exists,   what   prestigious  ones,  which   are   doing   anything
        do we do?  Do  we  sit  back  and  waste  our  time   meaningful  in  that  area.   The   State   medica
        doing menial  little  jobs  taking  one  family  tq   schools  which  train'the  bulk  of  medical  stu-
        the  doctor.  SHO  now  can  have  some   kind   Of   dents really  just  are  admitting  token  "black"
        identity  as  a  group  of  people  who  are   com-   students.
        mitted  based  on   some   conunon   feeling,   but     For the bulk of  minority  students  an  attempt
        there  is  the  feeling  that  something  needs  to   to increase admissions  would  require  a  supple-
        be changed. It can be  changed  within  the  health   mentary education  program  as  well  as  continu-
        schools, hopefully' We  can  begin  to   make   de-   ing financial aid. Students  presently  in  health
        mands on the  administrations  of  our  schools  to   schools could aid in all aspects of su        pro-
        set  up  some  kind  of  quota  system   to   admit   grams.
        minority  students,  to  begin  to  train  minority     The question now is  what  to  do  when  we  get
        professionals.  We  can  'begin   to   change   the   back to our  schools?  How  do  we  start  working
        whole  structure  of  medical  education  which  is   with   our   own   community   right   away?   Ten
        uselessly  long  and   brutalizing   because   they   weeks of experience  stands  between  us  and  our
        teach us to regard  patients  as  specimens,  some-   schools. Can we direct  ourselves  from  the  Very
        thing to be  worked  on  as  interesting  pathology   time that we get back to utilize the things  which
        under  the  microscope.,They  bring  in  gangs   of   we  have  learned  this  summer  and  apply   them
        residents  and  interns,  third  and  fourth   year   to constructive projects in our  institutions  and
        students to look at "this case ... .. examine    "this even to the basic concern of  relating  these  ex-
        patient." Another concern is  the  fact  that  hos-   periences  to  our  classmates   and   influencing
        pitals provide no mobility for  nurse's  aides  and   them? That's our bag. That's where iCs aL


                                                               Chapter 5

                                                             The Evaluation


                                              COLORADO STUDENT HEALTH PROJECT
             Alfred  Claassen  and  John  Quicker  are   sociol-            Professional    Background:    Twenty    of     the
             ogy graduate students at  the  University  of  Col-           students  were  from  medical   schools,   all   but
             orado.  During  the  summer  they   examined   many           foui- of  these  being  second  year  students,  the
             aspects of the project  including  general  changes           others, third  year.  There  were  also  four  nurs-
             in student attitudes, the student's specific  feel-           ing, one  education,  three  social  work,  and  two
             ings  about  the  project,  and   community   resi-           law students.
             dents' and  agencies'  reactions  toward  the  SHP.            Social  Action  Experience:   Probably   the   most
             In addition, they compiled the logs  of  daily  ac-           valuable  experience  as  a   background   for   the
             tivities summarized  below  and  the  project  par-           Student  Health  Project   is   community   develop-
             ticipants' descriptions of tlic@ health care system           ment. 27  percent  of  the  students  reported  pre-
             in their respective areas, as  well  as  the  study           vious work in this area.  Public  health  experience
             of folk  medicine  in  the  San  Luis  Valley  pre-           is another factor  which  33  percent  of  the  stu-
             sented in chapter 1. The  r-qethods  used  are  de-           dents  reported;  30  percent  indicated  participa-
             tailed in the appendix.                                       tion  in  past  action  projects  similar   to   the
             They   worked   independently   of   the    project           S.H.P.;  50  percent  of  the  students   had   done
             staff. It was felt that  in  this  way  they  might           some  tutoring  of   underprivileged   children.   A
             come  upon  a  more  objective  analysis  than   if           total of 70 percent  could  call  on  experience  in
             they were considered a formal  part  of  the  proj-           one of these areas.
             eet. As a result, the opinions expressed  here  are            Residc-izee:  None  of  the  students  were   from
             their  own  although  most  of  the  project  staff           towns  of  fewer  than  2,500  people,  23   percent
             and  participants  would  likely  be  in  agreement           came from  small  towns,  (2,500  to  25,000)  ;  33
             with  a  majority  of  their  report   and   recom-           percent  from  medium  size  communities;  14   per-
             mendations.  I  have  taken  the   editorial   pre-           cent from cities  of  100,000  to  500,000,  and  30
             rogative as project  coordinator  to  control  cer-           percent from cities of over 500,000.
             tain points raised here  in  the  preface  of  this             Occupational    Background:    The     occupations
             book. . . .                                                   of  the  fathers  of  participating  students   were
                                                                           very high  in  status  as  they  have  been  in  the
                                                                           other  Student  Health  Projects.  Table   I   indi-
                   THE PROJECT EVALUATION                                  cates  the  breakdown.   Family   income   is   also
             Alfred J. Claassen and  John  C.  Quicker,  Department  of    high,  the  median  being  $15,000,   and   a   full
                Sociology, Universi ty of Colorado.                        third over $20,000.
             In this evaluation  we  begin  with  a  discussion
             of  the  students,  who  they  are,   their   back-                        Table I.-Father's Occupation
             grounds,  where  their  interests  lie,  and   what                                                                Percent
             their attitudes  are  like.  We  then  discuss  the           Medical  Profession -----------------------------         23
                                                                           Nonmedical Profession      --------------------------     20
             effects of the  summer's  experience  on  the  stu-           Executive       -------------------------------------     10
             dents and  the  interns,  evaluate  these  effects,           White   CoUar -----------------------------------         17
             and   suggest   improvements   for   next   summer.           Skilled Labor ----------------------------------          17
                                                                           Semi-skilled  Labor -----------------                     0
             This  concluded,  we  summarize  some  of  the  ac-           Unskilled Labor      --------------------------------     0
             complishments  of  the  project  in  carrying  med-           Farm       -----------------------------------------      0
             ical and related services  to  the  poor.  Finally,           No   Response ------------------------ I  ----------      13
             we turn to some of  the  problems  in  this  aspect
             of the  project  and  again  make  recommendations.             Religion:  The  distribution  of  religious  pref-
                                                                           erences of the students was also  not  that  of  the
             A. The Students                                               general  population:  40  percent  Jewish,  30  per-
                                                                           cent Protestant, 3 percent  Catholic,  and  27  per-
             1. Demographic Characteristics                                cent had no preference.
              Age:  Twenty-five   of   the   30   students   were   be-      Political     Party     Preference:     The     political
             tween  the  ages   of   21   and   24.   The   range   was    views   of   the   health   science   students    differen-
             from 20 to 28.                                                tiated   them    most    strongly    from    the    typical

             74


                                                       SUMMER 1968
        medical   student.   The   former's   party    prefer-   liberalism  in  views  toward  the  relationship   be-
        ences we re   43   percent   Democrats,   54   percent   tween  politics  and  medicine.   Scale   9   measures
        Independents,   3   percent   Peace    and    Freedom,   knowledge  of  the  culture  of  poverty.   Scale   10
        and 3 percent Republicans.                               aims  at  activism  or  militancy  or  the  radicalism
          Other  Characteristics:  All  30  of  the   students   of  the  methods  of  the   student   in   approaching
        were of the white race;  16  of  the  30  were  males,   our   Nation's    problems.
        and  75  percent  had  both  parents   born   in   the      The  first  six  scales  were  coded  4-3-27-1  and
        United States.                                           the  Colorado  scales  6-5-4-3-2-1;   in   each   case
          Main  Concerns:   When   they   entered   the   Stu-   the highest  score  was  given  to  the  most  liberal
        dent  Health  Program,  53   percent   of   the   stu-   answer  with  the  exceptions   of   scale   1   where
        dents  looked   forward   to   the   learning   aspect   "helping"  was  scored,high,   scale   6   where   un-
        with greatest  interest,  27  percent  to  being  able   favorableness  was  scored  4  points,  and  scale   9
        to help the poor,  and  20  percent  to  a  gratifying   where   sociological   accuracy   was   scored   high.
        experience.  When  asked   to   list   their   primary   In the  appendix,  the  high  scoring  answer  is  the
        apprehensions   about   the   program,   33    percent   one  with   the   asterisk'There   were   32   students
        were  afraid  that   the   summer   would   bring   no   in  the  Colorado  Student  Health  Project   and   in
        concrete  accomplishments,  20   percent   were   wor-   9 of the 10 scales the  N  was  29  with  both  before
        ried   about   personal   inadequacies,   17   percent   and after  responses  and  for  scale  5  it  was  28.
        questioned  their  ability  to  gain   acceptance   in
        the  poor  community,  and  23  percent  listed  other   Initial Attitudes
        concerns.                                                   The  most  salient  characteristic  of   the   stu-
                                                                 dents'  attitudes  at  the  beginning  of  the  summer
        2. Attitude Scales                                       was  that  they  were  extremely  liberal  for   medi-
          Identical  attitude  questionnaires   were   admi-n-   cal students  in  political  views  generally  and  in
                                                                 feelin                                               I-
        istered  to  the  students  as  they  registered   for         gs  about  the  medical  profession   and   med'
        the  orientation  period  at  the  beginning  of   the   cal problems  specifically.  In  order  to  illustrate
        summer  and  again  at  the  evaluation   session   at   these  views,  table  II  gives  the  mean  scores  on
        the  end  of  the  10  weeks.  The  questionnaire  was   each of our scales.
        made  up  of  the  10  scales  to  be  found  in   the
        Methodological   Appendix   ranging    from    7    to                            Table
        14  items  each.  The  first  six  scales  have   been
                                                                                                Mean    Mean       Possible
        used  in  the   past   by   the   California   Student            Scale Number          Score   Score        Score
                                                                                               (In  June)  (In  Augmt)
        Health.  Project,  the  last  four  were   constructed
        by us for the Colorado S.H.P.                             1  Education        --------------- 22.38 20.68     36
          Scale  I   measures   the   relative   emphasis   of    2  Physician         involvement
        the   student   on   learning   from   the    summer's         versus aloofness     -------- 45.31 46.25      56
        work  or  on  helping  the  poor.  Scale  2   measures    3  Public health clinics     ------ 29.97 31.45     44
                                                                  4  Humanitarianism      -------- 24.79 24.89        28
        the degree of compas
                                sion,  as  opposed  to  aloof-    5  Beliefs   about   the    poor ----- 30.24 30.24  40
        ness that  the  student  feels  the  physician's  role    6  The     medical      profession---- 24.86 26.10  36
        should  entail.  Scale  3  measures   attitudes   con-    7  Liberalism-conservatism --- 52.67   56.67        72
        cerning the  idea  of  public  health  clinics.  Scale    8  Politics     and     medicine ----- 47.03 47.44  60
        4   concerns    humanitarianism,    or    more    spe-    9  Knowledge      of      poverty----- 44.87 44.87  60
                                              y                  10  Appioaches     to      change ----- 60.97 62.62  78
        civically, the degree of  respect  for  the  poor  and
        their  characteristics.  Scale  5  gets   at   beliefs
        and  misconceptions  about  the  poor  and  is   coded      In  order  to  convey  a  feeling  for  what  these
        for.   favorableness   and   unfavorableness.    Scale   raw  scores  represent,  we  will  give  several   ex-
        6   measures   favorableness   toward   the    members   amples  of  median  answers  to  various   items.   On
        'and  practices  of  the  medical  profession.   Scale   scale   7,   liberalism-conservatism,   the   students
        7  involves   domestic,   political   liberalism   vs.   agreed  to   the   statement,   "With   our   Nation's
        conservatism.  Scale  8   measures   the   degree   of   great  wealth,  no   form   of   poverty   should   be
                                                                                                                      75


                                      COLORADO STUDENT HEALTH PROJECT
        tolerated." They disagreed  to,  "Anyone  can  pull    those scales covered by it. Since  our  prediction
        himself out of poverty  who  has  the  will  to  do    was that there would be change in  a  liberal  di-
        so." With regard to the  medical  liberalism,  they    rection, the no change subjects are added  to  the
        agreed that  "Considering  +,he  incomes  of  other    negative change subjects in the  statistical  com-
        segments of  society,  physicians  earn  more  than    putations. Table III shows  that  with  reasonable
        enough already."  To  further  differentiate  them-    significance three of  the  eight  scales  confirm
        selves  from  the  average  medical  student   they    our prediction. Thus,  the  students  became  less
        agreed  that,  "If   community   medical   services    favorable  toward  the  medical  profession,  more
        are  to  be   expanded,   the   Government   should    politically liberal  and  more  activist-oriented.
        play the major role  in  backing  this  expansion."    However, as can be  seen,  the  changes  noted  in
        Concerning activism,  they  slightly  agreed  that,    the table are all in the predicted  direction  and
        "The system  has  a  way  of  corrupting  idealists    a Chi Square of the totaled items  is  significant
        who  think  they  can   work   within   it."   They    at the .001 level when including them  with  their
        slightly disagreed to, "In pursuing  social  change    reversals.
        breaking the law is never justified."
                                                                                   Table N
        Attitude Change
                                                                        Number   of   Number   of    Number    of Level    of
                                                               Scale     po itive     no  negalivo   X2   signific=ce
                                 y                                                           .g
         Fortunately, social ps chologists have deve                     ch:nges  changes  ch   es
        oped a large body  of  findings  on  the  mechanics
        of attitude change. A  survey  of  this  literature    2           15         2     12   ---------------
        led us to  predict  a  number  of  attitudinal  re-    3           17         5      5       .43   .30
                                                               4           14         6      9   ---------------
        actions to the experience  of  the  summer  on  the    5           14         3      12  ------      --------
        part of the students. For  two  different  reasons,    6           18         4      7   1.68      .10
        we anticipated  a  general  shift  in  the  humani-    7           19         3      7   2.79      o5
        tarian or liberal direction. First, the  milieu  of    8           14         3      12  ---------------
        the medical school is much less liberal  than  that    10          20         1      8 1 5.53    ,     .02
        of the S.H.P.  Thus,  through  association  with  a
        greater than  usual  percentage  of  liberals,  the     Again we will  turn  to  changes  in  median  re-
        general trend of attitudes should be to  the  left.    sponses to specific items to illustrate these gen-
        Secondly,  Festinger's  dissonance   theory   would    eral  trends.  To  the  statement,  "Many   physi-
        anticipate the attitudinal paralleling of  actions.    cians are in practice just  for  the  money;"  the
        Participation in the S.H.P.  is  a  liberal  action    student, first tended to disagree and later tend-
        and  conservative  beliefs  would  lessen  the  im-    ed  to  agree.  Also,  at  the  beginning  of  the
        portance of  the  summer's  activities  giving  the    summer they tended to  disagree  and  at  the  end
        actor  less  satisfaction,  The  more  successfully    tended to agree  that,  Physicians  are  generally
        the  student  perceived  his  summer's  activities,    not  responsive  to  the  health  needs  of   poor
        the more strongly  this  principle  would  operate.    people."
        Third, constant focusing on  the  problems  of  the     On domestic  political  liberalism,  the  follow-
        poor with a  corresponding  lack  of  attention  to    ing were the strongest shifts:  (a)  From  slight-
        competing problems such  as  high  taxes  and  mil-    ly disagree to slightly agree that,  "Police  bru-
        itary obligations would  be  expected  to  increase    tality was a  major  reason  for  our  riots  last
        the salience of poverty  as  a  problem  and  hence    summer."  (b)  from  disagree  to  strongly   dis-
        bring a liberal shift.                                 agree that, "Minority groups are  trying  to  move
          A  second  prediction  was  that,  again  because    too fast in seeking reforms."  (e)  from  disagree
        of the salience  factor,  our  eight  students  as-    to slightly agree that,  "Conditions  are  so  bad i
        signed to  health  clinics  would  change  more  in    in our cities' ghettos  that  no  Negro  could  be
        a liberal direction on  the  five  scales  touching    blamed  for  rioting."  (d)  from  slightly  agree
        medical problems than  would  the  other  students.    to  agree  that  "The  unemployed  should  not  be
          Table III gives the results  of  our  first  pre-    blamed  for  turning  down   low   paying   menial
        diction concerning  the  shift  to  liberalism  for    jobs."

        76


                                                                              SUMMER             1968
              There   were   also    several    revealing    shifts    on                  consciously,    or    more    often    unconsciously     toward
           activism    items:    (a)    From    slightly    agree     to                   adapting   to    his    social    environment,    then    large
           agree    on,    "Most    liberals    talk     humanitarianism                   environmental    differences    are    likely    to    parallel
           but  are   not   willing   to   make   the   sacrifices   de-                   important    differences     in     attitude     change.     In
           manded   by   action."   '(b)   from   disagree    to    only                   the Colorado        'S.H.P.   half   of   the    students    worked
           slightly   disagree   that,   "Nothing    can    be    gotten                   in   the   midst   of   turmoil   and   a@sense   of    urgency
           from    'White    America'    without    violence     forcing                   pervading     Denver's     urban     ghettos.     The     other
           the   issue."   (e)   from   slightly    agree    to    agree                   half    worked    in     rural     agricultural     communities
           that,   "The    system    has    a    way    of    corrupting                   primarily     with      Spanish-Americans      who      settled
           idealists   who   think   they   can   work    within    it."                   the    Southwest    three    and     four     centuries     ago
            Table   IV   summarizes    the    findings    relevant    to                   with   a   "mafiana"    culture    and    emphasis    on    the
           our    second    prediction     concerning     the     strong                   extended   family   that   served   its    people    well    in
           "effect   of   working   in   clinics   on   medical    atti-                   the   past   but   in   the   context   of   American    indus-
           tudes."  Scale  9   is   included   because   most   of   the                   trialism    leaves    them    confused    and    in    poverty.
           items    concern     knowledge     about     health     prac-                      With   such   contrasts   we   felt    certain    that    the
           tices   of   the   poor.   Here   the   students   who    had                   radically    divergent     experiences     of     urban     and
           close   contact   with   the   medical   problems   of    the                   rural students would show up in their                          attitudes.
           poor   all   summer,   as   expected,   showed   change    in                   Table   V   confirms   this    supposition.    It    will    be
           the   direction   of   greater    accuracy    of    knowledge                   recalled  that  -scales  7  and  10,  the.   political   liber-
           in   this   area.   On   the   attitudinal    scales,    even                   alism    and    activism     measures     were     the     ones
           though  the  trends   are   in   the   direction   predicted,                   that    most    strongly    confirmed    our     first     pre-
           they   are   not   strong   enough   to   confirm    matters.
           It   is   interesting   that   the   only   slight   reversal
           comes   on   attitudes   toward    the    profession.    Stu-                                                  Table V
           dents    from    clinic    placements    maintained     their                   Scale          Site           Positive No change or     FUher exact
           same   level   of   esteem   for    physicians    in    their                                                 change negative change    probability
           general   approach   to   the   poor,   whereas   the   other                   I-----   Urban    ----        3                   1 1----------------
           students became more disenchanted.                                                       Rural    -----       6                   9
           Although    we    did    not     make     further     predic-
           tions,  the   theory   of   attitude   change   led   us   to                   2-----   Urban    ----        7                   7----------------
           become    interested    in    another    aspect    of     the                            Rural    -----       8                   7----------------
           questionnaire   responses.    This    is    the    difference                   3-----   Urban    ----        8                   6----------------
           between   the   changes   of   those   students   in    urban                            Rural    -----       9                   6----------------
           and   rural   placements.                                                       4-----   Urban    ----        7                   7----------------
           If   attitudes   are   viewed    as    functionally    under-                            Rural    -----       8                   7----------------
           standable    responses    which    the    individual    makes
                                                                                           5-----   Urban    ----        4                   10                     .10
                                                                                                    Rural    -----       10                  6----------------
                                       Table IV
                                                                                           6-----   Urban    ----        9                   5----------------
                                     Positive   No   change     F13her exact
           Scale      Site           change  or n               probability
                                                     ,=tive                                         Rural    -----       9                   6----------------
                                                 c   ge
                                                                                           7-----   Urban    ----        13                  1                     .001
           2------ Clinic ---------        5          3   ----------------                          Rural    -----       6                   9-----------------
                 Nonelinic   ------      10         11    ----------------
           3----- Clinic ---------         6          2                          .10       8-----   Urban    ----        8                   6----------------
                 Nonclinic   ------      11         10                                              Rural    -----       6                   9----------------
           6----- Clinic ---------         4          4
                                                                   --------------
                 Nonelinic   ------      14           7   ----------------                 9-----   Urban    ----        9                   5               .05
           8----- Clinic ---------         5          3   ----------------                          Rural-----       4                    11 -----------
                 Nonelinic   ------        9        12    ----------------
           9----- Clinic ---------         6          2
                                                                                 .01       10----     Urban  ----        14                  0                    .001
                 Nonclinic   ------        7        14    ----------------                          Rural    -----       6                   9----------------

                                                                                                                                                                    77


                                        COLORADO STUDENT HEALTH PROJECT

       diction  of  a  general  liberal  trend.   However,   we    3. Careers
       now  learn  when  partialling  by   sites   "lat   ';.le     Included   in   both   the   pre-   and    post-summer
       effect  is  entirely  due  to  the  urban  students  who    questionnaires   was   the   open-ended   item,    "De-
       almost   unanimously    become    more    liberal    and    ,cribe   your   immediate   and   long   range    career
                                                                   s
       radical. In  fact  60  percent  of  the  rural  students    plans."  Since  the   program   was   almost   entirely
       remained   the   same   or    became    more    conserv-    made  up   of   returning   students,   the   immediate
       ative.
                                                                   plans   largely   concerned   finishing   school.   The
         Now  turning   our   attention   to   Scales   5   and    change  in  long-range  plans  is  indicated  in  table
       9   (measuring   respectively   favorableness   of   be-    VI.
       liefs  about  the   poor   and   accuracy   of   beliefs
       about  them)  further  light  is  shed  on  the  differ-                           Table VI
       ences.   Students   in   the   urban   setting   changed
       tonvard   significantly   more   accuracy    in    their                                           Before     After
       assessment     of     demographic     and     behavioral
       characteristics  of  the   poor   and,   at   the   same    Career type only mentioned   -------------  6         6
       time,  were  less  inclined  to  accept  liberal  plati-
       tudes  about  the   poor.   The   rural   students   be-    Undecided   -----------------------------   9         6
       came less objective and more favorable.                     Career including poverty work  -----------  14        17
         Different   types    of    experiences    must    have
       influenced  these  findings.  First,  the  great   feel-
       ing   of   frustration,   immediacy,    and    necessity     Before   and    after,    six    students    mentioneda
       in  Denver  with   the   constant   threat   of   riots,    specific   career   such   as   private   practice   asa
       incidents  of  police  brutality,  and  militants   pre-    pediatrician   or   radiologist,   without   mentioning
       dicting  chaos   impressed   the   students   with   the    a  desire  to  become  strongly  involved  with   prob-
       need  for  extensive  reform  at  the   earliest   time.    lems  of  the  poor.  However,  14  did  mention   such
       "Go  slow"  methods   were   not   working.   The   poor    plans  in  June  and  17  in  August.   This   is   not
       are   angry   and   vocal,   making   their   discomfort    significant statistically but we feel  it  is  a  trend
       extremely  visible.  On  the  other  hand,   the   rural    worth   considering   because,   if   anything,   there
       poor  are  still  generally  content  with  their   life    were   perceived   demand   characteristics   in    the
       styles  and  in  many  cases  are  not   aware   of   or    questionnaire  in  June   to   appear   committed   and
       concerned with existing poverty programs.                   dedicated that  were  not  as  -important  at  the  end
         Secondly,  as  we   will   explain   later   we   feel    of the  summer.  Thus,  if  our  findings  erred,  they
       that  the  urban  sites   were   generally   more   suc-    would  almost  certainly  have  done  so  in   a   con-
       cessful  than  the  rural   ones.   Thus,   again   from    servative direction. At  any  rate,  we  feel  that  an
       dissonance   theory,   there   would   be   a   tendency    increase  of   three   professional   medical   practi-
       on  the  part  of  some  rural  students  to   repudiate    tioners  committed  to  a  life  of  concern  for   the
       the  whole  philosophy  of  aiding  the  poor  with  the    underprivileged    is    a    noteworthy    accomplish-
       existing   approaches   rather   than   identify    with    ment in the program.
       what   they   perceived   as   an    unsuccessful    ex-
       perience.   Thus   a   conservative   attitudinal    re-  - 4. The Summer as a Learning Experience
       action would be understandable.
                                                                     In addition  to  all  of  the  above,  which  is  cen
         Finally,  it  should  be   mentioned   that   at   the    tral to  the  question  of  the  meaning  of  the  sum-
       beginning  of  the   summer   the   students   put.   tt    mer  to  the  students,  we  asked  them   to   comment
       relatively   higher   emphasis   on   the    educational    on  the  success  or  failure  of  the  summer   as   a
       experience   goal   of   the   summer    program    than    learning   experience.   We   coded   their   responses
       on   the.   concrete    accomplishments    that    would    on  a  continuum  from  0  to  9  with  0  representing
       come.   This   became   even   significantly    stronger    failure,  9  representing  total  success,  and  4  ind
       by  the  end  of  the  summer.  Perhaps  this  was   due    5  representing  moderate  success.   The   mean   rat-
       to  the  sobering  realization   of   poverty's   magni-    ing  -by  the  students  was  a   complimentary   6.94.
       tude and their own limitations.                             Again  the  urban  score  of  7.56  was  more  positive

       78.


                                                      SUMMER 1968

         than the rural 6.36. Thus, the  students  averaged      Secondly, they suggested that the  high  school
         a rating of  very  favorable  for  the  summer  as   interns be included in the  orientation  sessions.
         a learning experience.                               We  wholeheartedly  agree  with  this   and   will
            In addition to their  own  expressed  satisfac-   discuss it further with other aspects of the'  in-
         tion  about  previously  rp-entioned   significant   tern program.
         shift of the  group  as  a  whole  toward  a  more
         humanitarian   and   committed   approach   toward   6. The Intern Program
         the  problems  of  the  poor,  and  to  a  greater      Eighteen high school interns  from  the  place-
         emphasis  on  careers  associated   with   poverty   ment  areas  aided  the  students  throughout  the
         work,  their  increased  knowledge  of  the   cui-   summer on all but one of the sites.  We  have  in-
         ture of poverty is  an  extremely  important  fac-
         tor. All  of  the  students  are  nearing  an  end   formation on this phase of the  project  from  in-
                                                              terviews with local  citizens  familiar  with  the
         to professional educations that  in  a  few  years       ect, from the SHO students    .and  from   the
         will  place  them  in  a  powerful  upper   middle   proj
         class  where  the  impact  of  their   experiences   interns themselves.
         of  living  and  working   in   poor   communities      There were three general goals for  the  intern
         cannot help but be felt.                             program. First, it  was  hoped  that  the  interns
                                                              would be helpful  in  planning  and  carrying  out
         5. The OTientation                                   projects with the SHO  students.  Second,  it  was
                                                              hoped that  through  the  experience  the  interns
           The project  began  with  a  3  day  orientation   gained  from  the  summer  they   might   have   a
         for the students in a  hotel  in  a  deteriorating   basis for doing  further  poverty  work  in  their
         section of  downtown  Denver.  The  students  then   communities. Third,  through  close  contact  with
         moved to their placement  locations  for  2  to  3   well  educated,   academically   successful   role
         more days of on  site  orientation.  Questionnaire   models, it was hoped that  the  interns  would  be
         items  asking  for  evaluation  of  this  summer's   encouraged to expand their own career plans.
         orientation and suggestions  for  future  orienta-      We will briefly discuss- the project's  success
         tions were given out at the  end  of  the  summer.   in meeting these three objectives and  then  offer
         Again, favorability was coded from  0  to  9.  The   some suggestions for next summer's project.
         mean rating  was  5.21  or  slightly  more  favor-      Concerning the first goal, half of the  12  in-
         able  than  unfavorable.  Two   suggestions   were   terns who were able  to  come  to  the  final  de-
         offered by the majority of  the  students  and  we   briefing session felt  that  "the  best  use"  had
         are very much in  agreement  with  both  of  them.   been made of their skills in  the  project.  Those
         First, there should be  a  much  heavier  emphasis   who   were   disappointed    almost    unanimously
         on concrete problems  wl-.ich  are  likely  to  be   mentioned  that  they  had  never  understood  SHO
         faced  and  co.nerete  options  for  meeting   them. and its goals  and  thus  were  never  quite  able
         This  would  go  hand  in  hand  with  a  lessened   to figure out  what  they  were  supposed  to  do.
         emphasis on the theoretical  aspects  of  poverty.   Those  who  expressed  satisfaction  were   gener-
         The students enjoyed the  lectures  and  talks  of   ally in structured situations with  clear  respon-
         the resource people but    seemed  to   want   in-   sibilities.
         formation  about  how  they  might  proceed  given      About a third of the  SHO  students  felt  that
         their skills and limitations. The  rural  students   the  interns  had  been  quite  helpful,   another
         were even stronger in  feeling  this  way  because   third  felt  that  they  had  been  of  some  hel@
         of the greater relevance of most of  the  orienta-   particularly in instructing the  students  in  the
         tion  to  urban  problems.  We  would  go  farther   ways of the local areas and  in  serving  as  con-
         than  the  students  did  in  recommending   sepa-   tacts with community  people,  and  another  third
         rate orientation  sessions  for  urban  and  rural   felt that their interns had been of no help'
         people after a joint introduction to  the  mechan-      We feel that this goa o -;  ie  intern  program
         ics of the project. If such a separation were  not   was  not  successfully  realized.  We  would   not
         set up, greater specificity  would  be  irrelevant   want to set an arbitrary success  level  but  one-
         to one or the other of the two groups.               third  to  one-half  of  both  groups   expressing


                                       COLORADO STUDENT HEALTH PROJECT

        satisfaction  with  performance   is   clearly   not   have said before,  that  they  be  included  in  the
        enough.  The  interns  were  very   confused   about   orientation  session.  With  very  little  idea   of
        th e program and anxious  about  their  role  in  it.  what  the  program  was  all  about  generally   and
        Several of them felt  that  because  of  this,  much   what their role in  it  was  specifically,  we  feel
        of  their  time  was  wasted.  Several  others  felt   that the interns  performed  quite  well  this  sum-
        that  they  were  treated  as  inferiors  and  given   mer.
        busy work  of  no  real  importance.  On  the  other     Second, we feel  that  there  should  be  stronger
        hand, many  of  the  health  science  students  felt   selectivity in the recruiting of the interns. A  few
        burdened  by  the  interns.  Many  felt  that   they   of the interns  were  not  sophisticated  enough  to
        had  their  hands  full   being   productive   them-   fully benefit from and contribute  to  the  project.
        selves  and  were  unable  to  lead   another   per-   To achieve this, as well  as  for  reasons  we  will
        son  around.  We  will   discuss   suggestions   for   bring  up  below,  the  project  should  be   funded
        improving  this  situation  after   mentioning   the   for  planning   and   organizing   expenses   begin-
        other two goals.                                       ning  around  April  1.  There   must   be   expense
          The  second  goal,  of  providing  experience   in   money to allow  project  and  area  coordinators  to
        poverty  work  so  that  the  students  might   con-   spend  time  and  careful  consideration  in  lining
        tinue such efforts  in  the  future  was  most  def-   up   interns   with   high   potential:   Graduating
        initely fulfilled. The interns  were  in  the  midst   seniors with  intelligence  and  energy  but  little
        of  planning  Various  projects  and  took  part  in   direction.  These  individuals  are  often  informal
        their  execution.   They   are   -now   aware   that   peer  group  leaders  with  sensitivity  and   know-
        things can  be  done  to  alter  undesirable  situa-   ledge of  their  communities.  It  is  expensive  to
        tions and that they are ip- just  as  good  a  posi-   find  them  but  the  payoff  can  be  immeasurable.
        tion  as  anyone  else  to  bring   about   changes.     Third,  provision  should  be  made   for   weekly
        Whether or not they will use  their  skills  is  an-   pay checks to  the  interns  beginning  at  the  end
        other question  and  one  which  we  cannot  answer.   of the -first week.  This  sununer  they  were  paid
          The third  aim,  of  stimulating  the  careers  of   bimonthly  beginning  at  the  end  of  the   fourth
        the  interns,  was  extremely  well  fulfilled.  The   week.  This  is  strain  enough  for  the  SHO  Stu-
        interns were asked if their  plans  for  the  future   dents,  most  of  whom  had  outside  financial  re-
        had  changed  during  the  summer.  Seven   of   the   sources, but it is far  too  difficult  an  arrange-
        12  reported  change,  five  reported   no   change.   ment  for  low  income  high  school  students,  and
        Four of the  five  no  changes  had  planned  to  go   it resulted  in  considerable  difficulty  and  much
        to college  before  the  summer  and  still  planned   borrowing.
        to  do  so  after  the  summer.   One   intern   had     Finally, we   reconunend   that   the   proportion
        planned to get a  job  and  was  still  planning  on   of high school  interns  be  increased  to  one  for
        it.  Among   the   changers,   three   had   planned   each  SHO  student.  We  feel   that   the   project
        some technical  training,  but  now  wished  to  be-   should  consist  of  two  member  teams,  an  intern
        come  health  professionals.  Two  had  planned   to   and  student  each.  Several  reasons   lie   behind
        enroll in college  but  had  no  goal  in  mind  @nd   this proposal.  First,  we  think  that  this  would
        now  were  determined  and   confident   that   they   more  thoroughly   cut   through   the   status   ga
        would  finish.  Two  others  had  planned   to   get                                                      p
                                                               between  interns  and  students,  enabling  the  two
        jobs and now  planned  to  go  to  college.  At  the
        end  of  the  summer,,  SHO  was  able  to   arrange   groups  to  participate  on  a  more  equal   basis.
        full scholarships for three of the  interns  to  the   Second,  it  would  greatly  increase  the  exchange
        University  of  Colorado  who   would   not   other-   between  interns  and  students  allowing  each   to
        wise have been able to attend. We  feel  that  these   learn  from  the  other  to  a  far  greater  extent
        career changes  alone  are   important   enough   to   than was possible this summer. The inter         n's
        render the intern program very successful.             future would be affected  more,  and  the  student's
         We would  now  like  to  mention  our  'suggestions   empathy  with  and   understanding   of   those   in
        for  an   improved   intern   program   in-   future   poverty would be  accelerated.  Third,  the  interns
        projects. First, it  is  vitally  important,  as  we   would be more apt to be confident in the ambi
                                                                                                                 9-

        80


                                                       SUMMER 1968

        uity of an unstructured situation if  he  had  close      A  run  down  of  some  of   the   accomplishments
        intellectual  and  moral  support  from  a  student.    in  the  rural  placements  is  equally  impressive.
                                                                In  San  Luis,  students  staffed  the   Sangre   de
        B. Service to the Poor                                  Cri@  Medical  Unit,   provided   outpatient   serv-
           In this section we  want  to  look  at  what  was    ices  and  carried   on   an   educational   program
                                                                about the facilities available to  the  townspeople.
        accomplished  during  the  summer  as  far  as  con-
                                                                in  Grand  Junction,  students  helped  extend  cur-
        crete  action  is  concerned  and  then  locate  the
        weaknesses of  the  project  pointing  out  ways  of    rent  outpatient  mental   health   programs   while
        avoiding these difficulties in next year's  project.    drawing  up  proposals  for  new  ones,   and   con-
        The primary  sources  of  our  data  are  the  daily    tributed  to  educational  and   recreational   pro-
        logs, which most  of  the  students  completed  most    grams  for  children  and  teenagers  at  the  local
        of  the  time;  interviews  with  30  people  around    community  center.  In  Delta  they   conducted   an
                                                           I    extensive  survey  of  community  needs  to  provide
        the  State  who   were   knowledgeable   about   the    the documentation  for  an  energetic  school  board
        program;  the  evaluations  of  the   project   com-
                                                                to apply for the  funding  of  health,  recreational
        pleted by 31 of the 32 students  at  the  debriefing    and  educational   programs.   They   also   brought
        session;  the  evaluations  completed  by  the   in-    the attention of agencies  to  many  specific  cases
        terns;  and   extensive   conversations   with   the    where  health  care  was  badly  needed.  In   Pali-
        staff and students.in the project.                      sade,  three  health  science  students   opened   a
          Elsewhere  in  the  final  report  the  activities    teen center, helped   the   Public   Health   Nurse,
        .of the students  are  extensively  dealt  with,  so    published a  resource   information   booklet    for
        here we just  want  to  run  down  a  list  of  some    the migrant  laborers  and   worked   on   ways   of
        of the valuable services rendered  by  the  project.    making the   food   stamp   program   more    easily
          In Denver the  SHP  helped  staff  and  get  Proj-    available to the  migrants.   In   Fruita   students
        ect  Mainstream  off  the   ground.   The   students    helped  bring  low  income  families  into   contact
        encouraged  and  provided  technical  expertise  for    with  the  Neighborhood   Center   making   existing
        the   Welfare   Rights   Organization.   They   also    programs  much  more   effective.   At   one   point
        procured a  copy  of  the  unavailable  Welfare  De-    they took  a  bus  load  of  60  children  into  the
        partment   rules   manual   and   put   together   a    Grand  Junction  Clinic  to  get   their   immuniza-
        booklet of  legal  information  for  the  poor.  The
                                                           y    tions. They also  taught  health  education  classes
        helped  organize  community  pressure,   and   lobby    that were well attended.
        for safer and  cleaner  parks  and  pools  where  an    Just  from  this  sample  of   the   activities   of
        alarming  number  of  children  had   been   injured    the summer,  we  rate  the  Student  Health  Project
        by  broken  glass.  A  byproduct  of  this  was  two    as very successful. It  is  our  judgment  that  the
        new-   organizations   of   neighborhood    mothers.    students   were   dedicated,   creative,   and   ex-
        Students put a great deal  of  effort  into  helping    tremely sensitive  interpersonally,  and  that  this
        the'Fiesta on the west side.  They  did  some  ou,,-
                                                                paid off  for  the  people  served  and  in  the  re
        reach  work,  for   a   neighborhood   clinic   anci
                                                                wards  of  a  good  learning  experience.  But  this
        worked  for  more  personalized   health   care   at    does  not  mean  that  the  project  could  not   be
        that clinic. A great  deal  of  time  was  spent  in    improved   next   summer.   The    students    them-
        various  recreational  efforts-ma-ny  of  high  edu-    selves would  be  the  first  to  admit  this.  When
        cational value.  Two  bus  loads  of  children  were    asked to rate the success or  failure  of  the  sum-
        given their first ride in  a  jet  plane.  A  number    mer  as  to  helping  the  poor,  their  mean  coded
        of career,  sex,  and  healtb-  educational  classes    response was 5.61  again  using  a  scale  of  0  to
        were  held.  Shutins  were  taken  shopping  and  to    9  running  from  failure  to  success.  The   urban
        church  on  Sundays.  A  lot  of  work   went   into    mean  was  6.08  and  the  rural  means  was   5.13.
        the  planning  of  a  cooperative  supermarket  that    Thus, their own view of their  activities  could  be
        will not see final fruition for some tim'e.  A  free    described as only moderately successful.
        bus  was  set  up  to  take   low   income   mothers    With  the  knowledge   that   the   summer   was   a
        shopping.                                               good one, we  want  now  to  turn  to  the  problems

                                                                                                                  81


                                            COLORADO STUDENT HEALTH PROJECT
           that arose with an  eye  toward  a  still  better  ex-   people or  of  the  bureaucracy,  and  wait  for  the
           perience  next  year.  The  most  serious   difficulty   end  of  the  summer  keeping  busy  enough  not   to
           this  summer  arose  from  a  general  deficiency   in   be  conspicuous.  Fortunately  most  of  the   activ-
           planning.  We  feel  that  this  stemmed  from   three   ities turned out to be  quite  reasonable  and  coii-
           factors.  First,  and  most  obvious,  this  was  Col-   structive.
           orado's  first  Student  Health   Project   and   some     Finally, the loss in many  cases  of  the  first  2
           questions  had  not  been  confronted  before  by  the   to 3 weeks of the 9 weeks in the field  is  a  costly
           staff.  Second  and  of  great   importance   is   the   price  to  pay.  Whatever   the   final   course   of
           already  mentioned  fact  of  the  unavailability   of   action hit  upon  by  the  students,  it  could  have
           planning  funds  to  support   the   careful   ground-   been 50 percent  more  effective  if  the  period  of
           work  that  is  necessary  to  set   up   a   smoothly   uncertainty had been eliminated.
           operating  program.   Third,   we   feel   that   this     With   a   combination   of   measures   we   think
           summer's  project  put  too  much  emphasis   on   the   this could  all  be  avoided.  The  first  suggestion
           unstructured approach.                                   involves   a   structured,   preplanned    assignment
             There   were   several   undesirable    consequences   for the student for the first 3 to  4  weeks  in  the
           of  this  weakness   in   planning.   Preceptors   and   community.  It  might  begin  with  6  or   7   hours
           sponsoring   agencies   were   led   to   have   false   a day and taper down  to  3  or  4  at  the  end.  It
           expectations  as  to  what   the   summer   would   be   might  focus  on  outpatient  services  or  a   badly
           like  because  the  SHP  wasn't   exactly   sure.   In   needed  survey   or   anything   else   agreed   upon
           most  cases,   sponsors   expected   somewhat   closer   that  would  render  valuable  service  in  the  com-
           contact  than  the  students  were  willing  to  oper-   munity.  A  number  of  such   positions   could   be
           ate  under.  The   students   themselves,   who   were   agreed upon  ahead  of  time  by  the  preceptor  and
           fearful  of  being  drafted  into  meaningless   work,   area  coordinator.  When   the   SHO   students   and
           often  avoided  the  sponsor.  The  result  was   some   interns  arrived  in  June  they  could  settle  upon
           unnecessary  antagonism.   The   sponsors   felt   let   which of.the possibilities best suited their  skills'
           down  and  uninformed  of  the  students'   activities   and interests and the community's needs.
           and  somewhat   suspicious.   On   the   other   hand,    From  this   concrete   starting   point,   students
           students lost the  benefit  of  valuable  support  and   and  interns  could  get  to  know  each  other   and
           information about the community.                         the community.  They  could  also  slowly  be  think-
             Another  consequence  of   the   unstructured   sit-   ing  about  creating  projects  of  their   own   for
           uations  was   the   sheer   trauma   many   students'   the last two-thirds or  half  of  the  summer,  which
           experienced   when   they   found   themselves   alone   might or  might  not  be  connected  with  the  spon-
           in  a  poor  community  with  crushing  social   prob-   soring agency. This should be open.
           lems  and  no   idea   whatsoever   about   where   to    This,  or  any   other   approach,   would   require
           go  and  what  could  be  done.  They  then  began  to   about  $1,000  or   $1,500   in   planning   expenses
           busily  learn  about  the   community,   talkin   with   to  enable  each  area  coordinator  to  spend  about
                                                       9
           as  many  people  as  possible.  But   shortly,   per-   a week  in  April  or  May  at  each  site  carefully
           haps  after  2  weeks,  they   would   begin   feeling   setting  up  possible  options   for   the   students
           guilty  about  having  wasted  their  time  and   tax-   when they arrive in June. The s     ponsors      must
           payers'  money  with   no   accomplishments.   It   is   understand  the  desire  for  autonomy  and  creativ-
           also very difficult to  explain  what  you  are  doing   ity of most SHO  students  and  be  willing  to  lim-
           to  confused  and  suspicious  townspeople.  At   this   it their demands on  them.  For  the  first  3  or  4
           point  many  students  felt  compelled  to  jump  into   weeks with the preceptor    ' careful    plans    and
           any activity  to  justify  their  being  there.  Some-   procedures should be set up  so  that  serious  worl@
           times  this  resulted   in   unduly   ambitious   pro-   could  begin  immediately  on   the   students'   ar-
           grams  which  couldn't  succeed,  and   sometimes   it   rival.
           resulted   in   nearly   trivial   undertakings   with    We  feel  that  this  approach   would   have   some
           little  use.  Then  a  few  of  the   other   students   very worthwhile  results.  With  the  careful  spell-
           would   withdraw,   feeling    the    situation    was   ing out  of  roles  and  expectations,  the  friction
           hopeless  either  because  of  the  faults   of   poor   between  sponsors  and  students  would  be  cut  -to

           82


                                                       SUMMER 1968

         a  minimum.  With  a  productive,   structured   in-   the  timetable  of  the  migrants,  next   summer's
         itial period, the pressure would  be  off  the  stu-   SHP  should  not  include  a  Palisade   placement.
         dents  to  make  premature  decisions   About   what   There  is  an  acute  need  for  the  students  all
         to  do  with  the  summer.  None  of  the   students   summer long in  (;rand  Junction,  Denver,  and  in
         would   feel   coerced   into   doing    meaningless   many  other  communities  in   Colorado,   particu-
         things  with  the  agencies.  There  would  also  be   larly in the San Luis Valley.
         no   embarrassment   in   explaining    what    they     A final item we  wish  to  mention  is  that  the
         were  doing  with   community   people.   They   are   two law students were  as  successful  as  any  two
         "working   with   the   health   department's   edu-   other students  in  the  project.  They  were  very
         cation and information program," etc.                  useful  to  the  program  and  beautifully  supple-
           Planning  difficulties  were  the  summer's  ce-n-   mented  the  health  care  and  community   organi-
         tral problem and  were  most  acutely  felt  on  the   zation  work  of  the  other  students.  We   think
         western   slope,   but   the   students    performed   that five or six could be a still greater  benefit,
         well  in  spite  of  them.  We  now  want  to   turn   to next year's project.
         to  some  more  specille  'Problems.  First,   there
         were  many  occasions  in  which   resource   people   C. Conclusion
         within  the  SHP  were   needed   but   unavailable.     In conclusion,  we  have  found  that  the  first
         Important  planning  decisions   about   which   way   Colorado  Student  Health  Project  was  very  suc-
         to proceed are often difficult  to  make  for  rela--  cessful. The students learned a  great  deal  about
         tively  unexperienced  students  and  interns.  This   poverty and problems  in  the  delivery  of  health
         summer  there  were   only   two.area   coordinators   care to the poor. As  a  group,  they  also  became
         instead  of  the  proposed  three   and   this   was   significantly  more  humanitarian  in  their  atti-
         unfortunate. There  was  also  a  tendency  for  the   tude  toward  poverty.  The  interns  also  had   a
         two  area  coordinators  to  become  too  tied  down   valuable    experience,    becoming    much    more
         at  their  homesites  which  caused  some  hardships   aware  of  problems  in  their   own   communities.
         for other students. In  Denver  this  also  led  the   More than half of them  also  raised  their  career
         overworked   full-time   project   coordinator    to   aspirations  during  the   summer.   Most   import-
         take a good deal of  his  time  away  from  a  heavy   ant, the students provided a long list of  services
         administrative load  tG  be  of  assistance  in  the   summarized  above  to  low  income   areas   around
         solving  of   low-level   problems.   We   recommend   the State. On the basis of all  of  this,  we  feel
         that next year  there  be  four  area  coordinators,   that  the  project  should  be  funded  again  next
         one  each  for  east  and  west   Denver   and   one   year.
         each  for  the  San  Luis  Valley  and  the  Western    We  have  also  found   some   problems   in   the
         Slope,  and  that  they  be  encouraged  to   remain   summer's  project.  The   rural   students   as   a
         free and available.                                    group  did  not  become   more   humanitarian   and
           The  Palisade  placement  on  the  western   slope   tolerant of the  poor.  The  interns  were  not  as
         was also  a  problem  this  summer.  There  is  very   valuable as  had  been  hoped  in  contributing  to
         little poverty in  the  community  during  the  year   the project's activities.  The  orientation  period
         except for the  fruit  harvesting  season  with  its   was somewhat  too  theoretical.  Also,  the  struc-
         large  influx  of  migrant'laborers.  This   usually   ture of the project  was  loose  in  general,  par-
         takes  place  about  the  first  week   of   August.   ticularly in  the  Grand  Junction  area,  and  the
         At this time there  is  a  great  need  for  medical   area. coordinators were often inaccessible.
         services  of  various  kinds  which  the  SHP  could    In  order  to  benefit  from  the   knowledge   of
         provide,  but  not  before.  This  year  the   three   these  difficulties  we  have  made  the  following
         Palisade  students  spent  the  -first  6  weeks  of   recommendations for next year:
         the  summer   there   working   energetically   with       (1) The  orientation  should  place  a  heavier
         the Public  Health  Nurse  in  neighboring  low  in-              emphasis  on  the  practical:   specific
         come  communities,  in  setting  up  a  teen  center              suggestions  about  possible  modes   of
         and  in  making  preparations  for   the   migrants.              action    when    confronting     common
         We feel that given the  structure  of  the  SHP  and              problems.

                                                                                                                 83


                                        COLORADO STUDENT HEALTH PROJECT
              (2) Except for  the  first  day,  there  should        (6)  The  grant  should  include  about  $1,500
                     be separate  urban  and  rural  sessions                to  pay  planning  expenses   for   the
                     during the orientation.                                 area coordinators in the spring:
              (3) The  interns  should  be  included  in  all        (7)  There  should  be   structured   positions
                     aspects of the orientation.                             for  the  students  for   approximately
              (4)  The  number  of  interns  should  be   in-                the first 3 weeks  with  the  remainder
                     creased to  equal  the  number  of  stu-                of the summer unstructured.
                     dents.                                          (8)  There  should  be  four   area   coordina-
              (5)  Interns  and  students  should  be  paired                tors.
                     into  working  teams  engaged   in   all        (9)  There  should  be  an   increased   number
                     activities together.                                    of law students in the project.

           84


   PV

        A
               k

                                     Appendix

                  .1 '

                                            i
                                            i

                                            I
                                            i
                                            I


                                               COLORADO STUDENT HEALTH PROJECT
                                                            PARTICIPANTS

                                                                                                           High School Interns
                Health Science StUdelits       High school Interns          Health Science Studeitts
                                 Grand Tunction                             Daniel Kraus
                                                                            University of Rochester
                Nancy Adams                Glenda Romero                    Med II
                University of   Colorado
                Social Service                                              Gail Wilcox, R.N.
                Jeffrey Reichenthal                                                        Denver-East Side
                Downstate Medical Center                                    Larry Corinan              Marie Arrington
                Med II                                                      University of Maryland
                                      Fruita                                Med II                     Bert Brussard
                Eva Adler                  Virginia Martinez                Steven Feig                Norman Harris
                University of Colorado                                      University of Maryland     Vincent Robinson
                Nursing IV                 vickey Martinez                  Med II
                Jeffrey Kluger             Candy Medina                     Jack Lissauer              Clara White
                Medical College of                                          University of Maryland
                New York                                                    Med II
                Med 11                                                      Joseph Sprague
                Judy Lindauer                                               University of Colorado
                University of Colorado                                      Law III
                Nursing IV                                                  Linda  Sprague
                                      Palisade                              James  Swallow
                Mary Jaeggli                                                University of Colorado
                University of  Colorado                                     Med II
                Nursing IV                                                  Marion  von   Buettner
                Kenneth    McConnochie                                      University of Colorado
                Darfanouth Medical College                                  Med II
                Med II                                                      William   Walker
                                                                            University of Colorado
                Nancy Roland                                                Med II
                University  of  Denver
                Graduate Student, Social                                                     Denver-West Si4de
                 Work
                                        Delta                               Joseph Bergquist             Gary Baca
                                                                            University of Colorado
                Norman Chenven              Adrian Pebahsy                  Med III                      Wayne Barella
                Downstate Medical Center                                                                        et lavato
                                                                            Steven    Berman             Margar
                Med III                      Mario Ramos                    Temple University
                                                                            Med II                       Jake Pino
                Dinah Chenven
                                                                            Marylou    Buyse             Lawrence Sena
                Jane Patterson                                              Women's Medical College
                University of Colorado
                                                                            Med III
                Graduate Student,
                  Education                                                 Keith Henriquez
                                         San                                University  of  Denver
                                                                            Graduate Student, Social
                Suzanne Campbell, R.N.       Jo Anne Apodaca                  Work
                Robert Frampton              John L4aCombe                  Charles   Holt
                                                                            University of Colorado
                University of Oldahoma
                Med II                        Rocky Madrid                  Med III

                ,86


                                                              SUMMER 1968

         Health Science Students            High School Interns             Health Science Students           High School Interns
      Marcia Looney                                                      James Pachl
      Francis Payne Bolton                                               University of California
      School of Nursing                                                  Law III
      Nursing III
      Ida Jean Newton                                                    Jerry Yucht
      Women's Medical College                                            Wayne State University
      Med III                                                            Med 11

                                                                                                                                     87


                                              COLORADO STUDENT HEALTH PROJECT

                                                            PRECEPTORS

           Grand Junction:                                              San   Luis:
                Robert Ross, M.D.                                            Sangre de Cristo Medical Unit
                     Medical   Preceptor                                     Mr. Charles Jackline, director
                Grand Junction Neighborhood Center                                Preceptors:,  Dale  Thomas,  M.D.,  Lawrence
                     Preceptor: Mr. Augie Reyes                                    Andreini, M.D., Bo@e Camp, M.D.
                Mesa County Mental Health Association
                     Preceptor: Mrs. Mary Humphries                     De?tver-East Side:
                Mesa County Public Health Department                         Curtis Park Community Center
                     Preceptor: John V. Sessums, M.D.                        929 29th St.
                                                                                  Preceptor: Reverend George Turner
           Fraita:
                                                                             East Side Cormnunity Action Center
                Robert Orr, M.D.
                     Medical   Preceptor                                     2800 Glenarrn Place
                Fruita Neighborhood Center                                        Preceptor: Mrs. Sarah Collier
                     Preceptors:  Mrs.  Del  Martinez,  Mr.  John            East Side Neighborhood Health Center
                      Montgomery                                             529 29th St.
                Fruita Teen Center                                                Preceptor: Burris Duncan,
                     Preceptor: Mr. Jack Chaney
           Palisade:                                                    Denver-West Side:
                                                                             Inner City Parish
                Chester Bliss, M.D.
                     Medical   Preceptor                                     912 Galap@go
                Mesa   County    Migrant Council                                  Preceptor: Reverend Harland Beech
                     Preceptor: Mrs. Harry Talbot                            Mariposa Health Station
           Delta:                                                            1178 Mariposa St.
                R. J. Bennett, M.D.                                               Preceptor: Andre Chabot, M.D.
                     Medical   Preceptor                                     West Side Connnunity Action Center
                Delta County Public Schools                                  1042 Santa Fe Drive
                     Preceptor: Mr. Harry Anderson                                Preceptor: Mr. Leo Rodriguez

             88


                                                                     SUMMER 1968

                                                       CONFERENCE SCHEDULES

                                                       Colorado Student Health Project Orientation
                                                          1612 17th Street, Denver, Colorado

                            Sunday, June 23, 1968
                                  Arrival of Health  Science  Students
                                  8     p.m.-"Mixer"
                            Monday, June 24, 1968
                                  7:00-   8:00     Breakfast
                                  8:00-10:00       Registration
                                  10:00-42:00      General  objectives
                                                       Michael   Reiff    Randall Lortscher
                                                       Lisa Wilson        Skip Bry
                                                   "Health and the Community"
                                                       Dr. C. Henry Kempe,  Chairman,  Department  of  Pedi  trie-s,  Univer-
                                                         sity  of  Colorado  Medical  School;   Sponsor,   Colorado   Student
                                                         Health Project
                                  12:00-  1:00     Lunch
                                  1:00- 3:00       "The  War  on   Poverty"
                                                       Professor Howard  Higman,  Director,  Action  Research  in  Socializa-
                                                         tion Processes, Boulder, Colo.; Professor, Department of  Sociology,
                                                         University of Colorado
                                  3:30- 6:00       Free
                                  6:00- 7:00       Dinner
                                  7:30- 8:30       Movie: "Harvest of Shame"
                                  8:45-            Small groups: "Why are we here"?
                            Tuesday, June 25, 1968
                                  7:30-   8:00     Brealdast
                                  8:15-   1:00     Community    panels
                                                       Mr. Paul Reese
                                                   Assistant Director, VISTA
                                                   Welfare  Rights  Mothers
                                                       Mrs.   Anna   Deleon   Mrs. Sonja Betts
                                                   The Ghetto Scene
                                                       High school dropouts
                                  1:00-   1:45     Lunch
                                  1:45- 2:45       "Some Aspects of Cultural Shock"
                                                       Dr. Sidney Margolin,  Professor,  Department  of  Psychiatry,  Univer-
                                                         sity of Colorado Medical School
                                  3:00@ 4:00       "Black Power"
                                                       Mr. Frank Bailey and panel
                                  4:30- 6:00       "Civil Rights and the Community"
                                                       Mr. Warren Alexander, Civil Rights Commission
                                  6:40- 7:00       Dinner
                                  8:00- 9:00       "The Law and the Community"
                                                       Mr. Edward  Sherman,  Public  Defender,  City  and  County  of  Denver
                                  9:30-            Small groups: "Where are We Going"?
                            Wednesday,  June  26,   1968
                                  7:30-   8:00     Brealdast
                                  8:15-12:00       "The Urban Community"
                                                       Dr. James Kent, Mr. John Hernandiz, Mr. Nate Av os
                                  1:15-   4:00     "The Rural Community"
                                                       Mr.  James  Chavez,  East  Side  Neighborhood   Health   Center;   Mr.
                                                         Tomas Atencio, Colorado Migrant Council
                                  4-00-   4:30     "Malnutrition and Community Life Styles"
                                                       Dr. Peter Chase, Department  of  Pediatrics,  University  of  Colorado
                                                         Medical Center
                                  7:00-            Sit down dinner

                                                                                                                                        89


                                                   COLORADO STUDENT HEALTH PROJECT

                                                            Midproject Conference
                                                                   Dr. Ke@pe's Cabin
                            Friday, July  19,  1968
                                  1:00            Arrival of students
                                  3:00-  5:00     Group session-reports from individual projects
                                                  Supper
                                  8:00            Group session-reports continued
                            Saturday, July 20, 1968
                                                  Breakfast
                                  9:00-12:00      Area meetings-individual problem solving
                                  12:00- 1:00     Lunch
                                  1:00-  4:00     Health science student meeting
                                                  High school intern meeting
                                  4:00-  5:00     "Planning Methods for Change"
                                                      Mr. Robert Hunter
                                                  Action Research in Socialization Progresses
                           Su-nday, July  21,  1968
                                                  Breakfast
                                  9:00-12:00      Keynote: "The American Health Care Crisis"
                                                     Dr. Quentin Young, Past Chairman, MCHR

                                                              Final Evaluation Session
                                                       University of Colorado Medical Center
                           August  28  @,,@08
                                  9:00-  9:30     Introductory remarks
                                                     Dr. Conger, Dr. Kempe, Prof. Higman
                                  9:30-1f):')n    Selected health science students' reports of summer experience
                                  10:30-1         Coffee
                                  lo-45-l' )O     Selected high school intern reports
                                  12:15- 1:15     Catered lunch
                                  1:30-  3:30     Peter Bonavith: "New Perspectives"
                                  4-00-  5:00     W.itten group evaluation
                          Aug@c   29,    1968
                                  9:00-12:00      Individual projects-successes and failures; prospective recommendations
                                  12:15- 1:15     Lunch in hospital cafeteria
                                  1:30-  3:30     Open forum
                                  3:30-           Mnal remarks: Project staff

         90


                                                                           SUMMER 1968

                                                 Demographic Data-Orientation Sessions
                                    1.   Birthday:
                                    2. Father's  occupation:
                                    3.  Check approximate income range of your parents:
                                          $0    to    $4,999
                                          $5,000  to  $9,999
                                          $10,000 to $14,000
                                          $15,000 to $19,999
                                          $20,000 to $24,999
                                          $25,000  and  over
                                    4.  Which of the following best describes where you lived at age 15?
                                          Rural farm community
                                          Rural nonfarm community
                                          Small town (2,500 to 20-,000)
                                          Middle-size town (25,000 to 100,000)
                                          City (100,000 to 500,000)
                                          Large city (over 500,000)
                                    5. Sex:
                                    6. Your     race:
                                    7. Your religion:
                                    8. Political party preference:
                                    9. Were both your parents born in the United States? (Yes) (No)
                             10.    Have you worked with. any other action program such as the Student Health Project
                                     (SHP)? (Yes) (No) If yes, list all the programs you have worked with.
                             11.    The one thing you are looking forward to most in SHP is:
                             12.    What, if anything is the one thing you are   most  apprehensive about in SHP?
                             13.    How important were the following items in making your decision to work in SHP? (Circle
                                    one   for   each   item)
                                       a.   Working in Colorado:
                                                 None
                                                 Very little
                                                 Moderate
                                                 Considerable
                                                 Very   high
                                      b.   Working with the poor:
                                                 None
                                                 Very little
                                                 Moderate
                                                 Considerable
                                                 Very   high
                                     c.   Helping in a health program:
                                                 None
                                                 Very little
                                                 Moderate
                                                 Considerable
                                                 Very   high
                                    d.     Salary:
                                                 None
                                                 Very little
                                                 Moderate
                                                 Considerable
                                                 Very   high
                                    e.   Friends   applying:
                                                 None
                                                 Very little
                                                 Moderate
                                                 Considerable
                                                 Very   high

                                                                                                                                           91


                                               COLORADO STUDENT HEALTH PROJECT
                                   f.    Opportunity to work with other health professionals:
                                             None
                                             Very little
                                             Moderate
                                             Considerable
                                             Very high
                                   g.  Acquire better understanding of welfare problems:
                                             None
                                             Very little
                                             Moderate
                                             Considerable
                                             Very high
                                   h.  Participation in a social experience:
                                             None
                                             Very little
                                             Moderate
                                             Considerable
                                             Very high
                                   i. Making a contribution to community improvement:
                                             None
                                             Very little
                                             Moderate
                                             Considerable
                                             Very high
                                   j.   Other (specify):
                         14.  What do you expect this summer to have in store for you? For each of.the items below
                               indicate your expectations.
                                   a.  How many hours a day do you expect to work on your project?
                                   h. How do you think your living conditions will be? (Primitive, Adequate, Ample)
                                   c. How much risk of physical danger do you expect to encounter? (Great, Moder-
                                         ate, Slight, None) If you answered "great" or "moderate," from what source
                                         do you expect this danger?
                                   d. How do you expect your working conditions to be? (Poor, Fair, Good, Excellent)
                                   e. How much do you feel you will accomplish in terms of (check one for each):
                                         (1) Learning about problems of the poor       Very little   Some     A
                                             great deal
                                         (2) Your professional education    Very little   Some     A great deal
                                         (3) Personal fulfillment   Very little   Some     A great deal
                                   f. How much social. involvement do you expect to have with the persons you work
                                       with? (Circle one for each)
                                         (1) Patients    None     Very little   Moderate     Considerable
                                             High
                                         (2) Coworkers     None     Very little   Moderate     Considerable
                                             High
                                         (3) Project staff   None     Very little   Moderate     Considerable
                                             High
                                         (4) High school interns     None     Very little    Moderate     Con-
                                             siderable   High
                                         (5) Preceptors    None     Very little   Moderate     Considerable
                                             High
                                         (6) Neighbors    None     Very little   Moderate     Considerable
                                             High
                                         (7) Community participants    None      Very little  Moderate
                                             Considerable   High
                      15.  Why did you choose to work with the SHP this summer?
                      16. What are your short and long range career plans?

        92


                                                                 SUMMEP.           1968

                    Student Attitude Scales-Orientation: Final Evaluation Sessions

                                                                       Scale
                        1. It is very important  to  achieve  some  goals  in  my  sum-         A       a        d        D
                               mer work that will have  an  effect  on  the  community.
                       2. Unless we do all we can to  help  the  people  in  the  corn-         A       a        d        D
                               munity this summer, it is  not  likely  that  much  will
                               get done.
                        3. The  chances  of  doing  much  more  than  getting  an  edu-         A       a        d        D
                               cation for myself this summer are very limited.
                       4. While it is desirable  that  we  help  provide  health  serv-         A       a        d        D
                               ice to the poor, our own personal learning comes  first.
                       5. The major purpose  of  the  work  this  summer  is  to  learn         A       a        d        D
                               about the problems of  delivering  health  care  to  the
                               poor.
                       6. Our main objective this summer  is  to  get  the  best  edu',         A       a        d        D
                               cation we can about the health  problems  of  the  poor.
                       7.  Even  if  no  improvements  in  health  care  for  the  poor         A       a        d        D
                               result from  our  summer  work,  the  summer  can  still
                               be considered successful if we learn  about  the  health
                               problems of the poor.
                      8. We have to try to  do  all  we  can  to  help  the  people  in         A       a        d        D
                               the  community  this  summer  and   forget   about   any
                               personal benefits.
                      9.  Unless  there  are  concrete  accomplishments  in  the   com-         A.      a        d        D
                               munity as a  result  of  my  efforts,  the  summer  work
                               cannot be considered successful.

                                                                  Scale    H
                      1. A patient's religious beliefs  should  take  priority  in  de-         A       a        d        D
                               termining the nature.of  medical  procedures.
                      2.  Compassion  is  a  luxury  which  the  busy  physician   can-         A       a        d        D
                               not afford.
                     3.  Patients  are  appreciative  of   sympathetic   treatment   on         A       a        d        D
                               the part of the physician.
                     4. The  parents  of  an  unwed  pregnant  girl  should  always  be         A       a        d        D
                               told.
                                                       1)  Asterisks indi ate0G'm,,4ve,, highest score
                                                       2)   SA                 agr
                                                            A                y
                                                                       Str
                                                                          Ong
                                                                       Aqr-
                                                            a - SLA    SI ght
                                                            d - SLD            I    gr_
                                                                            IYL
                                                            D          S ghtly
                                                                       D   gr-
                                                            SD         Str..gly di..gr.

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                                                   COLORADO      STUDENT HEALTH PROJEI CT
                               5.  The wife of a patient who has just contracted syphilis      A       a       d       D
                                    and refuses treatment, should be informed.
                              6.  All patient-, that have a fatal disease should be told.     A        a      d       D
                              7.  Patients from lower income groups are unable to un-         A       a       d       D
                                    derstand the nature of their illness.
                              8.  It is important for physicians working with poor pa-        A       a       d       D
                                   tie@ to get to know them well so as to best serve
                                   them.
                             9.  The patient has a right to demand a specific treatment.     A       a       d       D
                            10.  A physician cannot just concern himself with things         A       a       d       D
                                   medical, but must consider all aspects of the com-
                                  munity life.
                           11.  A physician must make every effort to preserve the life     A        a      d       D
                                  of a grossly abnormal baby at birth.
                           12.  Itisimportantfortheattendingphysiciantodetermine            A       a       d       D
                                  if a hospital patient has received visitors.
                           13.  The unconscious patient is entitled to, and should re-      A       a       d       D
                                 ceive, the same consideration as the conscious
                                 patient.
                          14.  In dealing with patients, it is enough for the physician    A       a       d       D
                                 to advise treatment without explanations.

                                                                   Scale
                           1.  Clinics sponsored by local health agencies are mainly      A        a       d      D
                                intended to keep down the pressure for socialized
                                medicine.
                          2. Public health clinics can provide good preventive            A       a       d       D
                                health care.
                          3.  Becauseofthewayinwhichpubliecliniesareorganized             A       a       d       D
                                and-administered, it is just not possible for them to
                               provide a high level of medical care.
                         4. Public health clinics can do very little for the people      A       a       d       D
                               ihey are supposed to serve.
                         5.  Medical personnel who work in clinics cannot provide        A       a       d       D
                               highly individualized service to patients.
                         6.  Physicians who work in public health clinics can get to    A        a      d       D
                              know patients fairly well and provide them with good
                              medical care.
                        7. Public health clinics are not in a position to provide       A       a       d       D
                              high quality medical service to the poor.
                        S. it is possible to provide first rate medical care in a      A        a      d       D
                             public clinic setting.
        94


                                                                SUMMER 1968
                           9.  Physicians who work in public health'clinies really care    A       a       d       D
                                about poor people and their health needs.
                         10.  Health clinics for the poor can achieve only a very         A        a      d        D
                                limited degree of excellence.
                         II.  Medical personnel who work in public clinics just can-      A       a       d       D
                                not give the time that is necessary to adequately
                                handle each patient.

                                                                  Scale IV
                         1.  Those who accept charity lack dignity.                      A        a       d       D
                         2.  An unwed pregnant woman is to be respected.                 A       a       d       D
                         3.  Any unmarried mothers who have morp than two ille-          A       a       d       D
                               gitimate children and are on public welfare, should
                              be sterilized.
                        4.  An individual cannot be judged from the amount of           A        a       d       D
                              money he earns.
                        5.  Forceful sterilization of the mentally retarded is an act   A       a       d       D
                              in violation of the dignity of the individual.
                        6.  The experimental use of potentially dangerous drugs         A       a       d       D
                             in habitual criminals, against their will, is justifiable.
                       7.  Despite all the problems involved, good health care can     A        a       d       D
                             be provided to the poor.

                                                                Scale V
                       1.  The Mexican concept of manhood is based on the size         A       a       d       D
                            of a man's family rather than the quality of his
                            family.
                      2.  Mem'can-Americans want to take care of themselves;           A       a       d       D
                            they do not want help from others.
                      3.  In the Mexican-American community, the people who           A       a       d       D
                            achieve respect are the gang leaders and big drinkers.
                     4.  One of the striking things about poverty people is the       A       a       d       D
                           need they have for individual contact and the con-
                           cern of others.
                     5.  Poor people are content; they, are generally satisfied      A        a       d       D
                           with their lot in life.
                     6.  Poor people are generally receptive to efforts at being     A       a       d       D
                          friendly and helpful.
                     7.  The majority of poor people are concerned and inter-        A       a       d       D
                          ested in improving themselves.
                    8.  It is difncult to escape the conclusion that most poor       A       a       d       D
                          people are apathetic about their situation.

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                                                   COLORADO STUDENT HEALTH PROJECT
                              9.  Poorpeopleoftentakeadvantageofthegovemrnent.                 A       a        d       D
                             10.  Mexican-Americans live for today and can see no pur-         A       a        d      D
                                    pose in worrying about tomorrow.

                                                                       Scale VI
                              I.  Many physicians stand to lose a fair amount of their        A        a        d      D
                                   practices if public health clinics are put into opera.
                                   tion.
                             2.  Many physicians work very hard because they are              A       a         d     D
                                   compulsive people, not because they are altruistic
                                   (or have a desire to serve).
                             3.  Many physicians are quite cold, aloof, and conde-           A        a         d     D
                                   sr-ending in their relationships with patients.
                            4.  Many physicians are in practice just for the money.          A       a          d     D
                            5.  A physician should determine his fee in part by pa-          A       a          d    D
                                  tients' ability to pay.
                            6.  Physicians are generally not responsive to the health        A       a          d    D
                                  needs of poor people.
                            7.  Many physicians feel that the health needs of the poor      A        a          d    D
                                 are being met by existing agencies and services.
                           8.  A large number of physicians feel that the reason many       A       a           d   D
                                 people are poor is because they are lazy.
                           9.  Physicians cannot afford to do charity work outside of       A       a           d   D
                                 the traditional organized "donations of time."

                                                                    Scale V/1
                          1.  The public education received by most of the poor is    SA  A  SLA  SLD  D  SD
                                generally equivalent to that received by most of the
                                middle class.
                          2.  Police brutality was a major reason for the riots in our SA  A  SLA  SLD  D  SD,
                                cities last summer.
                         3.  With our Nation's great wealth, no form of poverty      SA  A  SLA  SLD  D  SD
                               should be tolerated.
                         4.  Minority groups are trying to move too fast in seekink  SA  A  SLA  SLD  D  SD
                               reforms.
                         5.  The poor feel degraded by our welfare system.           SA  A  SLA  SLD  D  SD
                         6.  Conditions are so bad in our cities' ghettos that no   S@    A     SLA     SLD     DSD.
                               Negro could be blamed for rioting.
                        7. Anyone can pull himself out of poverty in the United     SA    A     SLA     SLD     DSD
                              States who has the will to do so.
                        8.  Welfare should not be paid to women who continue to     SA    A     SLA     SLD     DSD
                              have illegitimate children.

        96


                                                        SUMMER 1968
                        9, The unemployed should not be blamed for turning  SA  A  SLA  SLD  D  SD
                             down low paying menial jobs.
                      10. Poverty in America is the fault of society and not in-  SA  A  SLA  SLD  D  SD
                            dividual lack of motivation.
                      11- ThePOvertYinAmericaisOneofmorediseomfortthan  SA  A  SLA  SLD  D  SD
                            of real deprivation as other countries know it.
                      12. Few receive welfare who do not need it.          SA  A  SLA  SLD  D  SD

                                                          Scale VIII
                      1. Medical care is a right not a Privilege.          SA  A  SLk  SLD  D  SD
                      2. A sizeable increase in the number of practicing phy- SA  A  SLA  SLD  D   SD
                           sicians would seriously threaten the economic well-
                           being of the medical community.
                     3.  Good medical care is generally not available to the poor SA  A  SLA  SLD  DSD
                          in our country.
                     4.  For all of @ problems this country's system of health SA  A  SLA  SLD  D SD
                          care is the best in the world.
                     5. Need alone should be the criterion for the provision of SA  A  SLA  SLD  DSD
                          medical care.
                     6. The physicians who treat the poor are generally of aSA  A  SLA  SLD  D   SD
                          lower quality than average.
                    7. Many of the poor are constantly in danger of losing SA  A  SLA  SLD  D    SD
                         their jobs because they cannot afford adequate medi-
                         e-al care.
                    8. Considering the incomes of other segments of society, SA  A  SLA  SLD  D  SD
                         physicians earn more than enough already.
                   9. Far more physicians are needed in order. to satisfy na- SA  A  SLA  SLD  DSD
                         tional health needs.
                  10. If community medical services are to be expanded, the SA  A  SLA  SLD  D  SD
                        government should play the major role in backing
                        this expansion.

                                                       Scale IX
                   1. Many of the poor have a stable, simple life with more SA  A  SLA  SLD  D  SD
                        happiness than they would know with a well-paying
                       job and a middle class life.
                  2. Knowledge of family planning is generally absent  SA  A  SLA  SLD     D  SD
                       among the poor.
                  3.  Drinking is more of a cause than a symptom of many SA  A  SLA  SLD   D  SD
                       of the problems of the poor.
                 4. In general, the poor would prefer a modest immediate SA  A  SLA  SLD   D  SD
                      gratification to a larger, long-term success.

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                                          COLORADO STUDENT HEALTH PROJECT

                                                                            SA  A  SLA  SLD  D  SD
                       5. Superstitions about matters of health by the poor still
                            form a significant barrier to adequate health.
                       6. In many lower class families the wife has a greater earn-  SA  A  SLA  SLD  D  SD
                            ing ability than does the husband.
                       7. In most cases the poor are concerned with curing pres-  SA  A  SLA  SLD  DSD
                            ent health problems but have little concern about
                            prevention.
                      8. The poor generally accept death more easily than do  SA  A  SLA  SLD  D   SD
                           members of the middle class.
                      -9. Minority poor have significantly more children than do  SA  A  SLA  @'3LD  DSD
                           poor Anglos.
                    10. Defeats and frustrations cause fatalism on the part of  SA  A  SLA  SLD  D SD
                           the poor more often than they result from it.

                                                         Scale X
                     1. In pursuing social change breaking the law is never  SA  A  SLA  SLD  D  SD
                          justified.
                    2. Local governments and business communities would  SA  A  SLA  SLD  D  SD
                         generally like to help work toward social improve-
                         ment.
                    3. As a first step toward halting lawlessness in America, SA  A  SLA  SLD  D  SD
                         agitators like Stokely Carmichael should be locked
                         up.
                   4. Notbing can be gotten from "white America" without SA  A  SLA  SLD  D  SD
                         violence to force the issue.
                   5. Most agencies that are designed to help the poor ham- SA  A  SLA  SLD  D  SD
                        per them as much as they help them.
                   6. Most liberals talk humanitarianism but are not willing SA  A  SLA  SLD  D  SD
                        to make the sacrifices.
                  7. Cooperation and process of subtle manipulation of in- SA  A  SLA  SLD  D  SD
                        fluential citizens is generally more effective than
                        confrontation.
                  8.  In the past decade, a good deal of progress has been SA  A  SLA  SLD  D  SD
                       made in improving the lot of the bottom one-fifth of
                       our society.
                  9. Most Americans would be content to tolerate the most ;A  A  SLA  SLD  D  SD
                       severe injustices in their society unless prodded into
                       action.
                10. The system has a way of corrupting idealists who think SA  A  SLA  SLD  D  SD
                      they can work within it.
                11. By soliciffying the conservative opposition to social SA  A  SLA  SLD  D  SD
                      change most demonstrations and protests probably
                      do more harm than good.
   98


                                                       SUMMER 1968
                     12. Demonstrations and protests are often a convenient  SA  A  SLA  SLD  D  SD
                           way of avoiding the responsibility of going out and
                           helping those in need.
                     13. Rich and impoverished segments of our society are now  SA  A  SLA  SLD  D  SD
                           farther apart economically than they have ever been.

                                                                                                          99


                             COLORADO STUDENT HEALTH PROJ.UCT
                 Individual Evaluations Collected Throughout the Summer
                                    COLORADO SHP DAILY LOG
                 Name                                    Date
                 Briefly fill out and turn in a log each day to Your area coordinator.
                 (1) What important feedback did You receive from the Poor community or Power structure
                   today?
                 (2) What was the most significant experience of the day?
                 (3) What was the most rewarding experience of the day?
                 (4) What was the most frustrating experience of the day?
                 (6) Other: Include any experience, idea, problem, et cetera.

                                       COLORADO SHP
                                 Community Medicine Questionnaire
                 (1) Name
                 (2) Descri e the present system of health care for the poor in your area.
                 (3) What are the most pressing needs in the way of getting better health care for the poor in
                  your area?
                 (4) What bureaucratic difficulties hinder the usefulness of present facilities to the poor in
                  your area?
                 (5) What concrete proposals do you have for Programs that might bring'better health care
                  to the poor in your area?
                 (6) In what ways do the values or culture of the poor in your area present problems for ade-
                  quate medical care?


                                                                      SUMMER 1968
                                       Student Questionnaire-Final Evaluation Session
                                                              HEALTH SCIENCE STUDENTS
                                       (1) In what ways was your suznmer a success or failure as a learning experience?
                                       (2)  In what ways was your summer a success or failure as far as services to the poor were
                                       concerned?
                                       (3) Whatsuggestions could you make that might be implemented next summer in order to
                                       make the SHP more effective?
                                       (4) a. In what Ways was the summer successful or unsuccessful as a learning experience for
                                         the high school interns in your  area?
                                       b. In what ways were they successful or unsuccessful in contributing to the program in
                                        your area?
                                       c. How could the intern program  be  set  u'p more advantageously next summer?
                                       (5) a. How valuable was your orientation at the Oxford Hotel?
                                       b. How could it be improved?
                                       (6) a. What agencies did you work with in the field?
                                       b. What were the specific successful and unsuccessful experiences you had with each
                                        agency  and why?
                                       c. What other agencies were available, but not utilized, and why?
                                       d. What agencies might be utilized advantageously n"t summer and why?
                                       (7) What are your short and long range career plans?

                                                              HIGH SCHOOL INTERNS
                                       (1) Home town
                                       (2) a. Did you ave any career plans before the start of this program? If so, what were they?
                                       b. Has this program in any way changed your career plans? If so, in what way?
                                       (3) a. What kind of work did you do this summer?
                                       b. Do you feel that the program made the best use of your skills this summer? Why?
                                       c. How could the sldlls of the interns be employed better next summer?
                                       (4) a. What were the failures of the SHO program this summer?.
                                       b. What were its succesm?
                                       C. How could it be improved for next summer?
                         *U.S. GOVERNMENT PRINTING OFFICE' 1970 0-3@=

                                                                                                                                101
                                                                                 e, U.S. C;OVERNMNT PRTNTING OFIIICE 1970 0355-230


                I
                I

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