ae wl ni o o MH - Chicago MH - Community Health Services/*/Chicago MH - Students, Health Occupations/*// KW - 20C PN - Ballance, Lee///// CN - Chicago Student Health Project//// CN - Presbyterian-St. Luke’s Hospital//// CN - Student Health Organization of Chicago//// CN - United States. Division of Regional Medical Programs//// TI - Chicago Student Health Project, summer 1968/G TC -. Student director: Lee Ballance. iM - [Bethesda, Md.,/Health Services and Mental Health Administration,/1970] CO - viii, 129 p.:illus. GN - Sponsored by Student Health Organization of Chicago and Presbyterian-St. Luke’s Hospital. GN - Project supported in full by the Division of Regional Medical Programs, Contract no. 43-68-1534. CP - O2NLM,O8HMS:WA 546:AI3.2:C5S9c::1970 CA - WA 546 AI3.2 C5S9c 1970:02NLM,O8HMS Y1 - $/1970/ LP - Eng LA - Eng MT - CORPORATE NAME MAIN ENTRY RO -O:MED RO - C:MED RO - M:CN1 DA - 710309 MR - 831204 LR - 831220 RI - rev EL - FULL LEVEL IT - MONOGRAPH UI - 1254501 7k (a al a CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 Sponsored by STUDENT HEALTH ORGANIZATION OF CHICAGO and PRESBYTERIAN-ST. LUKE’S HOSPITAL Student Director __....------ Lee Ballance Faculty Advisors __.......... Joyce C. Lashof, M.D. Adrian Ostfeld, M.D. Research Director ___...--..-- Philip Rushing Project Coordinators __..___-- Peter Bonavich Terry Fonville Elizabeth Butters George David George , Donna Kar] Lynnae King Gerald Kirk Leith Mullings James Pinney Patricia Rice Marsha Steinberg Joseph Thornton Intern Coordinators ___--- ‘.... Pamela Duncan Carlos Moore Pat Peterson Emerson Lenoir Executive Secretary ...--.- __. Rosalie Ross U.S. DEPARTMENT OF HEALTH, EDUCATION AND WELFARE Public Health Service . Health Services and Mental Health Administration This project was supported in full by The Division of Regional Medical Programs (Contract No. 43-68-1534) ihe I This report does not necessarily represent the views of the Public Health Service. PREFACE The Chicago Student Health Project—Summer, 1968—was carried out under a contract with the Division of Regional Medical Programs (PH-43- 68-1534) and was administered by the Section of Community Medicine of Presbyterian-St. Luke’s Hospital. The faculty advisors were Dr. Adrian Ostfeld who, at the beginning of the Project, was Professor and Chairman of the Department of Preventive Medicine of the University of Illinois College of Medicine, and Dr. Joyce C. Lashof, Professor of Preventive Medicine, the University of Illinois, and director of the Section of Com- munity Medicine of Presbyterian-St. Luke Hospital. Explanation of the structure of the Project and preparation of the report is in order here. The Project was devised, organized and directed by members of the Student Health Organization. The student coordinating staff consisted of a project director, Lee Ballance, a third-year medical student at the University of Chicago Pritzker College of Medicine, and 412 coordinators. Each area coordinator was responsible for the selection of sites in the geographic area and for students located at these sites. In addition, there were coordinators responsible for the high school interns and the law students. The student staff was assisted by a research director, Mr. Philip Rushing, formerly administrative assistant at a junior college in Mississippi, who also had experience as a community organizer and youth worker in both Chicago and the rural South. He aided in the develop- — ment of questionnaires which were used in some of the surveys under- taken by the students that will be reported in the following. He also served as an adviser and “‘troubleshooter” when problems arose. The preparation of this final report has been primarily the responsibility of Mrs. Irene Turner, Research Associate in the Section of Community Medicine. All students submitted site reports, research reports or personal essays at the completion of their assignments. All of these have been read; some are reproduced here in their entirety, others have been quoted and some abstracted for this text. Due to the lack of space some student’s reports have not been included. The format of this report is as follows: There is an introduction written by Mr. Lambert King, a fifth-year M.D.-Ph.D. candidate at the University of Chicago’s Pritzker College of Medicine and chairman of the Chicago chapter of the Student Health Organization. It concerns the implications of the project for the students. Mr. Lee Ballance, the project . coordinator, has written a statement giving background information and discussing the implications of the summer’s work for the Regional Medical Programs. Mr. Philip Rushing, research director, has described his overview of some of the problems faced by the project, dealing in depth with the black-white confrontation. - Til CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 The body of the report consists of two sections, the first composed of reports on the community sites where the students worked and the second an analysis of the work performed at a number of hospital sites. Mrs. Ann: Prosten, a member of the Section of Community Medicine, assisted in the preparation of the Community Sites Section. The final section presents a brief analysis of some selected charac- teristics of the participating students and was prepared by Mrs. Turner. The report of each student represents the work and thinking of that student alone, and its publication here indicates neither approval, or dis- approval of any other individuals, institutions or other students. A final editorial word: I hope that when the students read this final report they will realize that they accomplished more than many of them thought they had. They have indicated how much they learned and profited from their summer’s experience in their reports. I offer them my congratu- — lations. Joyce C. LASHOF, M.D. Director, Section of Community Medicine. IV ACKNOWLEDGMENTS We wish to especially thank the following individuals for their instrumental support of the 1968 Chicago Student Health Project: Dr. Robert Q. Marston, Dr. Richard Manegold, and Dr. Herbert Mathewson of the Division of Regional Medical Programs for their support and guid- ance; Dr. Wright Adams of the Illinois Regional Medical Program for his sense of innovation; Dr. James Campbell and Dr. Mark Lepper of Presby- terian-St. Luke’s Hospital for their unstinting dedication to health pro- fessions education and to the highest standards of community health care; Dr. Joseph English and Mrs. Edna Rostow of the Office of Economic Op- portunity for their creative support of the Student Health Projects during the past 3 years; Dr. Jeremiah Stamler of the Chicago Health Research Foundation and Pierre de Vise of the Hospital Planning Council of Metro- politan Chicago for their substantial assistance in designing our major research efforts. I\ CHICAGO COMMITTEE ON URBAN \~ > OPPORTUNITY INNER CITY POVERTY ZONES ‘ CINCOME- EDUCATION HOUSING -WELPFARE-DELINQUENCY) t CONCENTRATION OF POVERTY INDICATORS. LEGEND: PRMD = tot, cnzaTest CONSENTRATION szOMe t [EER] b+ 2nc.cnearest CONSENTRATION # ZOE 2 y SV" EEEEETE ERGY ce sre. cnzavest COMSENTRATION #ZONE 5 * if ANA Beneacnune iu bn i a A i HSI STSSLERTSSTRISLSSTSETS as agrees vac rarearessesrsessacss. rt SBSs58. t i COMMUNITY AREAS AND CENSUS TRACTS 1960 CENSUS OF HOUSING AND POPULATION TABLE OF CONTENTS PREFACE _____------------------------ 2-0 a ACKNOWLEDGMENTS -.----------------------- 007 MAP OF CHICAGO COMMUNITY AREAS ---------- anne renee Section I. INTRODUCTION “The Health Science Student Experience on the 1968 Chicago Student Health Project” by Lambert King -----------------------------70000077 “Background Information and Implications for Regional Medical Programs” by Lee Ballance ee ee ee een “The Black-White Confrontation” by Philip Rushing ------ ener re References .___------------------------ eee wee nee Section II. COMMUNITY SITE REPORTS The North Side __----_-------------------------7 2770777 . Uptown ___.---------------------------- errr Lincoln Park __._--------------------------0 07-077 The Latin American Defense Organization ---- ---- weeeee Erie House ..------------------------------ 0000077 Lawndale ___.------------------------- oo Martin Luther King, Jr. Neighborhood Health Center -- The South Side __.------------------------------ lees Abraham Lincoln Center ----------------------------7- The Robert Taylor Homes and Clinic ---- ---------------- Woodlawn ._---------------------------0- 0 The Southwest Side _..--.---------------2-------"----777 Benton House __----.------------------ eee ee ne eeeee Garfield Civic Association ----------------------------- Vil 10 11 11 23 34 35 38 41 43 47 AT 48 - 49 50 58 58 56 62 65 66 68 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 Englewood .---------------70r The Englewood Mental Health Center ------------"--7~ The Englewood Clinic ---------------- 7700777 Other Reports _-------------20 0 The Chronic Disease Detection Program --------------"~ Proposed Amendments to the Illinois Public Aid Code Relating to the Illinois Medical Assistance Program ---- Bibliography -.------------72 30 Section II. HOSPITAL SITE REPORTS Cook County Hospital ----------------- eee ee eee Presbyterian—St. Luke’s Hospital ----------------7777070777 University of Chicago Hospitals and Clinies ---------------- Emergency Rooms ---------------770 07 Mercy and Billings Hospitals .-------------77 707077707777 St, Bernard’s Hospital _----------------777-7 0000077 ables ..-------2en-e wee ~oeeee Section IV. THE STUDENTS ------------770707700077 eee ee , The Health Science Students _--------------077 The High School Interns re ee Section V. LIST OF PARTICIPANTS AND SITES Participants -------------- 707 eee eee Sites ...----n-nneeeceeen Vit Page 69 73 76 77 82 82 91 97 99 101 103, 105 106 107 108 108 109 110 111 112 119 119 123 127 128 Section |. INTRODUCTION The Health Science Student Experience on the 1968 Chicago Student Health Project by Lambert King (Medicine) The Student Health Projects (SHPs) were conceived more than 8 years ago by students in the health sciences as a primary step in their . efforts to enhance the quality of their educa- tional. experience. Initiated and designed by Student Health Organization members and cos- ponsored by leading medical schools and health care institutions, 12 major Student Health Projects have taken place—one in 1966, three in 1967, and eight in the summer of 1968. The burgeoning growth and the striking results of these projects have been unprecedented in health professions education in the United States. The energy, momentum, and creativity necessary to mount these projects are indica- tive of major change in the goals and attitudes of a broad sector of contemporary health pro- fessions students. An analysis of the experi- ence of the hundreds of students across the country who have participated in these. pro- jects is likely to yield implications of vital im- portance for the future of health science edu- cation and health care. ‘ The Student Health Projects are best consid- ered as an integral component of the more gen- eral student health movement that has ini- tiated the SHPs. Within only 3 years the atti- tudes and goals of the students involved in or- ganizing these projects have undergone a dis- tinct evolution. The socio-political-psychologi- cal evolution of the students participating in the projects reflects their response to a com- plex array of societal-wide issues and. condi- tions. Indeed the very flexibility of their res- ponse to the problems they have confronted is indicative of a capacity for self reappraisal that is a salient change in the social orienta- tion of health professions students. The implications of the 1968 Student Health Project in Chicago ghould be analyzed first for the central similarities of the 1968 student ex- perience as compared with the experience of students on SHPs during the 2 preceeding years; the commonality of the goals and res- ponses of the students to their experience in all of the projects during the past 3 years reflects some of the most consistent and important qualities of the new generation of health stu- dents. But proceeding beyond the areas of simi- larity in the past and more recent projects, one should also examine the distinct evolution that has occurred in the attitudes of each succeed- ing group of student project participants. It is in the evolution of the student experience that the most important trends for the future may be found and directed toward other health sci- ence students, teachers and administrations of health professions schools, and the other orga- nized representatives: of the health professions. The implications of the experience of these deeply committed progressive health science students must be heard and acted upon with a constructive spirit of renewal and reform. During the past 3 years health professions students have been the prime initiators of the Student Health Projects; they have recruited fellow students, negotiated for substantial funding, and have determined the location and nature of their own project experiences. The third distinguishing characteristic of our program involved a large amount of autonomy permitted—encouraged—in the 1 CHICAGO STUDENT HEALTH PROJECT SUMMER 1963 student participants. This intentional min- imization of its structure was intended to permit students to exercise their own ini- tiative in identifying and pursuing activi- ties in potentially fruitful areas within the broad context of their own particular summer placements * * * (1) Generally the quality of student leadership which has initiated and organized the SHPs has provided a convincing demonstration of student capability and creativity in determin- ing the nature of a sizeable segment of their educational experience. In the case of the Stu- dent Health Projects, this experience has cen-. . tered around the focus of action and research- oriented multidisciplinary community health programs. Each of the projects has brought students together for a previously unavailable interaction between students of all health dis- ciplines, community workers, community or- ganizations, and established health agencies. The impact of this somewhat loosely struc- tured yet uniquely ‘challenging experience for most of the students involved has led many of the student participants to compare the project experience with their own conceptual model of a “free university of health.” Throughout the 3 first years of the Student Health Projects, student participants have con- eluded that the projects have demonstrated that the health professions students them- selves are far more capable of determining the nature of their own educational process than the present organization and structure of their schools permits. As students we have no voice in de- -termining our educational process. Except for a minimal amount of time devoted to a narrow range of elec- tives, we are not allowed to plan our courses; nor are we allowed to judge our professors or examine the qualifi- cations for admission or promotion of our peers. In each of these functions the student has as much at stake as faculty personnel to promote the ex- cellence of the university. Both fac- ulty and students are subject to simi- lar errors of judgment. projects were inten changes in the sociopoli titudes of the largely m1 class student participan tended that the body of st would in the coming years constitute an experi- d corps of young health profes- of the United enced and unite sionals dedicated to reform States health care system. We focus around community health because we are dismayed at the re- treat of the health professions schools from contact with the clients of our professions. We are concerned not only with the pasic science view of health, illness, and therapy; we are outraged by the lack of education in the area of socio-economic determi- nants of health and disease. * * * (2) Students foresaw two major goals for the participants ; personal expe jects as distinguished from the equally impor- tant results of the students’ work. First the ded to result in basic tical viewpoints and at- ddle and upper middle ts. Second it was in- udent participants Perhaps the problem of changing society is insoluble, but after one summer of immersion in the frustra- tion of the South Bronx, I believe realities must be challenged and changed, hopefully with the coopera- tion of the full resources of our soci- ety. For the cancers that infect our society, only radical change offers any hope * * *. My summer’s experience leads me to conclude that students must create a new health profession concerned with the real problems of society. An organization which responds to the needs of the people and which ration- ally utilizes and provides for health manpower is needed.* * * We have not changed the places we worked in this summer, nor was it realistic to think that we would, But we have changed ourselves—our aspirations, actions, our beliefs. In this departure ‘from the lack of involvement with social problems shown by the past genera- rience on the pro- CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 tion of health students lies the catalyst for making our dream of a vibrant American health profession a reali- ty.* * * ( 3) Consistently the student participants on this year’s and on previous Student Health Projects have viewed their project experience as bridg- ing an all important gap in their formal health science education. This experience has led them to verbally and organizationally commit themselves to life styles and career orienta- tions centered about contemporary biogocial is- sues. I have looked and, perhaps I have found. I have been a member of the Student Health Project, I have met people who made my former “liberal views” pale by comparison * * # Most of all, I have been given the op- portunity to spend 10 weeks during my years of medical training thinking about riots and open housing and the welfare system as medically and so- cially significant entities which di- rectly pertain to me and for which I must attempt a solution. (4) Following the 1967 Student Health Projects, both the Student Health Organization of Chi- cago and other Student Health Organization groups across the country began to seriously examine the larger issues confronting them as a result of their 2 prior years of involvement in the community and in the development of their own projects. Health science student ac- tivists articulated a challenging conception of the obligations of health professionals. Their broader definition of their own future role led them to confront issues and problems that deeply affected the reform of health care and health science education. The defining purpose of the Student Health Organization is the achieve- . ment of human welfare, good health in a total sense. A commitment to human welfare must lead to concern with relevant political affairs. We consider the involvement of the people in the United States in the war in Vietnam to be inimical to human welfare in its sacrifice of life and disruption of cul- ture for the sake of unjustifiable mili- tary and political priorities. (5) | At the inception of the 1968 Student Health Projects, many of the student participants felt that such statements as the preceeding one were highly relevant to the goals of reform- minded and progressive health science stu- dents. Indeed the writing of the student parti- cipants on the 1968 Chicago project reflect a _more sophisticated and well-documented un- derstanding of such socially critical subjects as Black Power, war and the health profession, political dissent in medicine, and consumer control of health care planning. The 1968 Student Health Projects wit- nessed a widespread conclusion among student participants that the focus of their work must _ be broadened to include not only direct action in poverty communities but to encompass re- formation within their own schools and health care institutions. Many students on the Chi- cago project felt that their experience in black communities striving to develop their own leadership was detrimental to the eventual so- lution of problems of such relatively powerless communities. The students’ study and analysis of the shortcomings of health care in ghetto areas often lead them to conclude that the prime cause of this poor health care lies not in the black community but in the lack of signifi- cant commitment on the part of powerful insti- tutions, schools and government agencies to the solution of these problems. Seven students who worked attempting to set.up an evening medical clinic in the Robert Taylor Homes area on the 1968 Student Health Project concluded. * * * This student venture may be in- _strumental in adding another incident in a long series of disappointments, as well as acting as a channel to divert energy from places where it may be - more effectively placed. Fortunately, through a combination of coinci- dences, the Taylor project is at least functioning. Students do not need to organize in poor communities—Appa- lachian white, Spanish or Black-—to learn about the problems that affect CHICAGO STUDENT HBEALLEH rrusnys vusesnm —- the poor. Middle class whites are for- eigners to the poor and always will be. Contact with middle class whites, _SHOs own constituency, can teach the same classic lessons. The student participants on the 1968 Chi- cago SHP involved themselves deeply in the most difficult problems and issues underlying what has come to be known euphemistically as the crisis in health care delivery. For most of the student participants, their experience was of crucial importance—it was an experience that their own schools were either unwilling or unable to provide. A brief 10 week’s immersion in the milieu of poverty led some students to conclude that the “crisis in health care deliv- ery” had deep and intimate roots in the policies and attitudes of health schools, health care in- stitutions, and more broadly, in affluent, white America. As students, they concluded that they must concentrate upon obtaining more freedom in their schools to redesign and broaden the nature of their educational experience; as fu- ture health professionals, they concluded that they must work to bring change within health care system under the control of the impover- ished communities that have been most deci- mated by the lack of a humane, rational health care. The report which follows contains not only a description of the work of the students, their findings and impressions but gives clear evi- dence in their personal essays that they are moving toward nothing less than a long term commitment to a new health profession based upon both science and social justice. Background Information and Implication for Regional Medical Programs by Lee Ballance (Medicine) The 1968 Student Health Project was funded by the Division of Regional Medical Programs of the Health Services and Mental Health Administration of the Department of Health, Education, and Welfare. It is impor- tant that all parties concerned take some time out to look at what has been learned from the summer’s experience. First it is important to note that by giving 124 students from various health science fields the opportunity to work in and with community groups towards solution of community health problems, the project and its sponsors contributed to the growing pool of interested, aware, and vitally concerned stu- dents dedicated to the solution of America’s health problems. It afforded 75 high school student “interns” the opportunity to work within their own communities towards solution of their own problems. The project also gave one intern the motivation to become a doctor, another the insight that the solutions to his community’s problems lie largely within that community itself, and a good many the faith that things can be changed for the better. These immeasureable contributions are proba- bly the most important result of the summer’s experience, but the RMP’s also gained the not insignificant reports which make up the bulk of this volume. Some of these report events and insights which we think others should share. Others contain the results of the numer- ous and diverse research projects carried out by the intern-student teams last summer. In introducing this volume, no attempt will be made to force its contents into a series of neat generalizations. In putting it together out of the multitude of reports, questionnaires, and other documents which were left at the end of the summer, an attempt has been made to leave the summer’s story in the words of the stu- dents who experienced it. It would be insulting for anyone to try to tell the reader what it all means, Rather the reader is left to read the book through and find in it his own meaning. This introduction will serve only to provide some background information which should be helpful in tying things together. The planners of ‘Student Health Projects have been troubled since the beginning with the dichotomy between education and service. It soon became clear that the goal which could be most regularly and satisfactorily attained and quantitated was that of education of the student participants. It was equally clear that using the medically deprived community as a summer teaching laboratory without providing a fair amount of service to that community ranked with the worst forms of exploitation. It was the thesis of the planners of this project that one could learn a great deal without pro- viding a bit of service, but that one could not make a serious attempt at serving the com- munity without learning a lot as a result, But what kind of meaningful service can a group of nursing, preclinical medical, law, so- cial work, and high school students provide in 9 weeks time? This was a question which could only be answered by the community or- ganizations and groups with which the student teams would work. In order for any communi- ty-oriented project to be maximally effective in defining and attaining its goals, it must be con- ceived and planned with the full cooperation of all people directly affected by it. For this rea- son much of our energies during the planning stage of the project were devoted to discussions with the members and leaders of the communi- ties in which students were to work. Thus the individual site-projects evolved over the winter and spring. - Some students were assigned to doing com- munity health resources surveys and drug price surveys which the community groups could use to help their constituents get better health care. Other students found themselves working with the two community-sponsored clinics which grew out of last year’s project. Still others found themselves working on hous- ing, urban renewal, and lead poisoning prob- 5 CHICAGO STUDENT FBALTH PRU bUL Dussseern oo lems which, while not strictly medical, were considered essential to the health of the com- munity. On a different level, many students worked on more conventional research projects. The focus for most of these was the attempt to un- derstand the current health care system of the city of Chicago. The majority of these projects took place in various hospitals and out-patient clinics in the city. Yet, as will rapidly become clear to the reader, the focus of the reports from these di- verse placements is confrontation: confronta- tion between health science student and intern, between community members and project workers, between students and politicians, be- tween students and staff, between old concepts and ideas and new ones. ‘Tt seems as if no one went through the summer without having at least one of his actions or ideas seriously chal- Jenged. Our research director, Rev. Philip Rushing, has analyzed the reasons for many of these confrontations in an accompanying paper. It seems also that these challenges were a significant part of the summer for most of the students. Reading their detailed reports, one can gain a great appreciation for many of the major issues which confront anyone who tries to work with the community in solving its health problems. The reports are also a valu- able record of success and failure in attempt- ing to meet these challenges. ‘With this as a background let me next dis- cuss the implications for RMP as I see them. RMP is not involved in the actual provision of medical care. Further, they are prohibited from “changing the existing organization of medical care”—a somewhat ambiguous provi- sion since RMP’s very existence changes the organization of medical care. The major prem- ise, as well as the initial impetus for RMP’s in- ception, is their potential to raise the health status of American communities by regional planning and regional problem-solving. The pest method of attaining this goal, is to work with and through community groups who have similar interests, i.e., improving the health conditions of the community. This is not simple 6 —-as the students learned this summer—but while it may be difficult it is most rewarding. The concept of regional medical programs appears to be a limited one. More appro- priately the concept should be that of regional health programs. The word, medical, implies ‘curing’ or ‘caring for’ when actually RMP must concern itself with the health of a region not the medicine or medical care provided in that region. This might mean that elimination of air pol- lution, implicated in the etiology of lung can- cer, may well be as important as sophisticated research into its chemotherapy or building and equipping intensive care units for post-pneu- monectomy patients. Resolution of the social stresses, implicated in hypertension, may be as important and economical as designing compu- terized link-ups of cardiac care units. The goal of prevention of disease must be- come as important as the goal of curing dis- ease. If RMP is to be concerned with such ap- proaches, then community involvement at every level in its various programs is essential. RMP can help a community achieve power and importance by allowing the community to make its own decisions, or be involved in deci- sion making, on its own terms. By doing so, it can create a climate in which many problems central to the total health needs of the com- munity can be solved. RMP can become a cat- alyst in the process of social change rather than another organization in a plethora of or- ganizations planning a surfeit of programs— most of which will have no lasting impact on the health of whole segments of the popula- tion. These broad definitions of the appropriate role of RMP may be very difficult of accept- ance, let alone achievement. Perhaps, change is indicated in RMP’s enacting legislation to per- mit it to broaden its approaches and deal with very real health problems involving whole communities. It is probably easier for students to embrace these approaches than it may be for RMP planners. Students have little or no vested in- terest in defending the present medical care CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 system since it is not “ours” yet. But RMP planners are part of that medical care system. It is “theirs.” Students are prepared to be, and indeed are, highly critical of that system, but criticisms of that system by members of the Establishment—as are most people in control of local RMP’s—is less likely to be forthcom- ing. Students are without power. The medical schoo] deans, hospital administrators, and medical society representatives who administer local RMP planning have a substantial amount of power. Resisting the temptation to wield this power as a club over the heads of con- sumer and community groups will not be easy. People in control of local RMPs will have to guard against their own, quite natural, tend- ency to defend and enlarge their own “em- pires.” They will need to sublimate their own needs for power and prestige to the- total health needs of the community and to the need for social change. Therefore for local RMPs to come to grips with some of the new and chang- ing scene will not be as easy as it was for the students—although it was not easy for them either. However, the demands of community groups for the right to govern their own lives will continue to escalate. This is attested to by the increasing demand for community control by such disparate groups as the Black Panthers, the Dissident Democrats and the American In- dependence Party and also by the increasingly common provisions for consumer and commun- ity control in Federal legislation. RMP will, as will many other American organizations, need to hear these demands and bring creativity and inventiveness to meet the challenge they offer. The students heard them and have been pro- foundly influenced by them. This will be evi- dent as their reports in this volume are read. We hope that these experiences will be of value in offering RMP new insights and avenues through which it can more effectively fulfill its promise. The Black-White Confrontation by Philip Rushing The project encountered several problems that caused some degrees of frustration for al- most all of the students. First, many students were perturbed by the ambiguity of their roles and complained that they did not know exactly what to do. Part of this uncertainty was due to the deliberate attempt of the staff to avoid sti- fling students’ creativity by a strict guidelining of their roles, thinking the summer’s experi- ence would be more productive were students independent to design their own activities. However, the students “syndrome” of having functioned more or less within a prescribed framework and of having their work proce- dures defined for them probably played a part. Second, organizational logistics—many stu- dents complained about poor communication be- tween themselves and staff. This situation was the result of the wide area over which the pro- ject extended and the inconvenience of not hav- ing ready access to a telephone. The project was officed in Presbyterian-St. Luke’s Hospital on a new floor of an unfinished building and was without telephone service (due to the Brotherhood of Electrical Worker’s strike). Office personnel had to go from the 10th floor of this building to the third floor of an adjacent building to make calls. This situation not only limited staff-student communication but also impeded effective coordination and administra- tion of the project’s activities. Third, the attitudinal confrontation between the health science students and the black high school interns—initially, some students had difficulty relating to their interns. Different at- titudes, value patterns, and goal objectives created a communication and social barrier be- tween student and intern. Both brought to the project preconceived expectations and were an- noyed when those expectations were not ful- filled. Students expected mature behavior from the interns while the interns expected an un- derstanding “big-brother” type .of behavior from students. Analytically, this confrontation 8. was a valuable experience for both student and intern. Both realized the difficulty involved in learning to relate to people who are ethnically and culturally different. Both seemed to realize that by working together for a common con- cern a meaningful affinity can develop between people in spite of their differences. At the close of the project, relations between students and interns were decisively improved. Between some at the wrap-up conference, there were in- dications that this would continue. Addresses were being exchanged, interns were leaving each other to sit and dine with students and vice versa. Though these problems had some signifi- cance, the overriding problem throughout the summer was that of the black-white confronta- tion. The effect upon the students stands out in almost all the individual essays, as will be seen in the reports that follow. The essence of the problem was poignantly described by one stu- dent as follows: Into the church where we worked walked Black Power. They told us in no uncertain terms that we were un- welcome in their “hood” and that we should leave immediately. A concen- sus of white opinion was taken and it was our most “noble” hour when it was conditionally decided that we would stay, at least until we had found out who the youths were, and whom they represented. In a few days following the incident, our physical stake was pulled and we left the neighborhood. My emotional stake re- mained, however, and I continued throughout the summer to work for the Clinic. I worked because I wanted to see a -lot of work come to fruition, and I worked because I didn’t want frustra- tion and finally despair to overcome the indigenous committee of women CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 who had been with this project from the beginning. What was wrong with all of this? First, I, and probably many others, assumed our jobs without a real un- derstanding of the past relationship between the white and black people in the area. Of course we know things were bad and could spout words like white racism and neo-colonialism but I, for one, didn’t really understand how these phrases could apply to our well-meaning effort. I didn’t realize until a few weeks after the beginning of the project that all our efforts at organizing the community were impeded by the belief of many that the Student Health Project was just another extension of the mistrusted | University of Chicago. Also, I didn’t know that because many other white liberals had come into the area before us and had changed nothing, we were judged either guilty or impotent by association. And lastly, I didn’t real- ize until much later that what I thought was our greatest asset—our organizational skills and abilities— was one of our greatest liabilities. (Stephen P. Rand.) . Militants precipitated situations that created a constant problem for students and at times threatened to submerge the project’s achieve- ments. Articulate, sometimes raw, and often provocative young militants spewed their rhe- toric as they evinced their position, stressing their determination to organize their own com- munities, accusing some students of being tools of the “Establishment” dispatched to safe- guard the Establishment’s “colonial” interest, and challenging white students “go organize your own community and leave ours to us.” On the premise that liberalism perpetuated rather than solved ghetto problems, Black Power re- jected it, maintaining that effective solution must be built into black ownership and control of ghetto institutions. «In addition to presenting some very ‘serious Problems, the black-white confrontation en- hanced the summer’s learning experience. This learning occurred on two levels—individual and community. 1. The individual level—The militants’ po- sition provoked students to really see, hear and feel the pathos, dynamics and mentality of ghetto life for the first time. In contradis- tinction to Negro passivity of previous decades, disciplined to deceive white liberals in order to incur paternalism, black militancy “told it like it was.” Initially shocked by this raw mili- tancy, students began to probe their own motives and intensified the on-going debate on the moral right of white students to interject themselves in the life of ghetto communities at a time when these. communities were strug- gling for esprit de corps. This direct personal encounter with militant segments of ghetto leadership, the introspection it precipitated, enlarged students’ understanding of ghetto problems, increased their appreciation for poor black people and inspired students to a creative search for a redefinition of their role as health professionals seeking change in a health sys- tem that is not responding to the health needs of the poor. 2. Community level—That the ghetto is un- dergoing radical ideological and organizational transformation was readily observed by stu- dents. New attitudes are forming and new manhood is developing as the influence of Negro passivity is waning while that of black militancy is increasing. The emerging black man is unwilling docilely to accept roles pre- scribed for him and is resolute in his commit- ment to master his right to self-determination. Consequently, militants are moving for control of ghetto institutions and the Negro power structures and they rationalize their activity on the premise that these structures are mere extensions of the “system” and are therefore illegitimate. Concluding whites are the true owners of Negro power, and reasoning that out of self-interest whites support and perpetuate a Negro elite, these blacks want whites out. “Get out, Whitey, and leave the driving to us,” was the cry often heard by white students. Currently, the Black Power confrontation is basically a conflict between powerless young 9 _CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 militants and old line conservative Negroes who occupy positions of power. These militants are dissatisfied with the way the affairs of their community are being conducted, and are pressing for change. Militants hold whites res- ponsible for the conflicts, thinking whites by means of liberalism deliberately keep the black community divided. Not having a constructive strategy for achieving their goal, young mili- tants roam their community seething with dis- content. Like a powder keg, they can be set off with the slightest provocation. Provocations are often provided in the form of exploitative business practices, excessive police forces or whites controlling ghetto institutions. Mili- tants feel black unity is a first priority to solv- ing ghetto problems and ridding the commun- ity of whites would facilitate this unity and thus control of community. Militants really want power over their lives to control their community, to rebuild it, to withdraw into it as they attempt to escape the frustration and complexity of an engulfing society. They want a place for blacks to develop their resources and “peoplehood” competent to function on a level equalling other ethnic groups. Lacking the means to achieve this within the context of the “system” drives them to struggle for it out- side the system. Sometimes impetuous and often unseagsoned, they maneuver without care- ful design, often alienating would-be support- ers and incurring repressive measures for both themselves and their community. 3. Students’ assessment of the black-white confrontation—In their assessment of the con- frontation, students tended to be overly critical of themselves. Three influences probably un- derlie this tendency to demean their personal effectiveness: (a) Solution to ghetto problems per se was not an overriding consideration underpinning student liberalism and desire for change. This is not to imply that students were not seriously 10 concerned about the plight of poor blacks. They were, but only as the blacks’ problem was a syndrome of a much larger problem, It is at this level students and militants part. Mili- tants are committed to the rectification of ghetto ills to the exclusion of other considera- tions; students are committed to a rectification of the ills of the total society. (b) Students’ inclination to underrate their own effectiveness was probably a rationaliza- tion of an emotional “hangup” that inhibited their capacity to grapple “head on” with the challenge presented by the confrontation. (c) Students tendency to devalue their com- munity contribution was probably influenced by unresolved feelings of paternalism—stu- dents felt the need to measure success and help in terms of “doing something for poor people” to the exclusion of “being something to poor people.” It was difficult for students to under- stand that “just being there” (emotionally as well as physically) had positive value. Finally, solutions to ghetto problems require the participation of student health projects. These projects bring to the community a sense of dedication and expertise desperately needed. However, future involvement in ghetto areas must consider the historical frustrations and disappointments sustained by ghetto people at the hands of well-meaning-liberals. REFERENCES (1) Report of the 1966 California Student Health Pro- ject. : (2) Peter Schnall, Lew Rosenbaum in Encounter, the Bulletin of the Student Health Organizations, Summer, 1967. (3) Robert Cohen, 1967 Report of. the South Bronx . Student Health Project. . (4) Claire Wittenmeier, Report of the 1967 Chicago Student Health Project. (5) Resolution passed by the Student Health Organiza- tion of Chicago on Feb. 5, 1968. Section Il. COMMUNITY SITE REPORTS More than half of the over 40 sites where summer of ’68 Student Health Project teams were assigned can be defined broadly as com- munity organizations. These are the settlement houses or special project centers sponsored by neighborhood churches, private agencies, or in- digenous self-supporting community associa- tions. Many of these have come into being in an effort to cope with community needs which society, or the appropriate government agency, may occasionally acknowledge, but which are not met with the requisite facilities, funds and personnel, nor with programs and policies nec- essary to assure their effective utilization. Several sites were community health clinics, in some cases established and functioning par- tially as a result of student health project par- ticipation, or where the students acted as cat- alysts enabling the community to establish such clinics. Common to all the community sites to which SHP teams were assigned was the community’s unmet needs for accessible, quality health eare and education. In some instances, the teams continued work begun by their predecessors during the sum- mer of 1967. In every assignment the work was health oriented, if not directly health fo- cused. The projects were defined through joint site-sponsor, SHP discussion and the execution of the project was subject to the guidance of the sponsoring group. This section summarizes the SHP commun- ity experiences as the students and interns re- ported them. In some cases the students’ essays will constitute the entire report on the site; in others, a precis of their experiences with quo- tations from their reports will be the mode of description. A number of reports and commen- taries are reprinted in full for the quality of work and thought which they reflect. The presentation is in general geographic se- quence; from the Uptown community bordered by Bryn Mawr Avenue (5600 north), to the Southwest area at Trumbull Park (105th Street South). THE NORTH SIDE Uptown The area: A strip that runs from 4000 North (Irving. Park Road) to 5600 North (Bryn Mawr Avenue) and from Lake Michi- gan on the East (about 400 West at that point) to beyond Clark Street (about 1600 west at this location). It is a portion of Community Area 3. The population: A mixture of Appalachian whites, American Indians, Spanish-speaking Americans, these groups are mainly recent in- migrants; a Japanese population which has been there since the end of World War II; a few blocks of predominantly black population; and a substantial number of mostly single, in- digent, elderly white people, many of whom have been located in Uptown by social service departments of mental and chronic disease in- stitutions. In 1964, the estimated white popula- tion of the whole of Community Area 3 was 93,000, while the nonwhite population was es- timated to be 2,225 (2.4 percent). (7) The only data available as to income and housing is based on 1960 census tabulations and the area has changed since then with. more poor people moving in. However, even at that time the percentage of families with incomes below $3,000 per year ranged from 16.6 per- cent to 30.1 percent in seven out of the 21 cen-_ sus tracts in the area. In these same tracts the percentage of substandard housing ranged from 25 percent to 60.5 percent with only one having lower than 23 percent poor housing. (2) Uptown is ranked as a zone 3 poverty area (the third greatest concentration of poverty in the 24 poverty zones as determined by the Chi- cago Committee on Urban Opportunity). In 11 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 ranking five mortality and morbidity factors, _ the section of Uptown in which the students worked ranks in the 2d (highest) quartile for numbers of deaths due to influenza and pneu- monia both for infants and noninfants; it is in the 2d quartile for deaths due to cervical can- cer and 2d also for new cases of tuberculosis; it is in the first quartile (the highest) for deaths due to unknown and ill defined causes. (The diagnosis, “ill defined causes” on a death certificate frequently reflects the extent or lack of medical care precceding death.) (1). SHP teams operated at three Uptown sites: The American Indian Center; the Tri-Faith Employment Service; and United People, a neighborhood organization concerned with the impact of urban renewal in their area. Medical student James Drake, working in the American Indian Center team, describes Uptown in these words: The Uptown area of Chicago boasts fine apartment buildings just off the {lake] shore, modern hospitals scat- tered throughout, and thriving busi- nesses on all the major streets. One’s first impression is that this must be a progressive and promising part of Chicago; in fact, a fine place to begin a career, invest in a business—even rear a family. But it doesn’t take a sharp observer too long to see Up- town’s more typical streets and dis- cover its “other face”: fhe face of poverty, slum housing high density. living, dirt, disease and ignorance. As one finds street after street in the same deteriorated condition, one be- gins to realize that this is indeed an area with grave urban problems. The ‘other face’ of Uptown, is described in greater detail by Lynnae King, SHP coordina- tor for the area. Her report is printed in its en- tirety. Health science students and interns, at both the American Indian Center and at the Tri- Faith Employment Service sites, undertook surveys of health needs and facilities and com- pleted a comparative study of drug prices 12 which had been started by SHP teams the pre- vious summer. The teams followed up the surveys with “test” projects, introducing residents to local clinical resources. They also participated in screening children from the Indian community for a lead poisoning detection program con- ducted jointly with the Montrose Urban Prog- ress Center. The American Indian Center team notes among its accomplishments: The health survey will leave a perma- nent record for use by the Center and other concerned agencies, including the Commission on Health Planning and Model Cities. It was impossible to determine the adequacy of health care for the American Indians from pre- vious studies, since the Indians were never considered as a distinct ethnic group. There were 133 personal interviews in the survey, yielding information for 620 individu- als. The essay, “Indian Summer” describes one such interview, and a more detailed report on the over-all survey will be found in the report, “Health Care in the Indian Community”. Some of the specific accomplishments of the American Indian Center team of students in- cluded: ¢ Preparation of a two-fold plan, adopted by the Montrose Urban Progress Center, for the treatment and prevention of lead pois- oning, now a widespread phenomenon a a- mong Uptown children: © Establishment of a North Side Treatment Center at the Montrose Urban Progress Center. (Children have had to go to the Municipal Contagious Diseases Hospital on. the southwest side of the City—a consid- erable distance). ® Creation ofa central file at the Montrose Center which lists dangerous buildings where lead poisoning cases have been iden- tified, and distribution of this list to the community and to the renting agencies. This team’s survey of drug prices in Uptown discovered some interesting pricing practices CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 in the 14 drug stores involved. For at least one of the prescriptions tested, 12 of the 14 drug stores charged Indians higher prices for the item than they did non-Indians. The variation in prices between drug stores however indicate that all residents of the area are victimized to some degree by the pricing practices of the surveyed stores. Description and results of the survey follow: As members of the Student Health Project, we have been working this summer in the Up- town area. Our sponsor, the American Indian Center, knows of all our activities; and with its consent, we have undertaken a drugstore sur- vey. From the results of this project, we have compiled information which we wish to relay, in the hope that you will save both time and money. The drug survey was conducted by six people, three Indians and three non-Indians. Six pre- scriptions were obtained from reputable doctors in the Chicago area. The six individuals in- volved in the price survey proceeded separately from one drugstore to another, asking the charge for filling each prescription. Many factors could have influenced the re- sults of the survey. One possible variable is that the pharmacists may have realized what the purpose of our investigation was, after being asked to quote prices to six individuals on six different occasions. In addition, different pharmacists may have misquoted prices from memory, but would have checked more accur- ately if the investigators had paid at that mo- ment. However, in analyzing our results, we have made the necessary assumption that all the prices quoted were given in good faith, with the expectation that the investigators really intended to buy the drugs. There were 14 drugstores in Uptown where the six investigators brought their prescrip- tions at separate times and requested informa- tion from each store as to the cost of filling the prescriptions. There was a wide variance in costs for each of the prescriptions both be- tween prices charged Indians and non-Indians and between prices of the different stores. The following are the data relative to differences in costs to the Indian and non-Indian investiga- tors. “Number of drugstores in Uptown i 2 § ® : at, BE offs ae Gog fp 1 3™ § FS Prescription Total 8 & S38 & Penicillin ....-.--- 14 5 5 4 Chlor-Trimeton ... 14 12 0 2 Ortho-Novum -.-_-- 8 2 4 2 The increase in prices for penicillin ranged from 4 percent to 100 percent more charged Indians as compared with non-Indians in the five stores where this occurred. The price vari- ations were even greater for filling the Chlor- Trimeton prescription. Indians paid from 1 per- cent to 195 percent more than non-Indians. Only one store had the low price differential of 1 percent. Eight of the 12 stores charging Indi- ans higher prices for this drug charged from 30 to 195 percent more. The two stores charging Indians more for Ortho-Novum charged them 12.5 percent and 66 percent more respectively. There was also a wide difference in prices charged between the different drugstores for all three prescriptions, as follows: Cost of filling penicillin prescriptions Number of stores TolIndianas Number of storea To non-Indiana 1 iii e eee eee $2.40 2 $2.50 1 ------------- 2.50 5 8.00 B ----l ieee 8,00 4 8.50 1 Lee. 8,50 1 4.00 1 Lele ee... 8.65 2 6.00 2 .----.------- 4,00 — ae 1 ------------- 4,95 wee wees 2 _------------ 5.00 wo an The variation in prices for filling Chlor-Tri- meton prescriptions is as follows: . Costs of filling Chlor-Trimeton prescriptions Number of Charged Number of drug storea drug stores non-Indians 2 _.------------ $2.00 1 $1.76 1 _.-.--------- 2.75 1 1,95 2 _------------- 3.00 1 2.00 8 -------------- 3.25 1 2.20 2 _...---------- 3.75 1 2.25 1 __------------ 4.50 4 2.50 1 ...2---------- 4.75 1 2.65 1 i... ------ 5.00 2 . 2.95 1 ..L2. ee ----- 6.50 1 3.45 : 1 3.50 18 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 Costs of filling Ortho-Novum prescriptions for Indians was only obtained for eight drug- stores but for non-Indians all 14 stores prices are presented: Costs of filling Ortho-Novum prescriptions Number of Charged Number of Charged non- drug stores Indians drug stores indians 3 LL ---------- $2.00 1 $1.35 4 __..---------- 2.25 1 1.50 1 __.--.-------- 2.50 3 2.00 1 2.10 4 2.25 3 2.50 1 3.00 Only one drugstore of the 14 charged Indi- ans consistently higher prices than non-Indi- ans for all three prescriptions. There was no discernible pattern of pricing for the other stores. They seemed to charge randomly re- gardless of the prescription or whether or not the prospective purchaser was Indian or non- Indian except in the filling of Chlor-Trimeton where Indians were charged higher prices in 12 of the 14 stores. The Tri-Faith Team reports: Local community organizations hope to use our report to support their ar- gument[s] for the need for better health facilities. [In] individual cases [they] were able to use our informa- tion to improve the health of their families. Working with United People, architectural student Barry Williams of SHP team reports: I built a model for urban change, a physical alternative to meet the di- verse cultural and economic needs of the disabled rural and indigenous people living in Uptown. The model is a cardboard product of intangible ideas made tangible initially gener- ated by community people and later translated and amplified into physical form by concerned professionals. The Hank Williams Village model (as it has been named) is a statement of community purpose* * * and com- munity hope * * *. The model is, in fact, a physical explanation of com- munity needs from the very gut of 14 that community * * * the people * * * the idea of a cooperative vil- lage that will provide low income housing, while being at the same time an economically as well as racially in- tegrated community. Community policy dictates the es- tablishment of three types of hous- ing: private ownership by resident landlords, condominium, and owner- ship by non-profit corporations or vil- lage cooperative. Community medical facilities will include a combined neighborhood adult and juvenile clinic. Hank Williams Village model pro- poses a method of rebuilding and re- newal in the urban community that will lessen the dangers of changing existing community patterns. United People, joined by private building and financial groups who support the proposal, will present its plan to the Department of Urban Renewal. The following three students reports sum- marize the problems and solutions as they saw them. It will not be helped as long as current policies, priorities, and values pervade decisions affect- ing the peoples’ lives—by Lynnae King (Nurs- ing) Uptown is a general poverty area—8b—for RMP purposes. ADC, general assistance and some help from friends are often the main means of support for many residents. J obs are hard to find: often both older and young men must compete at day labor places. Mothers rarely work—especially among the Appa- lachian. Generally the blacks, whites, and Indi- ans face many of the same basic problems as poor health, no work, no money, poor hous- ing, sick kids, alcoholism, transiency, and the overall cultural problems of poverty. However, each group (and add to that the elderly resi- dents) has unique cultural qualities and needs that must be considered for the effective insti- tuting of one overall scheme for health care. Each group must be contacted and involved in CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 the planning of any facility or service or else the service may not be useful or utilized by them. Health needs.—There is essentially no real health care given to the people in poverty in Uptown. Existing facilities as Infant Welfare Station Number One, private physicians, hospi- tal clinics and emergency rooms are makeshift, patch-up operations offering nothing to con- tribute to the purveying of decent care to any- one and everyone. The elderly are chronically ill, malnour- ished, diabetic, alcoholic, depressed and poor. Assistance comes from friends, small social se- curity checks and sometimes welfare. Many are immobile, confined to room or hotel. Wel- fare checks are frequently stolen. Few under- stand the use of food stamps—besides the stores honoring food stamps usually overcharge for very low quality food. Many elderly are robbed by young boys in the area. Housing is poor; chronic diseases with complications are not treated by nearby institutions (Weiss Me- morial Hospital’s clinic won’t handle a poor person with a chronic disease), and, of course, doctors do not make home visits. Public health nurses are likewise unavailable. The Appalachian whites are often transient and therefore disqualified from public assist- ance. The men who head the family do not want their women receiving aid; case workers are remarkably overworked and unable to be efficient. Job opportunities are poor, even if better than in the rural South. Often the money earned cannot begin to cover city living expenses, Stores often take advantage of the “hillbilly” and young people are soon in debt with no merchandise to show for the expendi- ture. Housing is remarkably poor; rents are unfair ; living conditions in general are subhu- man. Young couples—16 years old—marry and have a child soon afterwards. The girl rarely gets prenatal care, a decent diet or proper management. More often than not, no care is recelved because of fear, embarassment, or husband’s orders until delivery. (The infant welfare station waits for clients to ‘come in. Given the cultural problem here this is negli- Sent medical care!) After pregnancy the young girl continues to be anemic, weak, depressed and prone to illness. The men coming into the city are soon de- moralized by the brutality and lack of home life qualities. Many resort to alcoholism, drug abuse, violent crimes, etc., after day labor places and other unfair employment agencies, plus other living conditions ‘torture’ them. The children suffer. Protein deficiency pre- natally and post natally causes many cases of borderline mental retardation. Combined later with sensory deprivation, unfair and cruel ex- periences in school, and the problems of frus- tration, many of these children develop behav- ior disorders. Some are frankly psychotic but most are unable to do simple schoo! tasks and fulfill expectations of teachers. They are poorly dressed, malnourished, usually suffering with upper respiratory infections, middle ear infections and ugly cuts or open wounds. Head injuries are common. Lead poisoning is a large, real danger. Much more must be done to detect and treat it immediately. Dental care is nil. Folk medicine is often used in preference to humiliation at an emergency room, doctor’s office, or clinic, The American Indians in Uptown have a similar plight. Discriminated against, inarticu- late, shy, afraid, and demoralized, these people are getting just as poor care, They too have a large number of lead poisoned children, in- fected babies, mentally ill men and so forth. The blacks living up on Leland, Winthrop, ete. are, of course, better off than those on the West Side. They stay to themselves and gener- ally do not interact in the community. They too are poor, in need of health care facilities and hit by the same problems of poverty. Organizations— American Indian Center Tri-Faith Employment United People Join Community Union Thresholds Welfare Recipients Demand Action Voice of the Poor People There is an Urban Progress Center at 901 15 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 West Montrose and Infant Welfare Station #1 near 4600 North Sheridan. Thresholds serves mentally ill people re- leased from mental institutions to live in haltf- way houses in Uptown. The Urban Progress Center and Infant Welfare Stations function as others do in the city. The American Indian Center is excellent. It is controlled by the Indian community, has many programs and reaches many people. Do contact them for any health planning. They care and can act effectively, given the opportu- nity. The United People office is currently en- gaged in an urban renewal struggle, but is in- terested in health issues. The United People leadership is an effective link between the peo- ple and businessmen in the area. Some Uptown leaders see the problems, the causes and effects of poverty, racism, exploitive financial practices and selectively negligent health care. They should be contacted when Regional Medical Programs—at least nation- ally—is serious about setting up a different model for health care, Up until now such leaders have not been in- corporated into planning commissions. We have heard doctors and administrators in Up- town say: “Poor people don’t know how to plan a clinic’—“we’ll let them in later’”—or even “we aren’t servicing area 3b, so why?” What Uptown needs is a neighborhood health center—designed to serve anyone— whether or not they can buy into current health care delivery system. No serious at- tempt is being made at this time to do this. Agencies recently surveyed by a local hospital were not even remotely responsible or respon- sive to the poverty consumers in the area. The current Regional Medical Program-stimulated planning commission, voted not to include the consumers—and only one man_ objected. Therefore it is clear that no responsible, hon- est health care planning is being done for, with, or by the poverty consumers, And none . seems to be foreseeable. If some effort were to be made, the agencies and their leadership , would be excellent participants. 16 Problems.—Our project did not attack any one problem. We should have. If SHP works in Uptown during the year and next summer the issues of lead poisoning or clinic admissions policies or pediatric care—including guidance, training residents etc. or prenatal care or hos- pitals—real estate—urban renewal are all worthwhile. There is no reason for SHP to enter Uptown again unless they mean business about one main problem and intend to stay until it is over. We must begin to struggle for change within our institutions, having formed alliances and allegiances with indigenous com- munity people. All of these issues present that challenge. We learned that what is wrong with the health care delivery system in Uptown is what is generally wrong with our society, legisla- tion, and institutions. The system operating there excludes, manip- ulates, ignores and often punishes people una- ble to “buy in” or present the problem at the emergency room in an acceptable, middle class way. We were appalled at the insensitivity and racism of men who are in their own and oth- ers’ judgment “responsible.” They are, but not to those whom their decisions affect. by exclu- sion. The poverty community of Uptown is in crit- ical need—and it will not be helped in the im- mediate future as long as current policies, priorities and values pervade decisions affect- ing the peoples’ lives. Can RMP fulfill the promise of its legisla- tion? Does it believe in consumer control—the poverty consumer, too? Is it willing to put its money onto the streets and into the controlling forces for the poverty community to be served? Does RMP wish to serve poverty areas? If so, several things must be done: 1. Abolish the current “local control” of medical school deans. 2. Strictly demand indigenous community consumer control—and that does not mean the local banker. 8. Put money into grassroots resources— hire community people to do work organizing, planning. CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 4, Listen to, accept, and act upon commun- ity health needs. This would mean the end of playing politics, of allowing commissions to halfheartedly plan when indigenous people could do much of the work, and of delaying the development of de- cent system of health care for a poverty area. RMP could be a pioneer of sorts, despite legis- lative controls and an insensitive electorate. Resources must be allocated to areas and peo- ple of greatest need. Geographic and institu- tional boundaries will have to be disregarded in favor of responsiveness to cultural qualities, the problems and implications of poverty in America, and all the complicating aspects found in Uptown..The people in the area must have a voice in and the control of any facility entering their area. RMP people must know that health care is a basic human right which people in a free soci- ety inherently have and must therefore, have the power to control as well as to receive it. The residents cannot do that now. And they are being excluded in current plans designed to serve 3a. Health professionals participating in current plans declaring men free to control their own lives are negligent by this systematic exclusion of those in the most need. This is im- moral, and unprofessional; it must change. Indian Summer.—by Laura J. Simon (Medi- cine) The old man sighed, “I have 24 grandchil- dren. My wife and I had eight boys and girls. I have all kinds of grandchildren—Indians, Swedes, Italians, Spanish * * *.” “Irish, too,” put in his daughter from the next room. Her husband was Irish. He lit a cigarette, his right hand weak and trembling, and held it in his left hand to flick ashes out the tiny. unscreened kitchen window. I’ve been married 35 years. When I got sick a year and a half ago, I had to quit work. I was in the hospital in Wisconsin. After that, I went to stay with my sister for a while. We didn’t get along, so I came down here to stay with my ughters,” © phone rang, and his daughter ran down- | stairs to answer her call. “Who was that” he asked. . “Marilyn,” she said. “My older sister,” she added for my benefit. “She lives on the South Side.” “Did she ask how I was?” asked the father anxiously. “Yes, I told her you hadn’t had any weak spells for a couple of days,” replied the young mother. She was 8 months pregnant with her third child. She had not yet seen a doctor. When I urged her to do so, she said, “Oh, it doesn’t matter. I can’t take care of it, since I separated from my husband 3 months ago, so I’m going to adopt it out.” This she told me with almost no show of emotion, as though this is just something that happens to some people, and one should not feel sorry for himself if he happens to be the victim. (I later found that this idea is inaccurate. All the Indian parents I met seemed very affectionate towards their children. I have never seen any Indian strike a child.) Her father suffered a stroke, the illness he mentioned, and still suffers from the after-ef- fects. His right side is partially paralyzed; his speech is a little thick. He probably drinks a lot; his eyes have the peculiar bluish glaze of alcoholics’ eyes, rather than being clear and bright. Since he has no private insurance or Medicaid, he has not seen a doctor for over a year. He knows that his general assistance check is too small for his needs and realizes that he is eligible for aid to the aged, blind, and disabled; but when he went to apply, the mounting bureaucracy of question upon ques- tion, form after form, and repeated interviews with different people discouraged him from pressing on. He gave up and never went back. He recalls having applied to welfare in Wis- consin, when he had just come out of the hos- pital. He has never received any aid from that office. “The doctor had ordered me to drink a certain amount of wine every day, to improve my strength,” he told me. “When the young man came from the welfare office, I wasn’t drunk—I remember talking to him—but he could see that I’d had a few. Maybe. he. got 17 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 angry and destroyed my papers.” I tried to as- sure him that this should never happen, but I am really not sure of this myself. Once this summer I was trying to help a young married woman apply for emergency assistance at the central welfare offices. I watched her go through a series of interviews, one with a fat, rude, cigar-smoking social worker. I asked the next interviewer how we could go about mak- ing a complaint against this person—only to discover that the little client was almost too timid to tell the sympathetic office supervisor that the man had talked to her loudly and roughly, the way people talk to deaf people, to people who do not understand English, or to idiots. I had to start the story. Finally she said shyly, “It was almost—’she hesitated a long time—“almost as though he didn’t like Indi- ans.” That was all she would say. But if she had had enough experience with people who “don’t like Indians” to think she saw some- thing of the sort in the intake interviewer, then maybe the old man’s fears were justified. The old man spoke once more of his mar- riage. His wife, whom he apparently loved very much, is still alive. “She lives over there,” he said, indicating a spot four or five blocks north of the window with a wave of his ciga- rette. “When I got sick, I couldn’t work, so I. told her to find a man who could take care of her. I hear she’s living with a fellow who gets her everything.” he said wistfully. The old man and his daughter were the first people I interviewed in a survey which the team at the American Indian Center ran on health problems among Indians in Uptown. They made a great impression on me, as did many of the other people I met. Most suffer from the deficiency disease the whole summer project has tried to deal with: poverty, the lack of money. Some also suffer from physical illnesses, like alcoholism, tooth decay, and vari- ous other ailments which require treatment they cannot afford. We learned quite a lot about the problems these people have in find- ing medical and dental care when they need it, but we also learned a great deal about the peo- ple themselves. There are some 10,000 Indians in the Chi- 18 cago area, about three times as many as there were at the time of the 1960 census. They in- clude members of about 140 different nations, from Apache to Zuni, and the largest Eskimo settlement in the country outside of Alaska. The Indian community in Uptown has been es- timated at 6,000 people. This is possibly the third largest group in the area. The black pop- ulation is probably a little smaller than the Indian community; the Spanish-speaking peo- ple are the second largest group in the neigh- borhood; and the Appalachian whites form the largest group in Uptown. The American Indian Center provides social activities, youth groups, clubs, sports teams, and social services like family service and counseling for these Indi- ans. It is the first such agency in the country to be founded and run exclusively by the Indians themselves. It is totally independent of the Bu- reau of Indian Affairs, which the staff and directors feel encourages Indian people to be dependent, rather than helping them make it on their own to autonomy in the city. Only two people on the permanent staff are non-Indians, and one of these men is a student married to an Indian girl. The importance of such an organi- zation can scarcely be overestimated. City life must come as a tremendous shock to a family that arrives in Chicago on the Bureau of Indian Affairs Relocation Program. They have been promised decent jobs and a nice place to live, a life that is better than the reservation life they are leaving. Often they find that the apart- ments available to families with 10 children are at best no better than the places they lived in before, while the job hardly pays enough to take care of the rent, let alone food and clo- thing at higher city prices. Worst of all, with- out the Indian center, there would really be no place where they could meet other members of their own nation socially, and indeed only one other agency, St. Augustine’s Center, where they could go for help ina family crisis. The people I met at the Indian Center were quiet and gentle, and above all, generous. Gen- erosity is one of the chief virtues recognized ir. the cultures of many of the nations, along with courage, loyalty, and compassion. Strength anc dignity are inherent in the manner of doing CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 things at the Center. I think I have learned much from the people J met: how to do three or four different dance steps in a pow-wow; how to say good morning in Chippewa; and perhaps how to look at the city through the eyes of a tribal person, to see it as an insane place where people are stranded and cut off from each other in a mad scramble for money, which is admittedly important, but not worth the isolation. At the beginning of the summer, I had the impression that my own experience in growing up in a somewhat tribal and matriarchal Jew- ish family was somehow similar to the experi- ence of some of the young Indian people. How- ever, the matriarchy to which I belong has been an urban culture for centuries; the re- semblance to a truly tribal existence is only su- perficial. A member of the Center staff sug- gested to me the distinction between the urban man and the tribal man. The urban man is es- sentially a product of European culture, an in- dependent person who merely happens to be- long to certain groups which have more or less influence over him, as he chooses. The tribal man, like many of the Indians, is primarily a member of a group and defines his existence and main responsibilities in terms of this group membership. As I came to realize th error I had made by equating others’ experi- ences with my own, I realized that there are really two kinds of prejudice. One kind denies that people are similar; the other denies that they are different. No one on the project fell into the trap of assuming that people of a dif- ferent race or nationality from his own have different basic needs. But we “liberals” are perhaps all too prone to lapse into the fallacy that lies at the other extreme, the error of as- suming that people are not different. Certainly everyone needs food, clothing, shelter, someone to love them, and a place where they can feel that they belong. These are almost biologic needs, and in these respects people are similar. But not everyone sees society in the same way. It is unreasonable to expect a Sauk Indian to See American history in the same light as I do, living in northern Illinois where his nation once camped. The same government that extermi- nated his ancestors in the Blackhawk War gave refuge to mine. Many times in the course of the summer I was reminded of the differences be- tween the experience of Indians in the city and my own experience, Such a reminder came one day when J was plunking idly on an old piano in the youth room. One of the teenage boys came up to lean on the piano and watch my hands. “You’re really educated, aren’t you” Joe asked. I replied that I tried to learn things in col- lege. “Yes, but you’re really well educated,” he persisted. “I can tell by the way you wear your hair, by your earrings, even by the way you move your hands. Now take us,” he gestured towards a group of teenagers who were setting up a rock band behind me. “We’re just a bunch of poor, ignorant, low-down Indians. We’re born losers !” I wondered if the situation is as completely hopeless as Joe must feel sometimes, A few weeks later, while serving as my navigator on some errands for the Center, Joe gave me evi- dence that there is much hope for Indian peo- ple. “Are you going to be a doctor?” Joe asked. “Yes, eventually,” I said. “I wanted to be a doctor once, but now I don’t any more.” “What made you change your mind?” “I want to be a lawyer. I think I can help my people more that way. Look at the kids at the Center: most of them are so trapped that they’ll never get anything done. I think I can do something for my people.” | “What would be your strategy?” I asked. “First, I'll get the best education I can and go to a good law school. Then I’ll get my peo- ple behind me, and I’ll come forward to do what needs to be done.” “Then you might end up in a legislative posi- tion?” I pursued. bog “Yes, probably,” Joe said. 19 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 If Joe thinks there is room for a person within the traditions of his nation to speak to the white community about the needs of Indi- ans, he will probably succeed in doing it. I think there is also room for the converse ex- change: a sincerely concerned white person can help the Indian community tackle white society and the problems it poses. Our summer at the American Indian Center was a start. Health Care in the Indian Community.—by James Drake (Medicine) Laura Simon (Medi- cine), Rosalyn Netzky (Nursing), Ellyn Mill- man (Medicine) In the past, several studies have reported on patterns of medical and health care in the Up- town neighborhood as a whole. Most notable of these is the Lepper-Lashof report of 1965, which proposed a system for establishing com- prehensive clinics like the Mile Square project. However, although the American Indian popu- lation of Uptown has increased greatly in the past 5 to 10 years, none of the studies has yet distinguished the Indians as a separate group; and indeed no one knew just what does happen to Indians as a group. At the request of the staff of the American Indian Center, we have tried in this survey to describe patterns of medical and health care among the Indians in the Uptown area. Indian families in the Uptown area, and a few in Lakeview, were located from a list of the names and addresses of families sending their children to the Indian Center day camp, families using the family services at the Indian Center, and families who are members of the Indian Center. House-to-house surveying was also used; each family was asked where its Indian neighbors on the block lived, and build- ing managers were asked whether any Ameri- can Indian families were renting apartments. A responsible member of each family, usually the mother or the father, was interviewed ac- cording to an interview protocol, the Health Questionnaire, The six interviewers on the pro- ject included three white medical students, one white nursing student, and two American Indian high school students. Major findings of this survey relate to the "20 population itself and to health care in the pop- ulation. One hundred and thirty-three inter- views were conducted, with single people and representatives of families, giving information about a total of 620 individuals. Of the people interviewed 113 had children, for an average of 3.4 children per family (a family is defined in this study as a unit consisting of at least one adult and the children for whom the adult is responsible). Some 67.8 percent of the families go to the American Indian Center occasionally, while 32.2 percent reported no direct contact with it. The ages of 91 individuals, mainly adults, were not determined, but the majority of the remainder were under 21 years of age, and the median age for the group fell between 6 and 10 years. Only 15 of the families had been in Chicago less than a year, while 48 had been in the city more than 10 years. The me- dian time in Chicago was 7 years, but this does not reflect real stability of the population, since many of these families do not regard the city as their true home. They look instead to the reservation or town they came from, and many who have been here a long time still talk about returning home as soon as they can af- ford it. Some of these families live under ex- tremely crowded conditions, with an average of four people in three rooms. Families of more than five people are more crowded, with an av- erage of eight people in five rooms. Thirty per- cent of the families have private telephones, while 70 percent do not have them. Data on the characteristics of the population tell only half the story. The other half, the half we set out to discover in the beginning of the study, concerns where these 620 people, half of whom are children, get medical care when they need it. Of the individuals repre- sented in the survey, 84.8 percent have a family. dentist while 65.2 percent of the individuals have no regular dentist. Physical illness re- ceives more attention than dental problems: 55.8 percent of the individuals in the survey have some private physician, while 29.3 per- cent depend on clinics, and the remaining 14.9 percent have no regular doctors. Of the families surveyed, 60 percent report having contact with a clinic in Chicago, while CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 40 percent have not had any contact with clin- ics for any family member. Of those using any clinics, 88 percent said they would go back to the clinic they had used, while 12 percent did not like their experiences with the clinic and would not go back. The clinics most used were the Maternal and Infant Welfare Station (35 interviews), Children’s Memorial Hospital (20 interviews), Arvey Clinic of Weiss Memorial Hospital (six interviews), and the Argyle Clinic, a private clinic run by a physician (five interviews). Hospital experience was quite similar to clinic experience. Some 66.4 percent of the families had a member in the hospital in Chicago at some time in the past, while 33.6 percent had no experience with in-patient ser- vices in the city. Of the families that had some contact with in-patient service, 84.8 percent would return to the hospital where they re- ceived care if necessary, while 15.7 percent did not like the care they received and would not return if they could possibly avoid it. The hos- pitals mentioned most often were Children’s Memorial (23 interviews), Cook County (17 interviews), American Hospital (15 inter- views), Cuneo Memorial (eight), Illinois Ma- sonic (six), Weiss (five), and Ravenswood (five). Most of the visits to Cook County, American, Cuneo, and Ilinois Masonic Hospi- tals were related to the birth of children, just as most of the clinic contacts reported were with the Maternal and Infant Welfare stations. Next in importance, in both clinic and hospital experiences, was Children’s Memorial Hospi- tal. Apparently the birth and subsequent health of children receive more attention than the health of their parents. , Of the individuals in the survey, 59.2 per- cent, a little over half of the population, are covered by some medical insurance. Thirty- eight percent have no insurance at all; the in- surance status of the remaining 2.8 percent is unknown. Of those who have any insurance, 31.8 percent of the individuals are represented by interviews which mention some unspecified form of group insurance at the father’s place of work. Since some of these plans do not cover the children, the figure for the proportion of the population covered by insurance is proba-- bly too high. The Medical Assistance—-No Grant (MA-NG) program, known as “the medical card” or “the green card”, takes care - of the expenses for a very small number and a number have medical coverage under Aid to Dependent Children or other public assistance programs for a total of about 30 percent. The Blue Cross-Blue Shield plan insures another 20.1 percent of the individuals; while the Bu- reau of Indian Affairs, the Army and unspeci- fied private companies provide for the remain- der. When we asked where people go to get all the medical and dental treatment they may need, certain patterns became apparent. Nearly one-quarter of the individuals represented in the survey have both a family doctor and a pri- vate dentist. Another 8.1 percent have a pri- vate dentist and a medical clinic where they go fairly regularly. The private doctor is the sole medical contact for almost one-third of the in- dividuals; a clinic serves as sole contact for 21.2 percent; and a dentist is the only regular medical contact for 1.7 percent of the individu- als. Of the people represented in this survey 13.2 percent are medically isolated, having no regular contact at all with any medical or den- tal facilities. No survey can be more accurate than the re- search technique used in gathering the infor- mation, and the present survey is limited in its accuracy for several reasons. Most serious of the limitations is the biased nature of the sam- ple of people: although we found some people who were not on the Indian Center day camp or family service lists by going door-to-door, most of the families contacted were on the day camp list. Thus there may be more small chil- dren in our survey population, and fewer old people among those contacted, than are really present in the Indian community. We met no one over the age of 65, and no one on Medi- care; but old people may form a higher propor- tion of the real community than they do of our small sample. A related difficulty is that of find- ing working families during the brief times when they are at home: most of the surveying was done during the day, and many people were at work. Since the survey was conducted 21 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 _ during the summer, it probably also missed a number of families who spend their winters in the city and their summers “back home.” A further difficulty with our survey is the lack of experience of the interviewers in conducting such a project. Often our lack of experience led us to accept imprecise statements without ask- ing for more details. As a result, our notation as to the number of people in each family who are actually covered by the father’s insurance policy, the number of people in the family who actually go to the same clinic as the mother, or the number who have actually been in the hos- pital themselves, is not accurate. Some family histories were allowed to remain incomplete because we did not notice the gaps in our infor- mation. In general, the white students did not feel that racial fear or prejudice were affecting the interviews they conducted, so that problem probably has not affected our results. Within the limitations of non-random sam- pling and errors introduced by a lack of expe- rience, we feel that this survey points up some of the urgent health needs of the community. Almost two-thirds of the people lack dental care, both by their own report and by the ob- servation of the interviewers who noticed that many had very bad teeth. Besides lack of edu- cation on the necessity of dental care, a major factor in the lack of such care seems to be economic: teeth just are not worth the money one has to spend to go to the dentist. We there- fore suggest that a low cost dental clinic be es- tablished, on a plan similar to that used by some private. hospital clinics of scaling the fees to the patient’s ability to pay, to provide dental care for Indians as well as for others in the Uptown neighborhood. Vigorous education may help encourage people to use the existing facilities more; but when expense is a barrier, the only facility in the area is the McCormick Boy’s Clinic for children; and a public facility of some sort could provide adequately for their parents. Many people who had rather casual contact with large out-patient clinics, like those at Illi- nois Masonic and Children’s Memorial hospi- tals, complained that they had to wait for long periods and that they never saw the same doc- 22 tor twice. We realized in talking to people that some children—and adults, too—had not re- ceived adequate followup care for the problems that first brought them into the clinic, partly because there was no continuity of doctors from one visit to the next. We suggest that a family service clinic, such as the small service now being organized by Illinois Masonic Hospi- tal, might help meet this need. The clinic need not be associated with any particular hospital, but it must have cooperation from the institu- tions in the area. Each family should have its own private, or, to use the fashionable jargon, “primary” physician within the clinic. He should have specialists available in a referral service, but the primary physician should be the family’s main contact with the clinic and should take the major responsibility for all their medical problems. If a dental service could be associated with such a clinic, a truly flexible and comprehensive health service might be available. Such services might be financed partly by contributions from private charities or by the government, although efficient consolidation and use of expensive equipment like X-rays might cut the expenses to a point where a pay-as-you-can plan could enable the patients to support much of the clinic cost. A person who is ill and unable to work can- not afford medical expenses; and the medical aid programs of the city welfare system, while they do help many people, still do not meet the needs of all the medically indigent. Since it was apparent to the interviewers that some people did not quite know the uses of medical insurance or of the medical card, we suggest that a public education project in these techni- calities, as well as in the intricacies of getting service from existing medical and dental clinics, might help people take fuller advantage of the resources available to them now. A long-term goal that might be useful would be to establish a major medical insurance plan at low cost for people who need some insurance coverage and who do not qualify for the MANG program or other public funds. Improvement of health care for Indian peo- ple in Uptown seems to rest ultimately on two CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 cornerstones which have been repeatedly men- tioned: economics and education. Low-cost medical and dental care and insurance should certainly be available for people who need them; perhaps such facilities are already available in the city and could be attracted to set up agencies in Uptown. This study has not delved into the available facilities, although some fragmentary information about them is available from previous student health pro- jects. But even the best facilities will stand idle if people are not helped and educated to use them. We think it is important for the community to establish a health committee which could do research on the available facili- ties, help educate the people in the use of these facilities, keep track of complaints about bad treatment, and serve as advisors to educate the clinic personnel on how they could serve the Indian community better. In the long run, the ‘only clinics that will really succeed in Uptown or any other community will be those in which the people of the community themselves deter- mine and control clinic policies so the clinic functions to serve them best. We believe, from our encounters with various clinics in Uptown, that it is just as important to educate the doc- tors to this aspect of the running of clinics as it is to educate patients to other aspects of clin- ies. It is a job which only people from the com- munity can do. Lincoln Park Community area 7, Lincoln Park, has been subdivided into 7A and 7B. Median family in- comes for all the census tracts in 7 ranged from a low of $5,344 to a high of $7,088. How- ever, the percentage of families with incomes under $3,000 varied from one with 7.3 percent to the highest with 29.1 percent of its families earning incomes under poverty levels. (2) Area 7 is considered a zone 3 poverty area by CCUO criteria, However, area 7A was not considered & poverty community while 7B was considered to be a poverty area. Area 7B was ranked in the 2nd quartile for numbers of deaths from pneumonia and in- fluenza for infants and non-infants and also for deaths due to unknown and ill-defined causes. It ranked in the 8d quartile for deaths from cervical cancer and for newly discovered cases of tuberculosis. ‘(2) Therefore, while Lincoln Park is not, one of the inner-city’s deepest poverty zones, it pre- sents many health problems to which the stu- dents in the SHO project addressed them- selves, The students conducted a health survey of residents of the community; they reviewed the area’s hospital out-patient and emergency fa- cilities; and they arrived at several conclusions and recommendations. The entire report (which also describes the ethnic composition and other parameters of the population) is pre- sented. “Just Getting By’—an Analysis of Health Care in Lincoln Park.—by Susan Soboroff (Medi- cine), George Spinka (Medicine) Lincoln Park is a community made up of many different kinds of people. Compared with the rest of the North Side, its population has a relatively low median income. Yet it has within and near it a variety of health institu- tions and many practicing physicians. Is it true, then, that everyone is receiving good health care, regardless of their income? Do barriers exist that keep certain people from getting the best possible medical care? Are there problems unknown to city health depart- ments that do not appear in incidence of dis- ease statistics or mortality rates? Are there needs, especially among minority groups, that have not been recognized or adequately dealt with by health professionals, who are devoted to “serving the people’? To answer these questions we asked the peo- ple of Lincoln Park who are directly involved in health care problems. A survey was taken among a sampling of the lower income resi- dents and among hospital administrators. Their answers point to the need for better com- munication between these two groups. The purpose of the questions asked of the people was to find out: 1. How the people went about meeting their health needs. 28 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 2. If they thought these Means were ade- quate for their needs. If not, why were they not adequate and how could they best be im- proved, 3. How well hospitals and other health facil-. ities in the area were being used. 4, What the people thought of the treatment they received at these institutions, 5. How the health attitudes and needs of the people related to their social and economic sit- uations. . The method of inquiry was a questionnaire in interview form designed to document certain facts, but also leave room for as much informa- tion about health care as people wished to give, The questions tried to bring out the attitudes and opinions of those who answered, as well as facts and figures. A total of 176 people were interviewed within an area bounded by Larrabee, Fremont, Armitage, and North Avenues—a total of about 16 city blocks. A smaller area in north- ern Lincoln Park was also covered between Or- chard, Halsted, Diversy, and Wrightwood, and Lill between Seminary and Racine—together about six blocks. Usually, 10 families per block were interviewed. The sampling is not random, for we spoke only to the people who were home during the day and who were willing to answer our ques- tions. On many blocks this biased our respon- ses toward the large Spanish families in which the mother was most likely to be home and most receptive to us. The southwestern part of Lincoln Park was chosen as a sampling area deliberately, because the population is the most varied socially and economically. Thus it was thought the main health problems would be concentrated here, ‘That these problems occur in other parts of Lincoln Park is shown by the interviews from the northern areas, Many of the statements made below, other than the statistics, are subjective impressions. They come out of personal contact with the people and with their surroundings. We feel that this can only add to the figures, however, 24 just as the individual examples illustrate the reality much better than the statistics can. We did not wish to document the state of health of the people, though many diseases were found. Rather, we want to consider the social, psy- chological, and economic problems that are in- volved in getting medical care. The questions asked of five hospital adminis- trators were not systematized. Specific ques- tions about their available facilities were de- signed to bring out their awareness of the com- munity’s needs and their willingness to meet them. Planning for the future was an impor- tant area of concern. We have tried to evaluate from these answers, the hospitals’ attitude to- ward the Lincoln Park community and what their role will be in future planning for the community. The total number of people interviewed was 176. They frequently will be broken down by ethnic groups: white 88; Spanish 70; blacks 18. The types of health care received by ‘all roughly fell into three general categories, The first was the most secure, in which the people had hospital insurance and a family doctor, a ‘ private physician whom they see regularly. The second group of people were “just getting | along” in their health needs. The type of care | they received was usually fragmented, crisis- oriented, and often too costly for their incomes. They sometimes held hospital insurance, but could not afford large hospital bills, They often cited a private physician, but saw him only when they were ill. Many in this group used clinics and might be on welfare. Those in the § third group either have no knowledge about | ‘health facilities available or no concern about §f them. They had no private physician or health insurance, or hadn’t seen a doctor in many years. The breakdown of those interviewed into the three groups are: Percent Total Whites Spanish Blacke Have family doctor and insurance _._.__.___.. 81.45 16 12 Just getting along _____. 60 48 72 16 | ; No knowledge or concern. 9 4 12 122% Total .......__. -- 100 100 100 100 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 The majority of the people interviewed fall into the second group. A. significant number fall into the third. group. The whites are fairly evenly distributed be- tween the first and second groups, but the Spanish and blacks fall mainly into the second. To some extent, length of time in the com- munity determines the kind of health care re- ceived. Familiarity with services available and positive experience with them often lead to better care. The dynamics of the population are: . Percent Total Whites Spanish Blacks In area 1 year or less _... 20 12 25 41 In area 1 to 5 years ____- 36 24 49 41 In area over 5 years ____- 44 64 26 18 Total... 2 LL 100 100 100 100 The majority of white are well established . in the community. Many of the Spanish are relatively new and nearly a quarter are very new. The blacks are the newest to the area, few having lived there over 5 years. Health insurance is an indication of income. level and of attitude about health needs. Percent Total Whites Spanish Blacks Have insurance ___..____ 60 13 51 50 Self-paid ...._-_..._____ 25 12 40 25 Welfare and Medicare ___ 15 15 9 25 Total __.._...____ 100 100 100 100 A slight majority of the people have insur- ance; with welfare and Medicare, 75 percent are covered by third party payment of some kind. This leaves 25 percent of the people who must pay for all health expenses themselves, The distribution of insurance among the eth- hic groups differs significantly. Having a private physician and seeing him regularly is the ideal form of health care in our society, This is our definition of a family doctor, He must have an interest in the health 88 well as the disease of the whole family. Percent . Total Whites Spanish Blacks Have a family doctor _... 50 70 36 18 Use a private doctor ..__ 26 12 36 41 Use no private doctor ... 24 18 28 41 Total _..-.------- 100 100 100 100 One half of the people have a family doctor, One quarter see some private physician, and nearly one quarter see no private doctor at all. A large majority of the whites have a family doctor, though a significant number have none. The majority of Spanish and blacks do not have family doctors. The blacks have the high- est percentage without a private doctor of any kind. Dental care is the least health concern. Most people who see’a dentist go only when they have trouble; many others do not go, even when they have trouble with their teeth, for a variety of reasons—money, time, discomfort among them. Percent Total Group I Groupll Group Lil 94 (58) 44 16 18 Do not see a dentist _ 68 (39) 46 82 82 Use a dental clinie _ 14 (8) 10 3 -- Total _.._---- 176(100) 100 =: 100 100 See a dentist .____. Nore—Numbers in parentheses are percentages of total. Most of those who have seen a dentist fall into group I. Those who are “just getting along” in group II usually do not see a dentist. Use of private doctors and clinics show some of the patterns for attaining medical care. The heavy use of clinics is evident. Total Use private doctor only ..2......---.-2---- W1 (44) Use private doctor and clinic _........__._- 64 (40) Use clinic only ..-____---.--.------2------ 20 (12) Use no doctor or clinic -..-_...-.....----. 4 (4) Total ..__.--.-----2----- eee eeee ee 159(100) Nore.-Numbers in parentheses are percentages of total. . Nearly half of the people see a private doc- tor only; the majority of these are family doc- tors. . 25 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 Almost as many use both clinic and private doctors. More than half of the people use a clinic. Answers relative to emergency care show knowledge of and confidence in the area hospi- tals. Had experience at hospital named -------------- 60 Had no experience at hospital named ----------- 19 Named clinic or private doctor ----------------- 8 Didn’t know where to go --------------------777 18 Total ...-------------e ccc 100 A substantial percentage of the respondents have had previous experience at a hospital and would rely on its emergency room. 18 percent did not know where they would go in an emergency. Use of the area’s hospital out-patient and emergency facilities. The totals for emergency room are the number of times it was men- tioned, not necessarily used. Hospital Clinic Emergency room Children’s Memorial ----------- 40 25 Grant _--------------------- 13 26 Illinois Masonic -.------------- 12 18 Northwestern ----------------- 8 5B County ._--------------------- 5 10 St. Joseph ...----------------- 8 7 Augustana cece enececeeneeeeee BB 15 Alexian Brothers .---------------------- 7777777 5 Henrotin, Roosevelt Memorial ------------------ 2 American, Columbus --.---------------------077 8 Total __------------------ 7-7 - or 116 Clinics used most frequently are Children’s Memorial, Grant and Illinois Masonic. Heavy use of Children’s indicates an empha- sis on child, rather than adult care. Hospitals such as St. Ji oseph and Augustana are mentioned more frequently for emergencies than clinic usage. Group I: Those people classified in group I in general have their medical needs well taken care of. They meet four basic criteria. First, they receive preventive medical care, usually from a family doctor to whom they go for reg- ular checkups. Second, they are able to finance extended sick care treatment either through private health insurance, Medicare, a welfare 26 medical grant, or prepaid union clinics. Third they are knowledgeable about the existing health care facilities in the community. Fi nally, they see the need and importance of 7001 medical care and are conscientious in attempt ing to obtain such care. A profile of a typical group I subject woul: include the following characteristics: White well-established in the neighborhood—ofte having lived there more than 5 years—steadil employed as 4 white or blue collar worke: businessman, or professional ; has a famil doctor, very often located outside of the Lir coln Park area; tends not to use out-patier clinics; if he does use a clinic it is most likel to be Children’s Memorial, Augustana, Northwestern University; has a dentist; h< health insurance; knows of a local hospital - go to in an emergency, most likely Grant « Augustana. ‘ Group I families are more likely to | smaller, with fewer pre-teen children th: group II or group III families. There are al many senior citizens within the group, who a likely to be taking advantage of or relying : Medicare when they are ill. In conclusion, t most significant fact about the group I subjec is that they are only 32 percent of the tot sample. Group II: Many different types of people 2 in the category of those who are “just getti along” in health care. They have neither family doctor nor health insurance, our ¢ teria for being medically secure. Most of th: have had some experience and have s0i knowledge of health facilities in the area, i would like to know more. Two definite patte: do appear within this group, one for the Sp: ish and another for the black population. general description of each as well as spec examples from the survey follows: The Spanish-speaking Americans are re tively new to the area; most have lived th less than 5 years. Some adults speak no, very little English. Families tend to be lat with many young children. Almost all of men work, usually as factory workers or t. own small businesses. Very few are on welf: CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 About half of the people can afford health insurance; the others must pay all their medi- cal expenses themselves. They prefer to see a private doctor who speaks Spanish and who is geographically close when they are ill; few of these physicians are their regular family doc- tors. The Spanish utilize clinics whether or not they have a private doctor. Those with chronic conditions are especially likely to use a clinic, and families with young children very often go to Children’s Memorial. The infant welfare station on Halsted and the clinics at Illinois Masonic and Grant hospitals were also well used. They would turn to these in emergencies. Most of the Spanish people do not have a dentist, but some wanted to find inexpensive ones, Children had received immunizations ei- ther at the clinics or in school. On the whole, their attitude toward health care is conscien- tious, but few can afford the cost of a regular family doctor or even insurance. Language barriers also keep them from dealing with large, unfamiliar institutions and from obtain- ing more information about available facilities, Women with many small children and working husbands have difficulty getting to doctors and clinics, even when they are very ill. They would benefit by having a neighborhood clinic that offered a comprehensive and personal, family-oriented approach to health care. Some examples of the Spanish interviewed: 1, Mr. S. has seven children and has lived in the area 2 years, His take home pay comes to about $80 a week. They have no family doctor, but he brings the children to two frequently named Spanish-speaking physicians when they are ill, One child with a heart condition is about to be operated on at Children’s Memo- rial. Mr. S. must take the child to the clinic each week, His insurance will cover the boy’s hospitalization, but it does not pay for private Office visits. His wife delivered at County Hos- Pital.: The family has no dentist. In an emer- » they would calt their doctor. Mr. 8. like to see more convenient clinic facili- the area. S. has five children and has lived in the community 9 years. She normally goes to one of the Spanish-speaking doctors first when she is ill. A school nurse suggested that she ' take her children to St. Joseph’s eye clinic for glasses. When she registered three children there they received complete physical exams. She has gone to the infant welfare station and to hospital clinies for prenatal care. Her den- tist is in the area, and her husband has Blue Cross insurance from work. In an emergency, they would go to St. Joseph. 3. Mrs. C. has nine children and has lived in the area for 8 years. Her husband works as a laborer and must pay for all medical expenses himself. He goes to one of the Spanish-speak- ing physicians only when he is ill, but the chil- dren are seen regularly at the Children’s Me- morial clinic. These visits cost only $1, but there is a long wait. Mrs. C. received prenatal care at the infant welfare station and was de- livered at County. They used to see a dentist at Casa Central, but can not afford it now. In an emergency they would go to Children’s Memo- rial or to county and not to Augustana, where the expense, they said, is too much. 4, Mrs. H. has seven children. She does not speak English and has lived in the area for 5 years. She brings her father to a Spanish- speaking doctor when he is ill. These visits cost between $5 and $8. Her children were born at County and Illinois Masonic hospitals. They do not use a clinic, and she would like to know more about clinic facilities in the area. They have no dentist, and she does not know where she would go in an emergency. One child had stitches taken at Grant where, since they have no insurance, the cost was too high. Although conscientious, the health picture of the average Spanish family is a confused ‘one. One or two private doctors, sometimes a number of clinics, different hospitals for deliv- eries, emergencies, and chronic conditions, and no place for regular care. Neither private phy- sicians or hospitals are concerned about the welfare—healthy and diseased—of the whole family. Even small emergency costs are often a burden, and extensive hospitalization is impos- sible for them to afford. Government programs such as Medicaid do not pay for these ambula- 27 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 tory services, and their low, but regular in- come usually makes them ineligible for poverty grants. In addition, these programs and clinic facilities were often unknown +o the Spanish. The blacks in group IL live, for the most - part, south of Willow. They are newer to the area than the Spanish; very few have lived there more than A years. Families tend to be small and occupations range from laborers to mailman to laid-off. A number are on welfare. The average person does not have a family doctor or even see a private physician. More often they turn to a clinic when they are ill, and the clinic is very likely to be Cook County Hospital clinics or Children’s Memorial. For prenatal and infant welfare the Board of Health clinics are used. Most of the families are covered by some form of insurance-hospitalization or welfare medical grant. They rely most often on County Hospital in an emergency. The only other hos- pitals used are Henrotin and Roosevelt, both known for the integrationist policies, and a few private clinics on the near north side. They usually do not see 2 dentist pecause of the cost. From the brevity of their health care de- scriptions, the biacks do not seem to have much experience with the different health fa- cilities in the community. Cook County Hospi- tal is always available, and, though many are dissatisfied with it, they continue to use it. The private doctors they see are mostly wel- fare physicians located near the Cabrini Hous- ing Project who see far too many people a day to be practicing good medicine. On the whole, then, their attitude seems to be a resigned one, giving health care a lower priority and getting help wherever they can when sickness or in- jury develops. Some typical examples of the blacks interviewed are; 1. Mrs. B. has lived on Burling 1 year with her one small child. She has no family doctor, put she does take her child to Children’s Me- morial clinie once @ month. Her child has been seen at the infant welfare station also. For prenatal care she went to the Cook County Hospital clinic and was delivered there. They 98 have no dentist. Mrs. B. is on welfare and has 2 medical card but would still travel to County Hospital in an emergency. Her experience there in the past was not good. 2. Mrs. L. is @ young mother of three anc has lived in the area 2 years. At present het husband is looking for @ job. They have nc family doctor, but do have hospital insurance She had experience at St. Joseph clinic wher the board of Health clinic sent her there as @ high risk pregnancy. For the delivery ghe wen: to Passavant and was treated well. She doesn’: know of 2 dentist in the area or of a clinic where her older children can get shots. She has used Children’s Memorial clinic in a emergency, but would rely on Cook County i the future. 3, Mr. L. has lived in the area for 2 year with his wife and two small children. His wif now supports the family. When ill, he goes to: physician on Chicago Avenue or a to a medice center on Division. His children were porn a County Hospital and his wife received no pre natal care. He does have health insurance. H would go to Henrotin in an emergency wher he has been treated for injuries in the past. 4. Mrs. S. is the mother of two children. He sister has supported her for the 2 years the: have lived in the area. They have no health in surance and no family doctor. She has gone t a doctor on Clybourn and to clinics at Count and Children’s Memorial hospitals. Her chi: dren were born at County and they would prok ably go there in an emergency. Some of the whites in group II might best b described by a few examples. For them, th main problem in getting good health car seems to be expense. 1. A family in northern Lincoln Park wit two children has been in the area for 3 years The husband does construction work. The ir fant gets regular care at the Diversy Clini and the older one is seen at Tilinois Masoni clinic. For the last delivery at Tilinois Masonic which was a cesarean section, their insuranc covered $200 of the $1,100 hospital bill. The would go to Tilinois Masonic in an emergenc} 2. Mrs. S. has a family of six in norther CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 incoln Park. They had a family doctor until cently, but can’t afford one now. She takes sy children to Children’s Memorial clinic. Her st three were born at home, and they do not ave a dentist, both because of the expense. he family is covered by Blue Cross, but it oes not pay for all of their medical costs. She rould like to have more low cost and conven- ant clinic facilities and to know more about he health facilities now available in the area. Group III: Subjects in group TiI are the east well taken care of. They receive little or io regular medical care. They are often new irrivals in the community. They are usually S$panish and speak little English, or black. Chey have no family doctor, although they nay know of a doctor whom they can go to when they are sick. They generally have no nealth insurance and do not know of a place to zo in an emergency. Most do not know of, or use, any outpatient clinics. Finally, they re- ceive no dental care. Some specific examples may shed some light on the special problems of the group III peo- ple: 1. Mrs. A. is Spanish. She has two children ages 6 and 7 and has been in the area only 8 months. She has no regular family doctor, but takes her children to a doctor on Clark and Division in time of illness. She doesn’t know of any clinics in the area, nor does she know where she would go in an emergency. She is on welfare and has a medical card. Her problem is basically lack of knowledge of the existing medical facilities in the area, for she is new in the area and has difficulty with the language. 2. Mrs. B. also is Spanish and has five chil- dren between the ages of 9 and 16. Her hus- band is a painter, and they have lived in the area for 2 years. They have no family doctor, and do not use any clinics; they do visit a doc- tor on North Avenue for minor illness or inju- ries, They have no insurance. Their problem is primarily financial. The husband is working and earning too much to qualify for welfare grants. Yet his income is still too low to cover the xpense of a family doctor or health insur- 8. Mr. C. is white and has lived in the area for 18 months, He is unmarried and works as a teacher. He does not see any doctors, nor does he know of any in the area. He doesn’t use, or know of, any clinic although he does have health insurance. His problem is not a financial one, nor is it really a lack of knowledge. It is simply an indifferent attitude towards medical care—a belief that it is unnecessary and unde- sirable to guard his health through regular visits to a private doctor or clinic. 4. Mrs. D. is white and has peen living in the area for 1 year. She has three children ages 2, 3, and 5. She and her family do not see any pri- vate doctors for the reason that they cannot af- ford to. They do not have insurance for the same reason. The only medical facility which her family uses is the infant welfare station on Clark Street. This family is obviously in need of information about the available clinic facili- ties that are designed to serve low income fam- ilies. In conclusion, the people in group TII receive inadequate medical care for one or a combina- tion of the following reasons: They cannot af- ford adequate care; they do not know what fa- cilities are available to them within their in- come range; they fail to see regular care as im- portant or necessary; they are reluctant or afraid to use institutions that are unfamiliar to them. There are seven hospitals in or very close to Lincoln Park. They range in size from Roosev- elt Memorial with 125 beds to Illinois Masonic Medical Center with 544. They range greatly in origins and in the kinds of services pro- vided, thus in character. Columbus, for exam- ple, has no out-patient clinic, but Grant has been providing clinic services for many years. Does a private hospital have an obligation to change its character to fit the changing needs of the community around it? We believe that it does, and we have evaluated the answers of hospital administrators within this context. For the most part, the. hospital is run by a board of directors who are representative of wealthy business interests on the North Side. An exception is St. Joseph whose board is 29 CHICAGO STUDENT HEALT: made up of nuns but, they are advised by @ board of community businessmen. Nowhere on these boards or advisory groups are the lower income people or their interests represented. An exception is the model clinic run by Chil- dren’s Memorial at the Cabrini Homes. Up until now, however, the advisory poard of Ca- prini residents has had only a minor role in the clinie functions and do not have the legal res- ponsibilities or interest of a true poard. As a result, the clinic is having serious problems in relating to the community. The private hospital can avoid looking out the window under the pretext that its medical staff determines the makeup of its clientele or inpatients. The results of this and other stud- ies, however, point to the pressing need for more and comprehensive ambulatory or out-pa- tient services. Five of the seven hospitals offer out-patient services in varying degrees. The three largest are open every day all day, al- though one still works on the old no-appoint- ment system. The two others operate for a lim- ited time with volunteer staffs. This is an out- moded, charity-clinie way of offering service. Tt has no place in a health delivery system that must move toward more ambulatory, compre- hensive care provided to all that need it at the hospital level. The emergency room is open 24 hours a day _ in each of the Lincoln Park hospitals and to anyone who needs it. A few of these are seri- ously overcrowded, especially after clinic hours; these are the same hospitals that are well known and trusted for their out-patient facilities, staff of community physicians, and acceptance of minority groups. Much of the ov- ercrowding could be relieved by other hospitals in the area, and by extending clinic hours into the evening and weekends, The need for non- emergent ambulatory care after clinic hours was shown by the fact that out of 8,200 pa- tients seen at the St. Joseph emergency room, only 26.6 percent of these were trauma or ur- gent cases. Similar stories were told at each of the other hospitals. One method for lowering hospital costs is to coordinate services with other institutions so that expensive facilities are used in the most 30 H PROJECT SUMMER 1968 efficient way. The Lakeview-Lincoln Park Hos- pital Planning Council is meeting now and trying to avoid duplication of services among the area hospitals. The council also has the po- tential to plan an efficient health delivery sy8- tem that would reach everyone in the Lincoln Park area, but has few plans like this. They should be discussing how the hospital can par- ticipate in community affairs and how the com- munity can participate in hospital affairs through free interchange of ideas between the council and the people. An awareness of theit needs and a willingness to listen to their sug- gestions and deal with them should be an inte- gral part of the council’s activities. Illinois Masonic.—The administration 0: the large, recently named, medical center is alone in its commitment and involvement witl the community around it. It is in direct com munication with Lakeview organizations ant agencies, and the hospital takes a leading rok in community affairs by serving the needs. Some examples of the wide array of service it provides are: an extensive outpatient clini that emphasizes personal care, and which of fers both sick and well care; a free Pap smea program ; physical exams for public schoo. children; psychiatry courses for local clergy Spanish and English courses for hospital pez sonnel. In the near future Illinois Masonic plans t build a large addition devoted mainly to ambt latory services. Tt will include a family prac tice program in which interns will be respons ble for the health of five clinic families fro the community. In this way general pract tioners on the staff can teach the lost art ¢ family doctoring while whole families recei\ thorough and personal care. If all of the hosp tals in the area participated in a program. lik this, a much more significant part of the lowe income population could be reached. St. Joseph.—The hospital was founded ar is administered by 2 Catholic order, th Daughters of Charity whose goal was orig nally to “serve the poor.” The attractive ne facilities do include a clinic with a wide ran; of specialty services, but its hours are limit CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 nd its existence ig little known. The Board of {ealth also runs a referral clinic there for high isk pregnancies and very ill infants. Its loca- ion, however, has kept it out of reach of the eople who need it, Better public relations and each-out programs would help to make it nore widely known and used. The administrator is head of a long-range jlanning committee to define the hospital’s role n health care of the city. Nowhere do com- nunity organizations, churches, schools, or in- lividuals appear on this committee to partici- pate in the planning. However, the council is seeking the people’s 4nvolvement in a referral service that was suggested for the Cabrini Homes. They want to improve medical care by sending patients to existing facilities and thus making the best use of these resources. Sister Vincent hopes to find interested members of the community to participate in this project. Children’s Memorial.—Children’s is a pedia- tric hospital that serves the entire North Side. Its major service to the community is a large outpatient clinic that is widely used. Long waits and only daytime hours are complaints that the administration is aware of and trying to improve, though slowly. The hospital also operates a neighborhood clinic on the near North Side that offers both sick and well care without charge, unlike the hospital clinic. The clinic claims a community advisory council, but the residents have little real say in how the clinic is run. In this sense, the administration of Chil- dren's seems only slightly open to ideas of com- munity participation in or even community communication with the hospital. It is aware of some of the problems, but has taken few steps to improve the situation. Grant—Grant has a history of providing outpatient services to the community. It is ‘Planning to expand these facilities in a new building and even now is equipped to take _ More patients. A problem for the hospital is how to make the people more aware of the fa- ties that are available. We suggest that they e themselves, as Illinois Masonic has, community organizations, churches, schools, etc., and take a leading role in com- munity affairs. Better communication and un- derstanding will lead to better utilization of the clinics and, of course, to better health. The medical staff at Grant is representative of many ethnic groups, and includes a number of physicians who practice in the Lincoln Park area. The hospital also trains many paramedi- cal personnel, technicians, and nurses. It is very active in future planning on the Lincoln Park-Lakeview Planning Council. Augustana.—Since it is owned by the Lu- theran Church, Augustana serves patients from a wide area. Only one-half of the hospi- tal’s inpatients come from Lincoln Park or con- tiguous zones. Today it offers little to the lower income people of the Lincoln Park area. Its new clinic operates on a referral basis for ob- stetrics and medical problems. The clinic is not being used to capacity, and the emergency room is not crowded. Augustana plans a large expansion program and has already acquired much land from Urban Renewal agencies. The hospital has purchased and torn down “slum housing” to put up more inpatient facilities. According to a Hospital Planning Council report, no more beds are needed on the North Side. According to us, more ambulatory, low-cost services are needed. Clearly, Augustana is not moving to meet the needs. On the basis of interviews with people of the community and with local hospitals, the fol- lowing conclusions and recommendations are offered. 1. The ideal of good medical care is in a large measure defined by the concept of prev- entive medicine. Preventive medical care in- volves safeguarding the health of the individ- ual and the family through regular visits to a qualified physician who is familiar with the medical history and special medical problems of the family members. The results of the sur- vey show that comprehensive care of this kind ig not a reality for many of the people inter- viewed. Only one-half of these people have a family doctor. Roughly one-fourth have con- 1 All emphasis, the students. 31 CHICAGO STUDENT HEALT tact with a private doctor, put only go to him when they are ill or injured. Finally, one- fourth of those interviewed have no contact with a private physician and must receive all their medical care at clinics, emergency rooms, or not at all. 2. Economics obviously play an important role in the kind and quality of health care re- ceived. Those most seriously affected by their ability to pay are not the indigent or unem- ployed whose medical needs are paid for by the government, put rather they are the people in the lower middle income range. These people earn too much to qualify for any kind of gov- ernment assistance, and in some cases to be el- igible to use outpatient clinics. Yet they cannot afford the cost of a private physician, dental care, or extended hospitalization. Even when these individuals have health insurance, the policy usually does not pay for preventive, am- pulatory, or dental care, and it does not pay the entire cost of hospitalization. Moreover, @ quarter of the people do not have health insur- ance of any kind. To sum up, most of the peo- ple in group 2 are “just getting along” because of their inability to pay for good medical care, and their situation applies to more than half of the people interviewed. 3. There are differences in the quality of medical care received according to racial and ethnic groups. For instance, 43 percent of the whites interviewed fall into group 1, while 16 percent of the Spanish and only 12 percent of the blacks are in this group. The large major- ity of Spanish and blacks fall into group 2. The reasons for these differences are in part financial; the minority groups generally find themselves in the lower income brackets. An- other reason is that white people are more knowledgeable about the facilities which are available in the community for they have lived there longer on the average. A third reason in- volves attitude and cultural factors. Many of the Spanish people are isolated from the white society by their language and unfamiliarity with American life. They are frightened and embarrassed by large institutions, and may be reluctant to seek help unless they are very ill, For the black people who rely heavily on 82 H PROJECT SUMMER 1968 County hospital, some reason—be it discrimi- natory policies, unfamiliarity, or simply force of habit—has kept them from taking full ad- vantage of the health facilities available in Lincoln Park. 4. The kind of dental care received is an- other index of the quality of general health care. Among the people interviewed, regular dental care was rarely reported and occasional care was received by only half. Roughly 40 percent received little or no dental care. 5. It must be emphasized that 10 percent of the people interviewed made up group 3, and received little or no medical care at any time. 6. On the basis of hospital interviews, it is obvious that a general lack of communication exists between the hospitals and the community. True grassroots community representation or hospital policymaking and planning boards is nonexistent. As @ result, hospitals have ig- nored the immediate area or are attempting tc define its needs without consulting its needy people. A number of the hospitals are moving ahead with expansion and building plans which at this time are not the most effective solutions to the community’s health problems On the basis of the preceding conclusions, ¢ number of recommendations for future courses of action aimed at improving medical care car be made. 1. Hospitals should expand their existing clinic facilities; all future building and expan- sion planning should include provision for more ambulatory, low-cost services. The leac in this area has already been taken by Illinois Masonic Hospital, which is planning a $5 mil- lion addition devoted mainly to ambulatory clinic care. 2. Hospitals should take steps to enable more people to use clinic facilities. This would in- volve extending clinic hours into the evenings and weekends, 80 that people who work or have small children can make use of them. 3. Hospitals must reach out to the commun- ity and assume an active responsibility in per- suading the public to take advantage of their facilities. As a first step they can make their services known through community newspa- CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 xs and by distributing information directly community organizations and agencies. They ould also work to remove the psychological wriers which keep people away by hiring ore Spanish speaking, Oriental and black edical personnel. The impersonality of the inic could also be improved by assigning each atient to his own doctor. 4. Hospitals must undertake more imagina- ve programs aimed at low-cost preventive iedical care for the community. Illinois Ma- onic is again leading by developing a family yactice program. All teaching hospitals in the rea could and should experiment with similar wograms. 5. Hospitals in the area must build and ex- yand true channels of communication with the ommunity if they are to serve its needs. This ices not mean talking only with associations of ocal ‘businessmen or professional people. It neans dealing with organizations that have di- rect contact with the average person. In Lin- soln Park these would include the Northside Action Group, Neighborhood Commons Corp., Concerned Citizens of Lincoln Park, C.B.C.A., block clubs, churches such as St. Teresa’s and Mt, Olivet, welfare unions, P.T.A.’s, settlement houses such as Christopher House, Wright- wood Center, J.Y.D.C.’s, boy’s club, etc. It is only through such dialogue that the health needs of the community can be accurately as- sessed and appropriate solutions developed. Only through dialogue and direct participation of the people in planning and implementation can projects aimed at improving health care have any hope of success. The above are steps that can be taken now for improving medical care. In response to the questionnaires specific suggestions and com- ments were made that bring out the needs of the community. Some of those mentioned are: 1. A general neighborhood clinic for the whole family. 2. Homes for retarded and delinquent chil- dren. 8. School nurses and visiting doctors. . 4, A referral service for medical problems. 5. Better housing. . 6. Doctors should be more personal and give the patient more information about his illness. 7. Hospitals bills are too expensive. A school-community representative who is deeply involved in the medical problems of the children at Arnold and their families and is a mother herself gave these suggestions: 1. Where to go when the children are handi- capped and are turned away from schoo]. 2. How important it is for family to have TB X-ray once a year. 3. Where to go when your child is retarded. 4. How important it is to have a diabetic test. 5. How important it is for younger girls and women to get prenatal care as early as possi- ble. 6. Whom to get information for psychiatric help. 7. Our neighborhood needs to know where to go for Alcoholics Anonymous help. 8. How important children’s eyeglasses are for them in and out of school. Where to go and find out if parents also need glasses. 9. Need for more dental care. 10. Medical care for fathers who are along with children or grandparents also (i.e. clinic hours open after regular working hours). 11. Health Fair should be in the community centers at least 2 days pefore moving to an- other center until all centers in the community are covered for i or 2 weeks at least. 12. Cab service for people who are alone and can’t travel by themselves. This community representative’s suggestions emphasize the need for more information about available resources and educating people to take advantage of them. Psychiatric help has not been dealt with in this report, but the need for more and better facilities has come up fre- quently. The Health Fair sponsored by the J.Y.D.C. last spring was successful in helping to educate the people as well as screening them for a number of diseases and disabilities. How- ever, its effect on the community was limited by its single location and short duration. Longer and more widely distributed fairs of 33 CHICAGO STUDENT HEALT this sort would have a greater influence on the health of all of Lincoln Park. Other communities and groups have worked toward better health care through more exten- sive and long-range projects, such as prepaid group practices and neighborhood health cen- ters. Some information concerning these fol- lows as well as our evaluation of their applica- bility to Lincoln Park. In any discussion of long-range solutions to improve the health of an entire community, prepaid group practice plans or health insur- ance offering direct medical services should be explored. Essential to such a plan are: (a) The people who subscribe pay a set monthly fee into a common fund, in return they receive medical service from a group of doctors who are paid from the common fund; (b) these ser- vices include preventive care, ambulatory sick care, and intensive sick care with hospitaliza- tion; (¢) the physicians who render care are paid a fixed salary, instead of fee-for-service ; and (d). they may render service in their own private offices, but more likely use a special clinic facility set up for the subscribers of the plan. Advantages to the subscriber are that through a reasonable monthly rate, like an in- surance rate, the patient is relieved of the costs of most preventive and ambulatory medical care as well as possible extensive hospitaliza- tion expenses. The salaried physician is freer to give the patient more thorough and personal attention. Advantages to the doctor are that he is relieved of the paper and clerical work in- volved in billing patients, and he is spared the expense of maintaining an office. Group practice plans similar to the one above are operating successfully in a number of places in this country and Canada. The Kai- ser insurance plan in California and the heaith insurance plan in New York have resulted in better health planning for the insured through — more efficient and effective medical service. Studies show that for families enrolled in the Kaiser plan, the total cost of health care is only 70 to 80 percent as much as employees under another plan. 34 H PROJECT SUMMER 1968 In each case, however, these programs have been begun by a corporation or government with a great deal of organizing power. A core of compulsory subseribers has been necessary to provide enough initial capital for setting uy the clinics and operating them. The pla should be a serious possibility in health care planning for Licnoln Park. Consumer Participation.—For a successfu Neighborhood Health Center, a strong com munity organization interested in health care and a willing hospital staff are needed. Our grateful acknowledgments to the follow ing people: Phil Bredine, Sherry Levin, Pa Devine, Jim Reed, Jerry Needem, Mrs. Jose. phine Aragon, and special thanks to Alice Cruz. The Latin American Defense Organization (LADO) This organization came into being approxi mately 2 years ago after rioting in the Puertc Rican community had sharply focused atten: tion on some of the problems besetting th« Spanish speaking people in Chicago. It has been a service organization in the sense that it tries to aid people and families with problems but it is basically attempting to organize the Spanish-speaking community around the issues of welfare, health, housing, and jobs. It is nol specifically a community organization since Latin Americans live in a number of different communities located in poverty zones of the city. As a result of urban renewal programs or Chicago’s - near west side, large numbers of Puerto Ricans and Mexican Americans were _ displaced and moved to different communities, just north and south of the near West Side. Three health science students and two higk school interns were assigned to work with LADO in setting up two projects. One was the organization and staffing of a day care center and nursery for children of Spanish-speaking families and the second was a program tc screen. children for intestinal parasites, 2 health problem in the Spanish community. Between 15 and 20 families responded to the day care and nursery center. Approximately CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 90 stool specimens were collected and sent to ae Board of Health for analysis. It was hoped aat this latter program might be a step to- yard the construction and maintenance of a arasite detection and treatment center. One of the health science students, reported m her summer’s experiences, in part, as fol- ows: in educational system which strips them of heir cultural heritage.—by Mrs. Terry McMurry (Sociology) From our combined experience among Span- ish-speaking youth in the Southwest, in New York City, and in Chicago, we recognized the crying need for such materials, and set out to fill this ‘informational vacuum” as best we could with our limitations of time and money. The first few weeks of the summer were spent on a “snipe hunt” for available materials on the history and culture of Spanish-speaking groups in this country. We contacted such in- stitutions as the Chicago Board of Education and the University of Chicago Lab School and found no materials whatsoever. Afterward we outlined the relevant topics which might be discussed under the heading of “Problems, Is- sues, and Answers of the Spanish-Speaking Population.” They included: 1. General history of the three major groups of Spanish-speaking people in the United States—Spanish Americans, Mexican Ameri- can, Puerto Ricans. 2. Discussion of the problems of Spanish- speaking people in both urban and rural set- tings, and their relation to problems of other minorities. 3. Treatment of the contemporary move- ments among Spanish-speaking people to de- mand equality and justice as citizens of the United States—Reies Tijerina’s Land Grant Movement, Cesar Chavez’s Farmworkers’ Union, Corky Gonzales’s struggle against the urban establishment, et. al. It was decided at this point that film strips and tapes would be the most appropriate means to illustrate these topics. The tasks of writing, taping, shooting pic- tures, etc. were divided among the three of us. Much of my SHP salary was set aside for pur- chases of equipment and materials. At the pre- gent time, the writing and taping tasks as- signed to my husband and I have been com- pleted, in addition to a brief pibliography of available references. Miss Tatman will complete the film strips when her position with LADO becomes less demanding. She anticipates coop- eration from neighborhood groups and perhaps from public-school officials in trying out our materials in the fall. , It may be asked how “medically relevant” our simmer’s work has been. Admittedly, our work will not reduce the chronic physical ail- ments of the Spanish-speaking poor in Chi- cago, nor ameliorate the discriminatory treat- ment they receive from the medical “establish- ment.” We hope, however, that it will ulti- mately foster emotional and psychological well-being among students who are presently being harmed by an educational system which strips them of their cultural heritage, and de- nies them the right to self-respect and pride in their specialness. The importance of teaching “Black History” to our school children has finally been recognized by the educational hi- erarchy. Likewise, we feel, the importance of educating our youth to appreciate all minorities must be seen in the near future. Erie House This is a settlement house on the near North- west Side. In addition to sponsoring a number of social and welfare programs, it houses an outpatient clinic staffed mainly by Northwest- ern University medical students. The community it serves is bounded on the east by Halsted Street (800 west) ; on the west by Ashland Avenue (1600 west) ; its northern boundary is Chicago Avenue (800 north) and its southern boundary is Grand Avenue (530 north). The population residing in this section of community area 24 is mixed. It is composed of Spanish-speaking peoples including Mexican Americans, Puerto Ricans and Spanish Ameri- cans; white in-migrants from Appalachia and 35 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 white Polish and Italian residents, usually older people; and a small Negro population. There are probably about 10,000 people in the area. Median family incomes in these census tracts was between $4,000 and $5,000 per year in 1960. - The students reported that the health re- sources most frequently used by residents of this part of the community include St. Mary of Nazareth (the nearest geographically), Chil- dren’s Memorial and Cook County Hospitals, the Northwestern Medical Clinics and Hospi- tals and Presbyterian-St. Luke’s Hospital. The utilization of health resources seemed to be affected by a number of factors unrelated to health itself. Quoting from one of the reports: Many claim to have private doctors, often because they seek doctors with — whom there is no language barrier (Spanish) ; [and] also as a matter of pride rather than accepting public aid. A large percentage of the people hesitate to use doctors and hospitals because of language barriers, money, negative experiences, long waiting pe- riods, rushed [and] impersonal con- tacts. And from the same report the health know-' ledgeability in the community was described as being at the individual level only, as follows: These people do not see health problems as community problems re- quiring community action [but]. rather as their own individual family problems, ©¢.£., mental retardation. They have not seen good health care and have no concept of what we term quality care. Therefore, they are grateful for what we consider to be fragmented health care. In addition, there is a great reliance on, and faith in, folk medicine. These people ac- tually constitute a rural society that is merely existing in an urban setting. Health concerns pertaining to chil- dren have much higher priority than _ those pertaining to the adults/parents - 36 * * * [they are] less concerned with subtle or nonobservable problems which do not interfere with their im- mediate, every day activities. Thus, they seek [a] doctor when symptoms interfere with their work or other ac- tivities * * * Still health receives less attention than (1) food; (2) housing; (3) employment; (4) recre- ation; (5) education ; and (6) health. The students worked primarily in the Erie Settlement House Clinic. This clinic is rur jointly by Erie and Northwestern University’s Medical School. It is staffed mostly by ‘medical students from that school and is open twc times a week. About 50 patients are seen ir those two clinic sessions. It is a free clinic and the students indicated that some patients at- tend it because they have been rejected by other clinics, particularly because they are un- able to pay for care. The students felt the clin- ie’s program was limited and needed to be ex- tended and enlarged. They were critical of the attitudes of the staff of the house insofar as the community was not, in their view, suffi- ciently represented or involved with the plan- ning of any of the social welfare or health pro- grams. They thought the community had very little to say about the programs currently available at Erie House or about what pro- grams that might be more responsive to their needs and initiated. The students described their activities, as follows: * * * the project tried to meet some immediate health needs, ¢.2., discovery and treatment of parasites, teaching mothers [health] skills xe # developing awareness among the Spanish community of their health problems and encouraging cooperating in solving these prob- lems, Stimulation of fellow profes- sionals * * * to consider the com- munity and their responsibility to the community. The students believed that there were nega- tive features to their presence and their work; CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 * * * More pacification of an al- ready apathetic community; leaving without adequate education as to where to complain and how to get ac- tion on problems; creating concern over inadequate health care and facil- ities without providing proper chan- neling for these concerns to the ap- propriate people * * *. When asked what they would have done, sing hindsight, if they were starting the sum- aer project again, the site report said: We would reassess the priorities of the community and work with hous- ing problems before moving to health problems. We would maintain the same long term goal of increased level of [health] in the community. Individual students echoed these sentiments : I am pleased to report that the families I have contacted have been most receptive and listened atten- tively to what I had to say. Whether they were stimulated by what I said about diets remains to be seen and de- pends greatly on their being able to fit my suggestions into their incomes x * + * * This is mainly because our first goals in life—better heath for instance—are not necessarily their first ones. (We have found that housing is several times more impor- tant than health in this Spanish com- munity. * * * The students assigned to Erie House were ambivalent about the project. A partial text of an essay which indicates this ambivalence sharply follows: As long as we have a way out, we are not peers of the ghetto inhabitant.—by Sandi Berkowitz (Nursing) * * * There is a huge cultural barrier be- tween the Spanish and Anglo communities which perpetuates separation from the domi- nant culture and consequently denies the Span- ish-speaking community access to power. This is racism. All summer I was torn between the knowledge that although unity comes from a group identity, power comes only after accul- turation—in a sense, a giving up of ethnic values and group identity. For example, was I to encourage the community health facilities to hire for staff Spanish interpreters (therefore decreasing the community’s need to learn the dominant culture’s language, English,) or was I to assume that it was better (in terms of power access) not to encourage the hiring of interpreters (thus accelerating the accultura- tion process by forcing the people to learn En- glish) ? Furthermore, I knew that the group of people with whom I was working was not even representative of the larger Spanish-speaking population. The group I became close with had already accepted much of the Anglo culture, as evidenced by their very participation in the white Erie Neighborhood House. So was I really changing anyone? It’s true that the health classes we sponsored may have taught some of the mothers skills, may have given them information with which to function more independently and more con- fidently. But the group we probably affected most was not the Spanish themselves, rather it was the group of health science students from Northwestern University Medical School who came to Erie every Thursday night to run a free clinic for the community. After a few early confrontations with the Northwestern people which did nothing but alienate them from our more community oriented ideas, the four of us in SHP calmed down, backed off and tried working with the Northwestern [stu- dents.] We planted seeds of question, pointed out workable ways in which the community could be involved in the clinic’s structure with- out presenting a threat to the students’ self-in- terest. My guess is that any change which is was possible for us to effect in Northwestern’s phi- losophy was because there at least, we felt we had a right to be talking. It was understood that we were their peers. Obviously, this was - not, and could never be, true in the ghetto com- munity. We should have known that as long as we have a way out, we are not peers of the 37 ghetto inhabitants. As long as we have that dime, we have no right to be talking to them. When I am asked, then, what the value of this Summer’s experience offers me convincing proof that as a health professional committed to trying to change the present health care de- livery system in the United States, my first responsibility lies in radicalizing my own pro- fessional community. * * * The ghetto communities will organize and radicalize their own people. THE WEST SIDE On the West Side of Chicago students worked in the West Side Medical Center hospi- tals (see Hospital Sites section), with commun- ity organizations; in neighborhood health cen- ters and clinics, and in settlement houses. A few students worked independently in a special program dealing with drug abuse conducted by a church agency. The West Side of Chicago is succinctly de- scribed by the SHP Area Coordinator whose report follows: No one has any power over his environment.— by Donna Karl (Nursing) The West Side of Chicago is a massive land area populated primarily by poor, black people. Once a thriving, Jewish settlement neighbor- hood with wide, handsome boulevards and well-tended townhouses, it has become an over- flow pond for poor blacks forced from southern farms for lack of work and pushed from other areas of Chicago by economically hind-sighted urban renewal. It has become a stagnant pool of wasted humans. And it stinks. Twice the number of people live here now as the area was originally constructed to house. The population density in some places, for in- ance, is 150-250 residents per residential acre which compares to the Lake Shore Drive area, characterized by many high-rise apartment buildings. In some places it is over 300 per acre. Education standards have deteriorated along with population change. Teachers who once 38 taught “challenging” Jewish students cannot understand the anger and educational apathy of black children. And black children cannot understand the middle class, white approach to supposed learning about their poor, black envi- ronment. A vicious cycle thus creates and per- petuates itself. The greatest percentage of residents there do not set health care at the same priority level as does the middle class. There are too many ‘more pressing problems to be dealt with— like the clogged toilet that hasn’t worked for 2 weeks, like a $125 rent payment for the three- room apartment without proper electricity, or like the son who got “busted” for being black and standing on a corner, All of these things indeed fit into health care if not medical care. But it becomes quite obvious why medical care facilities may not be freely used. Health to many people on the West Side means functioning. The concept of preventive, sometimes diagnostic treatment services does not become a part of their thinking. Illness is when one can’t work or take care of her kids or make it out of bed to the neighbor’s house. Illness is when normal, routine activities are stopped. Health care is not fixing cavities or drinking a quart or milk a day or getting a Pap smear. It is going to the Cook County Emergency Room when the pain gets so bad you can’t pull on your cotton socks, or when the baby is hot and shakes every once in a while, or the bleeding won’t stop and runs . down your leg. - Many people on the West Side used the emergency room of Cook County Hospital. Dangerously over utilized, it sees about 1,200 patients daily, 75 percent of whom are “seen and advised,” i.e., seen and sent home without further treatment at that time. Many of the small hospitals in the area will not or do not take welfare patients. Physicians are generally old, or specialists, or foreign educated, or part-time, or leaving, or have already left. There are however two OEO funded com- munity health centers which are attempting comprehensive care to ghetto residents in a community-based, self-determining health cen- ter. CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 The West Side is not a community if one de- fines a community as a group of residents within one geographical area with similar goals and some degree of group identification. Tt is a transient, brewing mixture of people thrown together. Many came North in search of “the land of milk and honey” and green bread. Unable to cope with the disillusioning reality of Madison or Sawyer Street, their dream has become scraping together enough money to return “home” to the South. They don’t have roots here. They merely float. And there is little interest in the urban affairs by which they see themselves hopelessly strangu- lated. The streets are strangely surrealistic. (Sear- ing breezes, brown and curl Hershey wrapper edges that blow the ashes down a side street and into the gutter.) People there cling to things for identification. A little girl holds her popsickle stick close. Old men play checkers. But no one has any power over his environ- ment, And there is little organization within it. And people remain pawns of a power structure which serves only its own ends. Students working this summer on the West Side were primarily attacking a common prob- lem—the disorganization of a society that has been herded into this state of mind. With no power, people react defensively and refuse to be a part of the structure. They project apathy to outside observers. And it grows, nurtured on the manna of nonexistence, into psychological disorganization that stunts any community en- deavor or collective action. One team of students worked at the Medical Center YMCA, which is located on Roosevelt Road at the northern edge of the Valley (North, Roosevelt Road; south, railroad tracks, run- ning from 16th Street on the east to 13th on the west; east, Ashland; west, Western.) Their task was to examine the health needs of the Valley area and work with the “Y” in an attempt to meet these needs. The team was conceived and set up as a dual group—black and white, with each respective group doing its Own thing. The medical students were to deal with medical aspects and the black college/high school students with the commun- ity aspects. For several reasons the plans as conceived failed. First, the two white students (medical) on the nine-member team appeared to dominate the project from the beginning and stifled others speaking out. The black stu- dents, not being from that community, were too inhibited to get into it. Prematurely and without true community contact, the group im- mediately began setting up a screening and re- ferral clinic. The clinic objectives were to do a simple series of diagnostic tests for chronic diseases, e.g., hypertension, diabetes, tubercu- losis, lead poisoning, heart pathologies, ane- mia, vision difficulties, etc, Their plan was to refer diagnosed patients to medical clinics, and also to use the data gathered in approaching the medical center to get more complete serv- ices for the people of the Valley, a hideously deprived area within walking distance of the medical complex. At first the community was not included in the group thinking. The students having con- tact with the leaders of the “Y” thought that this leadership was that of the community and. when these men spoke they were representing the community. In reality they represented the young, more militant section only. They seemed to alienate many of the older persons who also need medical care and representation in decisions made about such matters. When the idea of community representation did finally filter into the student’s thinking, the clinic had been physically set up. The students felt that until they could give the Valley resi- dents something, these people could not orga- nize. The assumption, in many. ways fallacious, partially goes back to the white man’s pater- nalism and need to give the black “native” something. The Robert Taylor Clinic on the South Side of Chicago was planned from the beginning by the community working with medical students, and thus avoided some of the pitfalls which seemed to be inherent in the medical clinic. But one significant happening came out. of the project. There were several meetings of many different people, each with a common in- 389 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 terest in the future of the Valley and the per- sons living there. Representatives from the Halsted Urban Progress Center, the Circle- Maxwell YMCA, the University of Illinois, the Medical Center YMCA, and the community (six community ladies) all sat down and dis- cussed the future of the Valley and how it could be shaped now by community interven- tion. The meeting demonstrated that, given the opportunity the extremely poor, black com- munity can be interested in itself and its fu- ture. The medical people associated with the clinic now have the job of helping to educate the community about its health rights so that it may become more sophisticated and articu- late concerning its medical rights and demand these rights, The clinic is quite limited and its services in- adequate. If further community activity does not continue, it will have been a failure. It will have been only another in a series of “summer things” that ghettos are the victim of every June to August. But it has the potential, hav- ing organized a community health committee, of activating the Valley and helping it grow into a community. Spanish-speaking people live in the same disorganized kind of apathy as many black communities. To deal with this problem a team of health science and Spanish-speaking high school stu- dents worked at Howell House (neighborhood service center). Their work concentrated within the realm of welfare recipient rights and organization around this issue. They worked with a leader of the Latin American Defense Organization who has had a degree of success in organizing Spanish-speaking people on Chicago’s Northwest Side. The ultimate goal is forming a permanent welfare reci- pients’ union in the Howell House area for Spanish-speaking people there. The community in that area is composed of primarily Spanish speaking but also a small number of older Czechoslovakian residents who have remained in their life-long neighbor- hood, and a few blacks from across the rail- road track (the Valley area). The people there 40 are marginally poor, e.g., there are many sec- ond-hand and wholesale stores. People have enough to buy used furniture but not enough to buy new. Most go to Cook County or Mother Cabrini Hospitals with the distinct emphasis on the former, Among 38 physicians in the area about half are GP’s, 85 percent are over 60 years old, and 50 percent were educated out- side of the United States. Residents complain of much exploitation, high medical fees and drug charges. But no one does anything about the conditions. Many people in this area, being within a marginal income bracket, are ineligi- ble for MANG but do not have enough money for medical bills above and beyond their nor- mal living costs: Students working in this community did a health survey of the types and numbers of medical problems facing people there and how they see, understand, and deal with them. The data collected is going to be given to the com- munity to use in negotiating with Cabrini Hos- pital to possibly set up a peripheral clinic in the Howell House area. The two medical students assigned to the St. Leonard’s Drug Abuse Program defined their experience primarily as educational, without a great deal of “direct” community contact. But their original goals were realized. Many preconceived ideas were destroyed. The “junkie” became a human being. The stereo- types fell away. They have been able to exam- ine and evaluate their original ideas about “junkies” and modify them to more reality ori- ented ones. For them the summer has been al- most pure learning and reacting and broaden- ing of mind. Students working in the tutorial program at the East Garfield Park Mental Health Clinic (a city board of health facility) dealt with the common problem of community disorganization at an early level—with grammar school reme- dial readers, Students at Lawndale Association for Social Health (LASH) participated more directly by becoming a part of the staff of this social-action agency dedicated to redirecting normal anger of repressed people into paths productive for them, to encouraging black con- sciousness, to promoting economic gains through a co-op grocery store and trades train- ‘ing program. The students learned about com- “gmunity responses and how they as white pro- fessionals of the future could fit into the scheme of providing medical services to such groups of people. The students involved in this project gener- ally agree that their main accomplishment during the summer was not really in dealing directly with community disorganization but in educating themselves. J would, however, object to the project in the future as it was conceived and implemented ‘ this summer. The Kerner Commission made it quite clear that the problems facing the ghetto are, in fact, based in the white, middle-class communities and the white institutions. The place for students, especially white students concerned about the black ghetto, is some- where outside of those ghetto boundaries, work- ing to help them “behind the scenes.” For 10 weeks I’ve looked and seen and tried to understand and to digest and to emerge with something tangible and significant. And now I’m tired. I’ve exhausted my thought processes. But I can say that for me the summer experi- ence has been most enlightening. I came into the program this summer with the same ideal- istic misconception as last summer. I came say- ing that the ghetto had given me much last summer and that I was tired of testimonials about “How I changed” or “What I learned.” I came saying that I had a debt to repay to the community and that I wanted to use this sum- mer to repay it for my experience the summer before. But as I look back, I can see that again I have gleaned much more from the ghetto than I could have ever given or ever will. ‘Again I’ve changed or been changed by my summer. It hs again been a summer of the SHO-w, with me the receiver. - But I have learned one thing: that is how to deal with communities and not for them. I have learned that they have as much or more to give me than I them, I have learned that it is a two- way street. The Valley The Valley is part of community area 28 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 (near West Side). Roughly, it is bounded by Ashland Avenue on the east (1600 west), Western Avenue onthe west (2400 west), and by Grenshaw Street on the north (1100 south) and 15th Street on the south (1500 south). A relatively large proportion of the land is de- voted to industrial use and railroad tracks criss-cross its southern and western bounda- ries. This factor, to some extent, has created a psychological, as well as a physical, separation of the community known as the Valley from its near West Side neighbors. Between 12,000 and 15,000 people live in this community. Four cen- sus tracts in the area, when enumerated in 1960, showed that each had more than a 90 percent black population, There is no reason to believe that this magnitude has changed except to become greater. The median family income, then, ranged from $3,828 for the tract with the lowest median to $5,014 for the tract with the highest median income. Two of its four tracts reported the percent unemployed of the male labor force as standing at 18 and 17 percent, respectively. It is not possible to determine whether these unemployment and income data have changed significantly from the 1960 cen- sus for this small area. One-third to one-half of the housing in the four tracts was classified as substandard. (2) No change appears to have taken place in this respect either since there has been no new building in the area and 8 years have elapsed with subsequent deteriora- tion, This community is probably one of the deepest poverty areas in the city of Chicago. While it is not possible to refine the mortality- morbidity indicators for this small section of community area 28, these data for the entire area undoubtedly reflect the conditions within the Valley as well. Community area 28 ranks in the first (the highest) quartile for all five mortality-morbid- ity indicators. This includes deaths due to in- fluenza and pneumonia for infants and nonin- fants; deaths from cervical carcinoma; deaths due to unknown and ill defined causes and new cases of tuberculosis discovered. (1) The students assigned to the Valley under- took the development of a screening clinic at the Medical Center YMCA “Outpost.” A most 41 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 important question concerning the future of the clinic was raised by one of the students (Jon Trefil) in his final report. * * * The main problem facing the clinic is urban renewal. At our first meeting where we had gathered to- gether all the community leaders we were asked how we, as representa- tives of the medica! center, could es- tablish a clinic when that same medi- cal center was planning, in the next few years, to tear down the entire neighborhood and build middle class housing and thereby displace all the people living there. Of course we did not have any answer. But this pointed to the real problem. What is the pur- pose of building a clinic when it will be torn down in a few years. The problems that these people are really concerned about are not medical but where they will go once they are kicked out of their homes. They have several other problems which are more important than medical care such as good education for their chil- dren, getting good jobs, and the con- stant police harassment. Our medical commitment began to seem more and more nearsighted. * * * A report describing the organization and functioning of the clinic follows for a more complete discussion of the students’ work. The clinic was converted from an old casket factory.—by Robert J. Tanenberg (Medicine) When I sit down and think about S.H.P. and the summer of 1968, two thoughts come to mind immediately. First, I think of how work- ing in a black community has enriched my life and rekindled embers of youthful idealism to meet the challenge of changing our socioecon- omic system which perpetuates the ghetto through racism and bigotry. Second, I feel much satisfaction in the realization that I was part of a small group of black and white stu- dents whose labors bore fruit—a small but concrete step toward righting the many wrongs committed against the black man in America. 42 That step was the creation of a community health clinic on the West Side of Chicago. This clinic began as the back room of a YMCA building which was converted from an old cas- ket factory. How did this clinic come into existence? * * * three medical and six high school and undergraduate students met with the young black director of “The Outpost”—a branch of the Medical Center YMCA serving a black community * * * in the heart of Chicago’s near West Side. Here we learned that this com- munity, although only a few blocks from the world’s largest medical center, had no perma- nent health facilities (with the exception of a few private doctors). The director’s answer to our question of what the community needed in the way of health care was, “everything.” Thus, given a free and supportive hand from the YMCA we decided to build a medical clinic. - We could not operate a complete treatment clinic * * * but we could run a screening and referral clinic where medical students could do simple diagnostic tests under guidance of a physician, and then refer patients to a hospi- tal. Thus, a person off the street could come to the clinic and undergo a 15-minute examina- tion by a medical student.* * * If a chronic disease was suspected, he would be personally assisted to a hospital for confirmation and treatment. The screening would be provided at no cost and treatment costs would be on a slid- ing scale with welfare recipients having free treatment.* * * Our problems, and they were numerous, can be considered as those involving medical know-how and equipment and those involved with “catalysis” of the community. In essence we came a long way toward solving the former and fell far short in tackling the latter. Con- tacts were made with a medical supply com- pany and an examining table and scale were donated. A valuable contact with the Preven- tive Medicine Department of the University of Illinois enabled us to borrow another examin- ing table and scale, two electrocardiographs, a spectrophotometer, and other medical supplies. After a week of painting, scrubbing and other types of hard labor, we placed our sup- plies in the room. Sheets hung from wires partitioned the room so that there was a gen- eral admitting area where case histories could be taken and [there were] two examining rooms. Meanwhile, several doctors had been contacted and we had standardized our screen- ing procedure. In brief, we were doing simple urine, blood, and physical tests for diseases such as diabetes, anemia, heart disease.* * * We mimeographed a form for each patient which contained questions for a case history, a list of medical tests with room for results and a legal release form signed by each patient or his parent, if under age. The medical students learned the use of the instruments from a lab technician and, in turn, taught the high school and undergraduate students how to take the various tests * * * [there were] lectures on the body and the diseases for which the clinic was screening.* * * Contacts were made at two hospitals so that our patients would have some priority.* * * Many doctors were con- tacted and one volunteered to act as a perma- nent medical adviser to the clinic. Essentially, we were [now] prepared as far as the medical aspects of the clinic were concerned. Now all we needed were some patients. The Student Health Project incorporated the idea of including black high school students as interns into the program to act as liaison be- tween the white medical students and the black community. Thus, we had hoped that our in- terns, along with two black undergraduate stu- dents and one black medical student, would go out to “their” community and bring people to the clinic. Unfortunately, these students, al- though black, were not from the community [the Valley] and were therefore strangers to the people we hoped to serve. Nevertheless, flyers were distributed and community leaders were approached to an- nounce that the clinic existed and would be open two evenings a week. This brought some response and we began testing. The YMCA ar- ranged for us to test * * * over 100 children from a summer day camp.* * * We arranged for the Chicago Board of Health to send a doc- CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 tor to the clinic once a week for lead poisoning tests. We also arranged for an agency to skin test area children for tuberculosis. We at- tempted to contact infant welfare stations to refer * * * for vaccinations. We unsuccess- fully tried to get a chest X-ray [unit] sta- tioned at the “Y.” Despite these efforts, the community res- ponse was poor. We next tried to motivate the community by forming a community health committee. More flyers and personal letters were sent and finally 20 people from the com- munity came to the “Y” and we talked about ‘health problems and the clinic. Many ideas were brought forth, a president was elected and plans were made. After a second meeting, the committee was for all practical purposes nonfunctional, yet its existence was necessary since it symbolized * * * the clinic belonging to the community * * * it was the first step of S.H.P. [in] fading out of the picture—an original goal of the group. Attempts to publicize and promote the clinic included mailing of letters to all adult resi- dents in the area; dedication of the clinic; and other methods, all of which met with limited success. Probably the method with the greatest potential was word of mouth * * * from treated patients. * * * In order to insure that the clinic would con- tinue in the fall, the medical students enlisted the help of the student AMA and other stu- dents of the medical college to volunteer 1 or 2 hours a week. When word came that the Uni- versity of Illinois might build a modern facil- ity in the community, plans were temporarily suspended, and it is presently hoped that all medical students will * * * have an opportu- nity to work in this community clinic. If they do, then hopefully, others like myself will commit themselves to the cause of better health care—not only for the wealthy but for the poor too, since health care is not a privi- lege, but a basic human right. Pilsen Howell House is a settlement house adminis- tered by United Christian Charities Service 43 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 and is located at 1731 South Racine. Predomi- nantly now a Spanish-speaking community (most Mexican, but a small number of Puerto Ricans as well), the area is also home for older Czechoslovakians and some Negroes. It was originally known as the Pilsen Neighbors so named by the Czech immigrants who settled there earlier. The SHP team consisted of two health sci- ence students and two Spanish-speaking high school interns who live in the community. Their project included a survey of community health needs; participating with the Latin American Defense Organization in working with welfare recipients; and assisting individ- ual families on welfare in securing health care. The major report of their project concerns their experiences with the health care survey in Pilsen. A summary of the students’ report describes this activity, and follows: Health Care in Pilsen—by Joseph Enderle (Intern), James McCulloch (Medicine), Jose Molina (Intern), Lewis Resnick (Medicine) When our group of medical and high school students was assigned to Howell House by the Student Health Project for the summer of 1968, we felt a need to do something which might be relevant to the community. Our pur- pose in being there was to somehow improve the health care of the neighborhood. We thought that, logically, in order to improve its health care, we should first determine the na- ture of the health care facilities in the area and then find out what kind of health care the people of the area were receiving. In answering these questions, we found that Pilsen, the area in which we were working, was a zone 2 (intermediate type) poverty area with a population of about 30,000. The area is now predominantly Mexican and Puerto Rican although there are still remnants of its origi- nal eastern European population and a fairly small Negro population. Most of the people liv- ing there are lower income workers and there are a good number of welfare recipients also. The housing is for the most part old and in various states of disrepair—for all practical 44 purposes, no new construction has been done in Pilsen for more than 50 years. This area, with a fairly large and heteroge- " neous population, has no hospitals located in it at all and only one recently established com- munity mental health center located in a store- front. The one infant welfare station which used to serve the area was moved out a few years ago. We found that there were 27 private doctors in Pilsen, of whom only 17 practice in Pilsen full time. More than half are foreign trained, six are over 60 and six have been out of medical school for 30 years or more. The 1965 report of the Chicago Board of Health recommended that community health centers be set up in each of the 24 poverty areas in Chicago. To date, two such centers have been set up in some of the worst poverty areas of the city. Our impression was that since Pilsen was located in a poverty area of the lower West Side and since the existing medical facilities seemed to be fairly sparse and relatively expensive, perhaps a community health center could be established in the area to its great advantage. We were aware that, given the existing po- litical and economic conditions in Chicago, no such center would be started unless significant pressures were brought to bear. Since we our- selves could’ not organize the community to form such an interest group in one summer, we thought that perhaps we could function by gathering information to be used by any such groups when they did form. To do this, we made a survey to assess the health needs of the community. Through this, we thought we could find what kinds of health care the people of the area were receiving and what their health needs would be. _ The questionnaire we used was taken pri- marily from one developed by Philip Rushing, Student Health Project Research Director, al- though we felt a need to modify and add to it slightly. It consisted of 48 questions, the re- sults of which are presented in the next sec- tion. We talked to 150 people during the months CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 of July and August, usually on weekdays be- tween the hours of 10 a.m. to 8 p.m. Our interviewing was done in the Pilsen area, from Ashland Avenue on the west to the Chicago Canal on the east and from 16th Street on the north to 22d Street on the south. Our method of selecting people to be inter- viewed can only be described as chance and haphazard. We would walk through the streets of the area and approach anyone we saw who was out on the sidewalk or on their front porch and appeared not to be doing anything pressing at the moment. We would then pre- sent ourselves and ask permission to interview them in something like the following manner: Good. afternoon, Sir. Perhaps you could help us, I’m a medical student working this summer at Howell House. Because I’m a medical student, I’m interested in the medical facilities in this area and the way in which people who live in this area receive their medical care. What we’re doing is making a survey, asking people questions such as if they have a family doctor or what hospital they use. We were wondering, would you mind if we asked you these questions? Using this approach, only 10 to 20 people de- clined to be interviewed. Our reasons for not using a more rigorous sampling procedure were our inexperience and our reluctance to engage in house-to-house canvassing. Because of this, our results may not achieve a rigorous definition of statistical accuracy. However, we are of the opinion that the people interviewed roughly comprise a representative cross section of the people living in the area. Since our in- terviewing teams were for the most part bilin- gual, both English- and Spanish-speaking peo- ple were included. Also, when the interviewing was done, we made an attempt to cover all the Streets in the area fairly equally. Although many of our respondents were women between the ages of approximately 25 and 50, our sam- ple included both men and women, the elderly and some older teenagers, ' The interviews were kept anonymous to en- courage freedom in answering questions. For similar reasons, no socioeconomic information was gathered. Such studies have been done in the past and our interest was only in building a picture of the health care needs of this com- munity. Like the poverty level of the area itself, the results of this survey seem to be intermediate in nature. Pilsen residents (interviewed) are by no means suffering from a complete lack of medical care; an overwhelming majority (82 percent) are receiving some sort of medical at- tention during a year’s time. On the other hand, there are definite indications that the health care is not all that it should be. Almost one-third (30 percent) of the people interviewed had no family doctor and thus were dependent on public and private institu- tions along with occasional visits to neighbor- hood doctors for their primarily crisis-oriented health care. This means that carefully super- vised followup care would probably not be available to or used by this group to any large extent. In addition, almost one-fifth (18 percent) of the people interviewed are not receiving medi- cal attention of any sort. This would seem to indicate that while most of the people interviewed receive some sort of medical care there is a significant group of people whose medical care is vastly inadequate. If we ask why this group is not receiving ade- quate health care, we seem to find that one of the causes is, not unexpectedly, that of pov- erty. Previous studies (1965 report of the Chi- cago Board of Health and a study done by the 1967 Student Health Project, among others) have shown that poor health care is associated with poverty, and even this study, which did not specifically concern itself about socioecon- omic problems, illustrates some relationships between inadequate health care and poverty. The reason given most often for why people didn’t have family doctors, why people didn’t go to doctors when they had medical problems, and why people didn’t go to dentists when they had dental problems was that of money. Also, in their choice of hospitals, the most fre- 45 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 quently used were Cook County and other com- paratively free clinics such as those at Presby- terian-St. Luke’s and Illinois Research and Ed- ucation. Even in an important matter such as emergency care, the hospitals which were used followed the same general distribution. People who used Cook County and other such hospi- tals for their emergency care reported that they went there because these places wouldn’t charge them and implied that they couldn’t af- ford to go any place else. Even when faced with the prospect of waiting for up to 5 hours which most people considered unfavorably, more people went to Cook County Hospital for their outpatient visits than anywhere else. Thus we can see that for people in Pilsen as well as in other places, poverty seems to have a decided influence on the choice and amount of medical care. An alarming consideration in re- lation to this is that most of the complaints for which 28 percent of the people did not consult doctors were or could be quite serious. This is a group of people, therefore, who need prompt medical attention but are not getting it. Another aspect of the area’s health care is the way in which Pilsen residents utilized med- ical services. Although 73 percent said that a yearly checkup was necessary, only 58 percent actually had one. And of the visits that people of the area made to doctors for any reason at all, only 28 percent were for checkups. From these results it would seem that, although the yearly checkup is important in theory, in prac- tice people only go when something serious ac- tually occurs. It is this kind of crisis-oriented health care that is one of the characteristic features of the inadequate health care received in poverty areas. Another important aspect of the health care picture in Pilsen is the apparent inadequacy of its existing health care facilities to provide for the total needs of the community. To receive their ordinary medical care, almost one-half (48 percent) of the people interviewed went outside the Pilsen area. The picture is even worse in regard to emergency care where fully 58 percent of the people had to go outside the area. In addition, more than one-third (87 per- cent) of the people made use of outpatient clin- 46 ies which of necessity caused them to go out- side the community since there are no hospitals in Pilsen. The average outpatient clinic visit required a 40-block round trip and about a 1 hour wait at the clinic. According to these measures, more medical facilities would thus seem to be indicated. But there are other measures which also de- serve attention. In relation to dental care, more than half (57 percent) of the people inter- viewed had not seen a dentist in the past year, even for a checkup. In addition, one-third of the people interviewed had dental problems in the past but had not gone to a dentist. When asked why, lack of money was reported to bea prime factor by most of the people involved. In a casual search through the telephone book, we found only 10 dentists practicing in the entire area. This seems to indicate a severe lack of dental services and dental care in the Pilsen area and appears to be one of the more press- ing health needs of the community. In relation to mental health, it is fortunate that the Pilsen Mental Health Center has been established. We found that 30 percent of the people interviewed reported that they had had some sort of nervous (emotional) disorder at some time. About 10 percent of the people in- terviewed reported having emotional disorders — at the present time, and another 5 percent re- ported emotional difficulties within the past year. This seems to be somewhat higher than the national average one out of every 10 Amer- icans and, if it is a valid figure, might be due in part to the conditions of poverty in the area and the conflict arising out of rapidly changing cultural backgrounds. A similar incidence (82 percent) of emotional maladjustments was re- ported for children in the area. When asked what they would do if faced with an emotional problem in themselves, only 47 percent of the people interviewed would see a doctor. Of the people who actually had an emotional disorder, about the same percentage (44 percent) ac- tually did see a doctor. Of the parents who re- ported having a maladjusted child, only 28 per-— cent sought medical attention. This is probably not a significant difference, however, since at least 46 percent of the parents attempted to in- CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 tervene somehow in the child’s problem, in- cluding medical care. Thus, there seems to be a definite mental health problem in Pilsen and it ig fortunate that it has its own community mental health center to deal with it. Perhaps the most significant result, how- ever, was the overwhelming 91 percent of the people who voiced their desire to have a com- munity health center established in the area. Most of these reaffirmed that a community health center was badly needed. Repeatedly, the comment was made that it would help the people of the area and a few were in favor of it only if it did and only if it were inside the Pil- sen area itself. In summary then, it seems that: there is a significant number of people who are not get- ting full health care, one of the principal rea- sons being its relatively prohibitive cost for them; a good number of the people in the area receive their health care in a crisis-oriented fashion, rather than allowing for more thor- ough, followup types of care; and emergency and dental services are especially deficient, causing most of the people either to go out of the area, for emergency care, or not have any, in relation to dental care. As our recommendation, then, these findings would lead us to believe that a community health center, located inside the Pilsen area, would act admirably to furnish all these addi- tional services at costs low enough so that all would benefit. Lawndale The area known as Lawndale is actually two community areas; one is North Lawndale, the other is South Lawndale. They are community areas 29 and 30, respectively. No two commun- ities could be more different even though they are geographically contiguous. North Lawn- dale is considered a zone 2 poverty area; South Lawndale is not a poverty area. North Lawn- dale is more than 90 percent Negro while the other is more than 90 percent white. SHP teams worked in North Lawndale and this report will deal only with that community area, No. 29, There are about 125,000 people living there. The median family income in 1960 was $4,981; 10 percent of the male labor force was unem- ployed; 25 percent of the families had incomes of less than $3,000 per year; 14 percent of the housing was substandard. (2) There has been virtually no new construction in this commun- ity since 1930 (when the population was about 112,000) with the exception of a small Chicago Housing Authority unit with 136 apartments. (3) North Lawndale was in the first quartile (the highest) ranking for all of the five mor- bidity-mortality factors. (2) Martin Luther King, Jr. Neighborhood Health Center.—The Lepper-Lashof report (1) issued in 1966 recommended that 24 neighborhood health centers be established in the poverty communities of Chicago to provide quality health care to defined populations of ‘these areas. To date, only two have been established and the Martin Luther King Center is one of these. Two health science students and three high school interns were assigned to this site. They worked in the day-to-day routine of the health center and with the community health aides so they had some exposure to both the center and the community which it serves. The students worked individually by conscious decision so they could function best in assisting in the work of the center and still work in areas of their particular interests. The three high school interns plan to continue working with programs during the coming year. As stated so commonly throughout most of the reports the students felt that they had been the recipients of the benefits from the sum- mer’s experience. Selected quotations indicate this. Raymond Zablotny a health science student, said in his midproject evaluation, My main goal in the SHO project this summer is to learn: * * * When I speak of learning I do not necessar- ily mean from the careful collection of statistics but rather knowledge from the mouths and lives of the peo- 47 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 ple with whom I come in contact in my work. * * * I have * * * made a special effort to try and understand the problem of community control of the center. I have spoken for many hours with * * * the community organizer of the Center, and have attended meetings of the Community Health Council. * * * T think my role as a student in this site is one that will enable me to become a better, more aware health professional.* * * Unlike some of the criticisms of the summer project which revolved around difficulties in relationships between health science students and the high school interns, health science stu- dents at this site did not have this experience. This seemed to be the feeling of the high school interns as well since in describing what all five students thought were the short and long term positive effects of the project, their report said, We have helped things to run a little smoother in some areas, to actually get a little more done, and to add to the convenience of the patients. * * * Our chief contribution here seems to lie in the area of human relations and a rather good spirit of working and being together. Lawndale Association for Social Health— Two health science students and two high school interns joined this 3-month-old pri- vately subsidized agency, staffed with psychia- tric and social work professionals. A new con- cept about some forms of mental illness is em- braced by this agency, i.e., * * * The concept that mental ill- ness is often * * * a normal, under- standable adaptation to an intolera- ble, stifling environment is a strong assumption at LASH. And so this As- sociation is unique among mental [health] institutions in that it deals with the environment of the patients rather than merely the symptoms of that environment as manifested by 48 the patient. LASH treats people in their usual setting, and in doing so attacks the environment *. * * The at- tempt is not made, as is usual, to re- move disturbed people from the stressful situation and treat their problems in an alien context. Instead, the orientation of LASH is to cure and prevent mental illness by helping people to alter those environ- mental conditions which contribute to their mental illness. * * * This description of the agency’s orientation is by one of the medical students, Howard Fenn. His reaction to his site assignment is presented in the following essay. I see myself in the role of an observer and a changer.—by Howard Fenn (Medicine) When I began the Student Health Project of 1968, the goals I foresaw for the summer were directed toward two areas: myself and the community. With regard to the community, I envisioned the possibility of perhaps slightly altering the sense of futility among the popu- lace. The despair and hopelessness so apparent in a poverty neighborhood are linked closely with so many other terrible characteristics of a poverty zone: high unemployment, low edu- cational level, political disenfranchisement, al- coholism, and substandard living conditions. It is true that a partial cause of all these factors is the capitalist system and a disinterest of the establishment toward the poor. However, also at fault in perpetuating these conditions is the mental state of the inhabitants of the poverty area. In order to alter the physical health of these people, which is hampered by the poverty state in which they live, the mental health must also be improved, And this was my origi- nal goal for the community: by attempting various self-help projects, the hopelessness and | despair present would be alleviated, improving mental health and thereby working against the poverty conditions. Unfortunately, the prog- ress I have accomplished in this area has been minimal. But the goals with regard to myself are being reached through my attempts to alter the community. CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 The goal for myself has always been to learn more about the “culture of poverty,” the condi- tions which bring it about, and what methods there may be too combat it. This I am slowly be- coming acquainted with. , The site at which I am working coincides well with my projected goals for the summer. The Lawndale Association for Social Health is committed to the concept that the mental health of the Lawndale community can best be im- proved through direct social action taken to better conditions in that community. Several projects are already underway in order to ef- fect such betterment: adult education, a coop- erative business, vocational training, and psy- chiatric workshops are just a few of the pro- jects. I have been engaged in helping and observ- ing several of these programs. In addition, I have been involved in a tutoring program in the local Lawson Elementary School, which is gaining speed. I have, with the help of a clini- cal psychologist from Madden Zone Center, been formulating a course in psychosocial de- velopment to be perhaps presented to possible dropouts at Farragut High School. This pro- gram is to be initiated on July 29, on an exper- imental basis. While engaging. in these efforts I have in- deed learned much of the neighborhood prob- lems and the possible solutions. But as for di- rectly affecting the people of the community I must admit that this gain is not visible. How- ever, it is hoped that in the next few weeks of the summer these projects will begin to take hold and continue as permanent scenes in the neighborhood. The psychosocial development course, in particular, will be initiated in this last half of the summer and will make a con- tinuing contribution to the mental health of high school age youngsters. In addition, my goals with regard to myself will be attained as I see projects take form and achieve small ef- fects on the community. “And this, indeed, is my major role as a health student in the community. For at my Present status and educational level,‘ there ems to be little effect I can have on a de- | prived community. But in my attempts toward change in the neighborhood, I am gaining the skills and knowledge for future, more success- ful attempts, when my higher academic level will also add to my degree of effectiveness. So for the present, I see myself in the role of an observer and a changer, with the emphasis on the former so that eventually my ability in the latter will be increased. Drug abuse.—Elsewhere in this report we have occasion to note the frequency with which SHP teams felt their 10-week effort had prod- uced little change or had “failed” entirely to meet the goals they had set. This reaction was less evident where teams were taking up the unfinished SHP projects of the previous sum- mer. Following is the report of a student who returned in the summer of 1968 to continue work she had begun in the Summer Health Project of 1967. Joint Community Program on Drug Abuse.— by Jeanie Snodgrass (Nursing) As this summer draws to a close and the pro- ject ends, people are going home, back to school or whatever; most are leaving Chicago behind—leaving the project with an education and with observations they’ll never let slip their minds. For me the 10-week project (my second affiliation with the SHO Summer Pro- ject) was really a renewed beginning, or maybe just a continuation of the commitment I’d found the summer before. Last summer I left the project after 10 weeks, having made not so much as a minimal contribution to the health center where I had worked: of course I gave nothing to the larger community of Lawndale. I did come away pondering. many new thoughts, my world of experience and exposure much expanded, which was of no lasting value to anyone but myself. I felt that I had taken something from the community, leaving noth- ing of value behind; what’s more I had used other people’s money to do it. I couldn’t leave with a record like that. That summer only whet my appetite for community involvement, and I just couldn’t leave—so I 49 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 stayed. I continued to work with the preceptor at the health center, who was in the process of planning the mental health services for the center. I took on the role of his “Girl Friday,” and I learned more and more. I became interested in one particular mental health problem that was plaguing the Lawn- dale community as it does so many other com- munties; this was the problem of drug abuse among the youth. I undertook an exploratory study to find out the true scope of the problem. During November and December I visited youth agencies, law agencies, health facilities and many individual persons serving the Lawndale area. I was taken by surprise by the findings that the problem was apparently. so great, yet no one really knew how great, and no one was making any effort to curb or deal with the problem. With the results of this study, my role for this summer became more clearly defined as I discussed the findings with many persons— some of whom I had interviewed during the study——-involved in youth work on the West - Side. By June I had several people interested in doing something about the problem. No one had yet defined what type of action should be taken, but gradually throughout the summer a specific program has taken shape. This had been done through combined efforts of over 40 community agencies who have banded together for the first time to combat the rising problem. ' At the present time, the actual program is about to begin, training programs for the po- lice and youth legal agencies, and the treat- ment center workers taking place in early Oc- tober. In the total comprehensive program, we are involving over 40 community agencies, 45 schools of five school districts, and 10 youth “Treatment” centers, plus the police Youth Di- visions of four districts, and the juvenile courts. Actual referrals of youths involved in drug abuse will begin November 1. I feel that my first summer was not wasted now, for it laid the foundation for me for a whole future’s lifetime work, and has truly been the catalyst for a program which is a 50. much-needed contribution to the community, and a contribution with long-lasting effects. I will be continuing my work with the program for the coming year, as the paid “Coordinator” of the program; but within one year I hope that the program will have become a successful integral part of the programs of each agency and institution involved. The ramifications of this program extend far beyond the treatment of youthful drug users. The program involves communication and co- ordination of activities among more than forty agencies, raising the level of interaction and intercommunication to a new level. Needless to say this work has defined a fu- ture role for me; more than that, it has clearly uncovered a new way of life for me. I feel now, too, that I have paid back the money and expe- rience debt I had accumulated that first sum- ’ mer, and I’ll be continuing to repay it the rest of my life. St. Leonard’s House This site is a halfway house administered by the Episcopal Diocese of Chicago. The staff in- cludes physicians, psychologists, social workers, and priests. Its purpose is to act as a re- habilitation and support center for ex-convicts and for narcotics addicts. It is located on Chi- cago’s west side but accepts guests from all over the city. However, it is closely related to the community in which it is physically 1o- cated; namely, the Mile Square. There is an ad- visory council composed of leaders from this community as well as therapists and others from the addict community. Private contributions, church charity funds, and Federal moneys support the work of this agency. A special program for rehabilitation of narcotics addicts is funded by the Office of Economic Opportunity. The agency is currently planning a program focused upon juvenile delinquency and drug abuse. It was in this area that the two students assigned to this site did the greatest amount of their work. They interviewed directors of about 20 West ~ Gide agencies. Their intent was to determine what kinds of programs, if any, these agencies sponsored that had to do with juvenile delin- quency or drug abuse. * * * We found that there are many and varied programs for juven- iles on the West Side, all of them at least indirectly affecting juvenile de- linquency. However, there were very few programs which were directed specifically to help kids who were in trouble with the law, though most of the programs took care of these cases when they came across them. As far as drug abuse was concerned, all agencies were aware of drug use of one kind or another, but almost none had programs of any kind on drugs, and almost all stated that they would like to know of.a referral agency or resource for further infor- mation on these problems. * * * Their learning experience was again stressed, as is common throughout the report: At two of the agencies we visited, we encountered some hostility which resulted in very poor communication * * * our interviews with these two agencies were “good for us” in that we were able to get a broader view of the spectrum of attitudes in commun- ity agencies, especially their feel- ings and reactions toward white liberals. * * * "Short term effects on ourselves consist mainly of broadening our out- look on the problem of drug addic- tion, and equally important, becoming acquainted with the people and their feelings in the ghetto. In the long run, the experience of this summer will help us to evaluate both our cap- abilities and our desire to work in community: medicine. If we should eventually end up in community medi- cine, we will perhaps be able to make a better contribution in light of the insight gained this summer. The impact of the site assignment on one of CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 the students is beautifully expressed in the fol- lowing essay. * * * T did not know my own ideas. * * * by Emily Gottlieb (Medicine) It seemed perfectly obvious to me: all these emotional arguments presented by the more militant speakers at the orientation ses- sion were nothing more than illogical ha- rangues directed at antagonizing the white au- dience. I was all for civil rights and integra- tion, but the leaders of SHP seemed a little too enthusiastic in their desire to be liberals— these speakers were one case in point, another being the pictures of Malcolm X which decor- ated the meeting hall. Granted a small minority may think these militant ideas, but I know that it certainly didn’t speak for most Negroes. Anyway, these militants were so illogical and disorganized, they would never be able to col- lect any sizeable following, much less accom- — plish anything concrete, since their modes of thinking were so obviously immature. The interns I met at orientation were of a more sensible nature, able to think in terms of Negroes and whites working together in a brotherly fashion within the ghetto to help Ne- groes better themselves. They were certainly more mature in their ideas than certain of the speakers I had listened to—and since they are the youth of the ghettos, do not they speak for the future? I was sure most of them didn’t really like Rap Brown any more than I did. He is all right, but a little too radical, and he doesn’t seem to want.any of the assistance of- fered him by white liberals today. The above is an approximation of the atti- tudes with which I began the summmer. They -were not changed by the few days of lectures during orientation. But perhaps the orientation provided the initial confrontation which was to force me into. a reevaluation of my attitudes throughout the summer. As I rode home from Camp Reinberg, I felt that, on the whole, I was in tune with the young Negroes of today—that I understood them, and that we shared com- mon goals. Yet, there were some disturbing ideas that came to mind occasionally: some of the speakers seemed very hostile toward the 51 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 white liberal in general, and suggested that whites had no business in the ghetto. I was. able to dismiss these memories easily, however, when I thought of the many people I had heard who had reinforced my own views on the problem of discrimination—I didn’t let the words of the militants stay in my mind long enough to bother me. My summer assignment was to work at St. Leonard’s House, a halfway house for drug ad- dicts and ex-offenders coming out on parole. St. Leonard’s is located on the near West Side of Chicago, just off: Madison Street. Many of the buildings in the area were gutted by fire last April, but they are still “inhabited” by addicts, winos, and little kids during the day, sitting on the doorsills or empty window frames, watch- ing Madison Street move by. A layer of pulver- ized glass covers the sidewalks and trash is ev- erywhere., Storefront businesses that are still in opera- tion are fortified by iron grillwork. The local Walgreen’s has replaced all its plate glass win- dows with obviously durable paneling. The schools in the neighborhood are easily recog- nized by the large number of broken windows. Occasionally, there is a vacant lot, of bricks and rubble, with a sign designating it as part of some plan for urban renewal, Richard J. Daley, mayor. Two blocks from St. Leonard’s is a very large, dirty building that exudes dust, the public aid office. At St. Leonard’s, I was introduced to the staff members who are black and white. On my own I got to know most of the people living at St. Leonard’s most of them black. My coworker and I both were astonished at the intellects of the people we met—people who had been on drugs, or who had been doing time for armed | robbery. And reluctantly we realized and ad- mitted the subtlety of our own racism—that we were surprised that blacks were intelligent. One man, I shall call him James, we got to know and like very much. James had just kicked his habit a few weeks before we met him. He could talk for hours on all sorts of topics, ranging from Malcolm X to jazz to Op- eration Breadbasket to the Communist Party. 52 Within a few days, I discovered an interesting thing happening to my conversations with James; I was scraping the ground to make this man like me, but the way in which I did this was quite fascinating. Knowing James to be of militant leanings, I mouthed to him the very ideas which I had heard at orientation, and with which I had so much disagreed. I do not know whether James believed me, but for a while I succeeded in convincing myself. Soon enough I realized what I was doing, and for the first time, I admitted that I did not know my own ideas, much less understand those with which I disagreed. It is difficult to describe the subsequent process in which I reevaluated my opinions, and at the same time sought to gain insight into the ideas which I had thus far rejected on the premise that they were insignificant. Given the ideas to which I had been more than superficially exposed at orientation, I was able to appreciate and bene- fit from various experiences at St. Leonard’s. There were several instances in which I felt I was discriminated against because of the white color of my skin. I once thought I had been able to talk meaningfully with a woman living at St. Leonard’s. But the next day, I ov- erheard her talking with a person of her own race (black), and she seemed a different per- son. What I thought I had been talking to was an act she had contrived because I was white. Whenever this type of thing happened, I felt very depressed. At the same time, I was begin- ning to experience, though on an extremely re- duced scale, some of the frustration, even anger, over events determined solely by skin color. No longer did “the race problem” remain a rather intellectual phenomenon to be read about, and mulled over in discussions; it was real to me in emotional terms. During the summer, I believe I was able to sense a feeling that hangs on everybody and everything in the ghetto. It is almost as if the ghetto is a forgotten part of the city. One sees the forgetters every day driving down Madison to the Loop—they never seem to notice what life lies between their jobs and their secure suburban ranch homes. What bothered me was a seeming apathy on the part of the people CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 in the ghetto—didn’t they know that nobody cared? Why didn’t they do anything and de- mand to be remembered? It wasn’t apathy I saw—it was an acceptance of the ghetto as their only way of life. What had the black man ever seen to suggest that black men should ex- pect more? Who has ever proved to a ghetto child that a schoolteacher makes out better in life than a good hustler? The more I seemed to be learning about the ghetto, the more I realized that to understand the feelings of blacks, one has to be black. Per- haps I knew what it was like to be judged on skin color, but I will never know what it is to be judged on black skin color. Along this same line, I slowly began to understand black objec- tions to whites in their neighborhood. First of all, whites had plenty to do in terms of clean- ing up their own communities, spiritually if not physically. Secondly, the black man is tired of saying thank you to the white man for the few crumbs that are swept his way. Lastly, blacks are starting to throw off their warped self-images of second rate human beings, and are taking pride in themselves and their com- munity—and it is they who will make the de- cisions about thmeselves and their community from now on. I am repeating ideas probably already quite familiar to many, and even accepted by many ——but they are reproduced here to illustrate my own change of attitude through the summer. I am grateful to St. Leonard’s and the people of the neighborhood for enabling me to see the in- flexibility of my original attitudes; and for having provided me with the opportunities to reshape my ideas, which, I hope, will continue to change and not stay fixed by disregarding any opinions contrary to my own.as they al- most did at the start of the summer. THE SOUTH SIDE Students were assigned to a variety of or- ganizations. and agencies on Chicago’s South- east and Southwest Sides. In addition to their — experiences in several hospitals (see Hospital Sites section), they also worked with outpatient clinics, civic associations, health associations, community. organizations, settlement houses - and church-supported or church-related agen- cies. Abraham Lincoln Center This site igs a settlement house which has been in existence for 50 years. It offers a wide variety of programs and services for all age groups. The community is serves is located in area 38, also known as Grand Boulevard. Its population is about 99 percent Negro and it is considered a zone 1 poverty area (greatest con- centration of poverty). (1) About 83,500 peo- ple reside in the entire community area. The median family income in 1960 was $4,329 but 32.6 percent of the families had incomes below $3,000 per year; 12 percent of the male labor force was unemployed. (2) The community area was ranked in the first quartile (the low- est levels of health) for all five mortality-mor- bidity factors. (2) There were three health science students and two high school interns assigned to the Abraham Lincoln Center. Their project goal was to help launch a community health com- mittee. The team reported briefly. “It did not succeed,” ascribing the failure to “community apathy,” and predicting that, “no one else can succeed here.” , Yet the essay that follows emerges as the most outstanding personal commentary on stu- dent’s experience during the summer. It sums up the continual theme of “learning” for SHP participants, black as well as white, during the summer’s confrontations. . “If you cawt appreciate a toothpick, a yard full of golden lumber won't do you no good.” —by Roscoe Woosley, Jr. (Premedicine) “Rocky?” * * * He was coming toward me with a huge blade now. He wanted, it seemed, to cut my throat and the razor blades he had used before weren’t good enough. My skin has a number of long slits that are bleeding quite freely * * * “Rocky! It’s 7:30” * * * He's advancing now. Slowly, every slowly, he moves with the blade raised high overhead. His black skin glistens with sweat. His face looks so hard and fixed it seems to have been carved from black ebony. His face is expressionless . 53 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 save the slight hint of a smirk, eyes glazed, and not a twitch of nervousness. He stops as a cat stops before he lunges at his prey. He rushes * * * “Rocky GET UP!” I abruptly but thankfully awoke and slowly climbed from bed. With a sigh of relief and twinge of remorse I vividly remembered last night’s dream. Why? What day is it? Oh yeah, today is Monday. The beginning of the week and work and mindful confusion. I put my clothes on and went downstairs to wash up. “See you later, Mom. Have a nice day at work.” “You too, Rocky, Eat a good breakfast be- fore you leave.” “OK.” I turned on the stero to have a little music with my cold ceral. I should have fixed some bacon and eggs but I just didn’t feel like cook- ing. “Well, I guess I better get going. It’s already nine o’clock.” The people have all learned the game every- one plays on the bus. Everyone keeps a straight, impersonal face so no one may hurt you, or think you’re crazy, or make a pass at you, Everyone puts their masks on when they enter the bus. The sad part of this game is that even the young children have learned to play and in the morning when they get on the bus going to day camp they don the faceless mask of unconcern! Even more tragic to me is the realization that I too, have a mask, or is it a God-sent gift? “Well the next stop is mine”. “Oakwood! Oakwood Boulevard, next stop.” I remember my first day getting off at this stop. Apprehension and the fear of physical harm cluttered and clouded my mind. I remem- ber meeting the old man. He was a short, elderly, potbellied man. He wore a pair of old, faded purple, blue pants that shined from wear. His coat was black and white checked and grayed with dirt. He wore a light blue shirt, opened at the neck. His shoes were an 54 old brown color and the heels were worn down so much they made him appear to walk with a rocking gait. His head was covered with a bat- tered gray felt hat whose crown had been molded so much, it looked like it had collapsed from exhaustion. Beneath this hat was a warm face. His eyes were black and penetrating, but they held a warm glow as a coal holds fire. His eyes darted from me to the street as we walked toward each other on the sidewalk, When we met he stopped me and asked if I was in col- lege. “Was it that obvious,” I thought to myself, I don't want to look like that. It wouldn’t be too healthy around here.” I said I was and he told me to stay there. Then he told me something, he said: “Always remember, if you can’t appreciate a toothpick, a yard full of golden lumber won't do you no good, son.” He told me he had graduated from Fisk University in 1937. I wondered under what circumstances he came to live in this neighborhood. I remember my first impression of the “houses.” Some were painted in a vain attempt to make them presentable to society. Some were just left to die a natural death. Some of the people tried to keep the grass growing, if there was any to begin with, to give the old places some new life. One house, in particular, was nicely, but rather gaudily painted in my estimation. This two flat was painted blood red on the face brick from the roof to the porch and down the cement stairs to the sidewalk. The storm window frames, door and down the middle of the steps were painted a deep, mossy, moody green. It had a shiny new, aluminum storm door and window awnings, and the grass was green and rich. I liked it and silently com- plimented the owners that first day. As I look at it again today I get a sick, depressed feeling inside. Another house farther down the street caught my eye, also. It had no windows; they had been broken out, the door. stood wide open off its hinges with at least six dogs lying in the dirt in the front of the house. An old black woman with big, gnarled hands, muscular arms and shoulders sat with a child in her arms on the wooden porch. I felt guilty the first day CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 because she turned my stomach. I couldn’t look her straight in the eyes. I stepped up my pace with head bowed in order to escape her seem- ingly stone gaze. Today, as I walk down this street, I find myself moving at a slower more relaxed pace. I still cannot look her in the face but I know now why, and how, and I under- stand her. I feel no pity for her, just a deep un- derstanding and a knowing frustration. The center stands on the next corner. It’s an imposing structure. My first impression was of a warehouse, It’s red brick, dirty, old, and looks very tired. The elevator doors opened onto the fifth floor and my office is room 5-B. About 3 weeks after I first arrived there the telephone rang. “Hello, Roscoe Woosley, Student Health Or- ganization.” “Hi, Rocky, This is Mrs. Hill. I’m down- stairs. I have something for you.” “OK, I'll be right down.” After what seemed to be an endless ride on the outdated, 5 m.p.h. elevator, “Hi, what’s up.” “Well, Mrs. Parker, here came in with her four children, One got bitten by a dog last Sun- day and she brought her here because she has no transportation or babysitter and the child’s leg is swollen up, See?” “Oooh damn! We better get her to a clinic. Let’s go.” That went on for 2 weeks. Ron and I picked up 7-year-old Karen and took her to the clinic for rabies shots. Karen, as most girls her age, was a slim gamely child. Her face, though, was not the face of child of seven. She had a beau- tiful full face that contained an unnatural awareness. She, seemed more self-reliant and mature than other girls her age. She wore clothes. that were too small for her and some- times soiled but she was probably fuller of life than other children. On the fifth day, after we had gained her trust, she seemed to have lost her easygoing, Sunday disposition. She seemed troubled and we asked her what was the mat- ter. “T feel fine.” “Then what’s wrong, Karen?” “T don’t want to go home right now.” A beautiful black girl with deep dark eyes and a razor-sharp mind would rather get shots than go home. There was nothing I could say to console her. Her younger brother lay crying at home in bed because the gnats and mosqui- toes, so abundant in the dirty two flat apart- ment building where they lived, had bitten him so much he had broken out in hives all over his body. “T’m hungry.” “Didn’t you eat this morning, Karen?” “I just had a sandwich before you came to get me.” My mother’s words came racing back to me. “Eat a good breakfast before you leave.” But I was too lazy to eat. What could I do? If I bought her anything she may realize the des- perateness of her station in life because she was black. But would that be good or bad? Who knows? My lunch sat cold and untouched in front of me that afternoon. “T want you all to start a diabetes program in the neighborhood.” “We want a clinic.” “What about all the children with tetanus that won’t be admitted into school this fall un- less it is cleared up?” “The main objective of this project at. this particular site is to effectively organize the community so that they may control their own lives.” “What are you doing here that KOCO doesn’t already do?” “You're just a fixture, you’re not effective and nothing concrete has happened.” This is what was asked, demanded, and said to us by members of the Student Health Or- ganization, the Concerned Parents Group of Ida B. Wells which consists of. no more. than 200 people whereas Ida B. Wells accommodates thousands, and other people who had been in the neighborhood for about 5 years. How could I organize or help organize any community 55 wose~wesse ee wareeayd AEA POI HG! SUMMER 1968 when I didn’t have an organized mind. I didn’t know what all the problems were, where they stemmed from, or how to effectively cope with them. I was unorganized and confused in my thought in terms of my identity, and in terms of what my role in life is to be. I didn’t know why I thought the way I did. In terms of benefiting the community, I was a total failure. In terms of myself and how the project benefited me, however, it has achieved one goal, It has made me aware and has made me change mentally. I realize now and understand why I had that dream. I was afraid of my own people. I had been brainwashed into believing my people hated me and anyone else who tried to get ahead and, therefore, I feared them. What was not drummed into my head was that the only reason my people dislike others who tried to get ahead was because they seemed to always forget or disown their own kind. The fear the first day at work is now 4s understandable as the feeling of remorse after the dream. The confusion my mind was assaulted by at the beginning of the summer has been con- quered, I understand, now, the cord which joins together the old man on the street to the woman on the porch to the little girl named Karen to me and the rest of the black people. No more will I be able to think and act as the people in the gaudy house who disregarded their neighbors and their people. No more will I be able to strive to think and act as a white man. For now I know what besets my people, and how, perhaps in a feeble way, to help them and myself. Now I am able to understand the proverb that was told to me a black, perse- cuted old man, If you cannot appreciate the smallest thing or the seemingly smallest per- son, a whole college education with an infinite understanding of the universe is worthless. How could I before, do anything to help the people in my site if I was as unorganized and as in need of help as they were. Now, at least, I am able to see more than before. The Demo- cratic National Convention was also a revela- tion. I had not before fathomed the power Em- peror Daley possessed. Now that some of the 56 pieces are beginning to fit and a pattern is pre- senting itself, it is up to me and all black peo- ple to begin to try to put the puzzles together which are themselves. Then, and only then, may we advance. For me there lie other pieces to be fit together and now is the time to re- group and advance. Before this summer, all of _ this was unknown to me and I am deeply grateful to the Student Health Organization for making this realization possible. For with this realization and a great amount of determi- nation and action there is hope and an answer for the “Karen’s” of the world and all. the “Classes of 37.” The Robert Taylor Homes The Robert Taylor Homes is a giant housing project, the largest one administered by the Chicago Housing Authority. It is located on 92 acres of land between 89th and 54th Streets on State Street, running about 2 miles in length and two blocks deep. (2) They are high rise units, most of which are located in community area 38, just described; however, some spill over four blocks in community area 40. The parameters for 40 are similar to those for area, 38. The Taylor Homes have become a commun- ity unto themselves, isolated from the sur- rounding South Side. Even branches of schools operate in apartments within the housing pro- ject, It is an extremely young community with 20,300 of its 27,200 residents below the age of 18 years. The average number of children is 4.7 per family. (3) The median family income at the end of 1967 was $4,860 per year and 48.7 percent of all the families were supported by one or more public assistance grants, Of the families with assistance grants, 75 percent were supported by the Aid to Dependent Children category. Racial occupancy is 100-percent Negro. (8). Ten health science and high school students were assigned to work with the Robert Taylor Homes Health Committee and the Robert Tay- lor Homes Health Clinic. The former is com- posed of residents of the project who are con- cerned with health issues in their community. Mostly women comprise its leadership. The lat- CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 ter has been a goal of the Health Committee since its inception. Student Health Organiza- tion members have been working with the Health Committee since the summer of 1967 assisting them in attempts to open a Health Clinic in the Taylor Homes. The clinic finally was opened in the summer of 1968. Students participated in the opening and the staffing at first. However, the Taylor Home site was one of the most trauma ridden for the students. The best description of the student involve- ment this summer at this site is their own re- port. The text of this report follows. Taylor Homes Area Site Report.—by Pamela Osbourne (Nursing), Suzan Simons (Psychol- ogy), Grace Dammann (Social Sciences), Steve Rand (Medicine), Mary Anne Caswick (Medi- cine), Andrea Gay (Biology), Vincent Torna- pene (Medicine) In the process of writing this report, it be- came evident that the report could be written from any one of three points of view: that of the ladies of the health committee, that of the white health science students, that of the black health science students. In view of the consti- tuency to which this report is directed, all stu- dents at the site agreed to write the report from the point of view of the white health sci- ence students. Student efforts in the Taylor story include two Student Health Projects (the summers of 1967 and 1968) and the efforts of the Student Health Organization during the in- tervening school year (1967-68). In this report the name “SHO (Student Health Organiza- tion) is used to include all the students who contributed to the Taylor story. What drives a college student who really knows nothing about a black ghetto to enter that ghetto? “I want to help these people,” said one SHO. member who worked in Taylor Homes on the 1968 summer project. “I thought I could learn a lot,” said another. With these ‘attitudes and all the ignorance and paternal- ism behind these statements, SHO, in 1967, sought its contact with the Taylor community and ended up with the Illinois Humane Society which has an office in the Taylor area. The Robert Taylor Homes, the largest public housing project in the world, are “high-rise concentration camps” (Dick Gregory) that pack 30,000 black people into’ a one-block stretch along 2 miles of South State Street. The city of Chicago built “Taylor Homes” with Federal funds during Mayor Daley’s second term and planned into the project such defects as totally inadequate playground and recrea- tional facilities, two small and often inoperable elevators for each building (1,100 people), and, most devastatingly, the swept-aside feeling that comes from being stacked into a 16-story prison. “Depressing”—that is the word most commonly used by people caught in Taylor Homes. In June 1967 the one black and three white health science students of the Student Health Organization went into Taylor Homes and im- mediately saw that the Humane Society had little real contact with the community. They then proceeded to conduct a survey of the health needs of the community by interviewing about 40 parents at great length. The Taylor residents told of the lack of health care facili- ties in their area, Several mothers said, “T need a place where I can take my children when they are sick.” After hearing statements like this the SHO students decided that it was pos- sible to set up a clinic to serve the Taylor Homes area. The Infant Welfare Station at A7th and State Streets seemed to be a logical place where a Taylor mother “could take her children.” The Infant Welfare Station, like all the Taylor Homes buildings, is owned by the ubiquitous Chicago Housing Authority. Taylor residents and other “project” péople of Chi- cago hold a special resentment for the Chicago Housing Authority, their “keeper.” Their jus- tifiable rage seethes when a baby falls 18 sto- ries because Chicago Housing Authority hasn't repaired a balcony fence, as happened again in September 1968. The Chicago Board of Health leases the Infant Welfare Station in Taylor Homes from the Chicago Housing Authority. This station, like the others in Chicago, does not serve sick children but only well babies who get routine checkups and immunizations. At the suggestion of one of the SHO mem- bers, several of the ladies who had been inter- 57 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 viewed met at a local church and decided that they themselves could indeed improve their neighborhood health situation. They com- plained about their health problems to each other and asked why these problems existed. This was enough to motivate the ladies to form the Taylor Residents’ Health Committee. They elected Mrs. Shirley Collins, one of the ladies present at the meeting, chairman, and they di- cided to seek better health care through the es- tablishment of a low cost clinic that would serve Taylor Homes and would be under their own control. Now, 1 year later, that clinic is operating. The Taylor Residents’ Health Committee con- trols the operations and there are finally no SHO people in any positions of authority. The doctors who practice in the Taylor area have met with the Taylor residents on friendly terms. The young men of the Taylor Homes, potentially the strongest power in the area, have forced changes in the structure of the Taylor Clinic. The removal of the white stu- dents, whom the Taylor ladies came to depend on, gives the Taylor Clinic a chance to be a constructive force in the black community. The Taylor Clinic revolves around Mrs. Shirley Collins and about seven other black women who make up the Taylor Residents’ Health Committee. Their determination over- came huge obstacles that would have stopped any average group of people—obstacles like a city that makes discrimination against the poor an avowed policy (i.e., the building of Taylor Homes), a history. of calculated dis- crimination against black doctors that left them alienated from their own communities, and lastly the obstacle of the white paternal- ism of city health officials, hospital administra- tors, and SHO that fostered dependency upon white institutions and catalyzed splits among groups of black people. On September 12, 1967, Samuel Andelman, then Commissioner of Health, said in a letter to Mrs. Collins, “We are glad to approve this re- quest (to use the Infant Welfare Station), and we will look forward to working out the de- tails with you at the time you are able to im- plement your program.” Armed with this com- 58 mitment the ladie set out with the strong help from SHO to open their clinic. Opposition from the black doctors at 51st and State Streets was strong. These doctors saw the Taylor Clinic as another attempt by the University of Chicago and Michael Reese Hospital to continue white dominance of health care facilities on the South Side of Chicago. The presence of white students from the Uni- versity of Chicago at all Taylor Residents’ Health Committee meetings only confirmed their suspicion, despite earnest disclaimers by students. Besides this, the doctors were con- fronted with a new phenomenon—a group of black women who had familiarized themselves with new developments in Chicago like the Neighborhood Health Centers and who had or- ganized themselves solely around the health is- sues. These ladies were demanding a measure of real control in the delivery of health care in their own area—a concept new to Chicago and to all its doctors. The conflict came to a head on January 25, 1968, when the Taylor ladies, three SHO stu- dents, the doctors, and some city health profes- sionals clashed in a stormy meeting. The doc- tors tried to explain the long history of dis- crimination against them which each physician knew well from bitter experience. They de- scribed the sorrowful but common phenomenon of a black man preferring a white doctor over a black doctor of equal or better training and ability because of the unremitting brainwash- ing that blacks had received. “During my resi- dency,” said one of the doctors, “a white resi- dent and I walked onto a ward filled with black patients and they wanted him, not me, to care for them.” The chairman of the meeting was one of the nine black doctors who had filed suit in 1961 against a number of defendants includ- ing 40 Chicago hospitals charging them with systematic exclusion of black doctors from their staffs. (An out-of-court settlement was reached by which the hospitals agreed to admit physicians to their staff without regard to race and the doctors reserved the right to reopen the suit if the hospitals did not comply.) The physicians at the meeting expressed the view that the proposed clinic would be another inad- CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 equate and unrealistic response to the commun- ity’s needs. In the end not one of the approxi- mately 25 doctors present spoke in favor of the clinic. If the ladies and the SHO students didn’t ap- preciate the positions of the battle-weary doc- tors, neither did “the doctors seem to appreci- ate the significance of this effort and how im- portant it was to the ladies of the Robert Tay- lor Homes” (from a letter written the next day by a witness to the meeting). SHO, instead of relieving tensions, only widened the gap be- tween the Taylor ladies and the doctors. The SHO students were unaware of the fact that many of these black doctors have been at- tempting to improve the health conditions of their people for many years. As long ago as 1956 the building of a new community hospital on Chicago’s South Side had the support of several of the black physi- cians. In 1965 they endorsed the concept of Neighborhood Health Centers and Provident Hospital submitted a letter of intent to cooper- ate in the establishment of such a center. (1) All of these efforts came to naught. The students were surprised to learn that, due to discrimination in medical schools and staff appointments, there are only 7,000 black doctors in the United States. In Chicago, 50 percent are over the age of 50 and 25 percent are over 65. The number of black physicians practicing in Chicago today is no greater than it was 20 years ago; indeed, it is believed to be slightly smaller, while the black population has almost doubled in the same period of time. The SHO people didn’t understand the doc- tors nor did they understand the devastating implications behind whites “helping” blacks organize and the subtle damage that this “help” can do to black efforts to organize themselves into a position of strength. Several young men from a black youth or- ganization clued SHO in. Upset about the whites coming unannounced into their neigh- borhood, they walked into an early July 1968, . meeting of the 12 Student Health Project peo- ple assigned to Taylor Homes for the 1968 summer and asked what they were doing in the neighborhood. The health science students ex- plained as best they could. One 19-year-old black youth told the whites to leave Taylor Homes. He said he represented 3,000 others like himself who resented the fact that SHO “sneaked into Taylor without telling anybody they were there.” The rest of his ar- guments are worth quoting directly: This is a ghetto. We are trying to make it a community. The reason it is a ghetto is that the people here have no control. People like you can sneak in and out. In a community the people control their lives. When asked about how the ghetto’s prob- lems would be solved, he answered, You’re the problem. If you go, we'll solve the problem. You people are here to experiment on us. The only thing you can do is give us your money and leave. The black youths objected to having any whites in positions of authority, which, obvi- ously, they still held in the Taylor Clinic. These young men were justifiably angered over the atrocities perpetrated by the whites against blacks. They objected to anything that fostered dependency on the white man. They didn’t want their women undressing in front of white doctors or a perpetuation of the situation of black school children who saw nothing but white teachers. To a white clergyman who was present they said, “Get out, we don’t want no more Father Groppis.” His answer, “I am stay- ing,” only angered them more. Despite warnings that they would hear “Whitey, go home,” the health science students were unprepared for this confrontation. Some began to leave immediately but most of them just sat bewildered. Who were these guys? Did they really represent 3,000 other youths? Were they even from the Taylor area? The questions were understandable, but regretta- ble. They didn’t understand what the guys were saying, i.e., that the 300 years of brutal oppression of blacks by whites has to stop. So rather than concentrating on the content of the 59 ' CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 blacks’ message, the SHO people could only say, “Who are these guys?” Malcom X had reached the blacks but not the whites. Realizing that the whites couldn’t compre- hend what was happening, the young blacks from Taylor resorted to threats of bodily harm which the whites did understand. The SHO members decided to leave the church because it was not safe to remain, but they vowed to con- tinue to work on the clinic. This decision to continue working on the clinic was very much in keeping with the his- torical approach of whites to black communi- ties. At best, the students assumed that the small group of people that they had made con- tact with were the voice of the community; at worst, they assumed that this decision was theirs to make and not the community’s, In their naivete, the students could not im- mediately understand that giving health care could ultimately damage the community. The decision to stay was made from their own per- sonal bias. It was facilitated by the opinion of the ladies of the committee, but the ladies re- present only a segment of the community. One student, who had had previous experi- ence working in black communities, was al- ready familiar with the problems engendered by her presence. Consequently; she was more concerned with pinpointing the ultimate causes behind the health care problems than with set- ting up a single clinic. To her the important question concerned the point at which they could most effectively apply pressure to ame- liorate the entire situation. She “felt guilty for getting into a situation like this because she had been in a similar situation before,” and said,“I should have known better.” The early confusion of the eight health sci- ence students and the six high school students assigned to the Taylor Homes area for the 1968 Summer Project added enormously to the problems. As a result of communication prob- lems between the groups of 1967 and 1968, the students, including the area coordinator, did not clearly understand the background of the Taylor story. They did not know the members of the Taylor Residents’ Health Committee or 60. what the committee did. One said, “It seemed to me the residents weren’t doing anything,” indicating complete ignorance of what had happened in Taylor. The drive and stamina of the Taylor Resi- dents’ Health Committee was, and still is, the central reason for the existence of the Taylor Clinic, even considering the great amount of work done by SHO. During the incredibly hard year-long struggles against Chicago’s political machine, opposing doctors, and indifferent hos- pital officials, the SHO representative to the committee during the 1967-68 school year said, “T felt like quitting many times, but the ladies just would not quit.” During their 1968 Summer Project orienta- tion the students got the impression that black students only, and not the whites, would have contact with the black community. The whites were to gather supplies, raise funds, and per- form other tasks that had to be done if ‘the clinic was to run. Above all, no whites would do any “organizing” in the black community. All this sounded fine but things didn’t work this way. Whites did contact the community. They were present at all clinic meetings, and they definitely influenced policy decisions. There were other sites in the Taylor area where the SHO people could have worked, but they seemed “so unstructured” that the health science students rejected them. At one site a medical student was expected “to cure a re- tarded child,” which understandably scared her away. So, it was a case of too many SHO people knowing too little about the enslave- ment of the blacks which still continues today and about the resulting present-day black drive for freedom. By the end of the summer, 1968, when the vestiges of white student con- trol were being eliminated one admittedly naive health science student could nevertheless say, “I don’t think we should have been there in the first place.” By September 1968, things had changed. The clinic was operating -two nights a week with the number of patient visits, then num- bering about 15 per night, increasing each night as the clinic became more widely known. CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 Doctors and nurses, all but one of them black, were volunteering their time steadily. (Taylor plack youth, in their efforts to make the clinic viable in their own community, would not allow any whites to work in the clinic and this included white doctors, Once the clinic had opened and functioned under these conditions, the youths, because they did not want to deny the community medical services, voted to allow up to five white persons to work in the clinic each night.) Procedures for culture taking and hospital referrals were still not smoothed out. But the Taylor ladies were carrying the bur- den of the work. Local black doctors who origi- nally opposed the clinic were offering their time. (The young men from Taylor were es- corting black nurses from the bus stop into the clinic and protecting the clinic.) The ladies themselves were obviously proud of their work. What had happened? What brought the la- dies, the young men, and the local black doc- tors together? The real answer is simple to state, but the meaning is profound: everybody working in the clinic was a member of the black community. The Taylor ladies, 10 local black doctors, representatives of three other community organiaztions, and two black nurses met on July 30, 1968, and for the first time they calmly discussed their mutual prob- lems and the future of the clinic. It is most sig- nificant that no whites were present. Whites were not invited. The doctors, seeing that no outsiders were strongly influencing or control- ling the clinic’s policies, agreed for the first time to work for the Taylor Residents’ Health: Committee in the clinic. These community groups themselves went a long way toward re- pairing the splits among themselves. This was facilitated, to some extent, by the efforts of the black SHO students to contain any destructive white influence. “In my mind,” said one of the black students, “the July 30th meeting was the beginning of the clinic and the end of the con- struct of some white man’s mind.” The earlier meetings between these groups were stormy partly because, with outsiders present, there . was a constant undertow of feelings. Blacks differing with each other in front of a white man “was like hanging out their dirty laundry in front of whites,” as one observer put it. Unfortunately there are still residuals of white intervention which still cause bitterness. For example, the ladies, when faced with get- ting some technical job done immediately have a tendency to turn to the long-standing depen- dency on white students rather than to black people who may, with admittedly more diffi- culty, be able to accomplish the same thing. This artificial dependency upon whites, which doesn’t have to exist, weakens the black com- munity. That dependency is exactly what. the young blacks hate most. The black volunteers now working with the Taylor Committee to in- crease the power of the black community must now surmount an extra obstacle placed there unintentionally by white students. The depen- dency relationship fostered by white people working in the black community slows the co- hesiveness of the black people working in the clinic, Until these splits between the various segments of the community are bridged, the black community will not be organized enough to resist the encroachment of a Model Cities program or neighborhood comprehensive care center that may not be in their best interest. No one can judge now what will be the long term value of the Taylor Clinic in the black - community. Mrs. Collins has always main- tained that “politics is our real problem.” Her committee waged an incredibly hard political battle with an insensitive, if not oppressive, "city administration. But the fight is just begin- ning. Other battles are coming. The lessons of the Taylor story are classic. First of all, there is the power of the black community embodied especially in the women of the Taylor Residents’ Health Committee and in the Taylor youth. They created something that didn’t exist before despite tremendous ob- stacles. SHO made some big mistakes. It’s tempting to say that knowing the black man’s view of history could have kept the SHO people from making these errors, but that’s too easy. How ~ does a white get this knowledge or appreciate its meaning? One thing for sure—it’s very 61 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 hard, but not impossible, for one man to under- stand another, especially if one is black and the other white. This takes a constant, monu- mental effort. Today the burden of that effort is on the white man because he has to change. It would be presumptuous to lay down direc- tives for SHO based on the Taylor story. But one question does deserve an answer: How is it possible for whites to come to a knowledge of the black man? Definitely not as the whites in the Taylor story did. Some of them learned things that will change their lives decisively, but the black community paid a high price for that knowledge. On one hand, the Taylor pro- ject appears to be functioning. On the other hand, the clinic is not yet funded and there are serious problems in persuading practitioners —hblack or white—to regularly give their time in a volunteer situation. In their process of learning, SHO attempted to treat a symptom rather than the cause. Since concerned black people made a concerted effort to prevent the clinie from becoming an issue that would fur- ther divide the community, the black commun- ity did not suffer from this “learning process” as much as it might have. But this student ven- ture may be instrumental in adding another in- cident in a long series of disappointments, as well as acting as a channel to divert energy from places where it may more effectively be placed. Students do not need to organize in poor communities—Appalachian white, Spanish or black—to learn about the problems that affect the poor. Middle class whites are foreigners to the poor and always will be. The real problem lies in the white community and must be dealt with there. Woodlawn Woodlawn is another almost all black com- munity on Chicago’s South Side. It is -geo- graphically adjacent to the University of Chi- cago with it’s massive resources. Woodlawn’s boundaries are the Midway (6000 south) and 67th Street (6700 south) ex- cept for a small strip that goes to 71st Street (7100 south); and Lake Michigan on the east 62 and South Parkway (400 east) on the west. (This latter street has just been renamed the Dr. Martin Luther King, Jr. Drive) Woodlawn is community area 42 and the population reported in the 1960 census was 89.1 percent black. (2) Approximately 77,000 people were estimated to be living in Wood- lawn in 1964, 98.4 percent of whom were black. (1) In 1960, 27.0 percent of the families in Woodlawn had incomes below $3,000 per year while the median family income was $4,797 per year. In that year 11.5 percent of the male labor force was unemployed and 30 percent of the housing was substandard. (2) No new housing has been built in Woodlawn since that time, although such housing is now being contemplated. If there have been any changes since 1960 in the parameters of this community, they have been for the worse, not the better. Woodlawn is considered a zone 2 poverty area. It ranks in the first quartile (the highest rates) for all five morbidity-mortality fac- tors.(1). Two SHP teams were assigned to Woodlawn projects this summer. One of these was a sex education program conducted at a neighbor- hood center. (This same center also offered a variety of programs, including arts and crafts, physical education and tutorial work.) One health science student and one high school intern participated in the sex education program. It offered girls, between the ages of 12 and 19, sex education including information about basic anatomy and physiology, the repro- ductive organs, personal hygiene, venereal dis- ease control, birth control, and nutrition. A number of community organizations (Woodlawn is a more highly organized com- munity than many others), cooperated with the program. The team felt the program was successful and are hopeful that it will be the beginning of an ongoing educational tool for the community. The medical student on the team wrote: I now feel that the time remaining in medical school should be focused on gaining the quality of medical train- CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 ing which will enable me to be a good doctor as well as a concerned and hopefully aware doctor in an inner- city ghetto clinic. The team’s “Final Report,” is reproduced, and describes this experience. Sex Education Program in Woodlawn.—by Dorothy R. Davies (Medicine), Georgia L. Houston (Intern) The project has involved exploration and work at several levels: 1. Meeting with representatives of a number of community service agencies in the Wood- lawn neighborhood to obtain their opinions of (a) the central needs in reproductive care edu- cation in the community; (b) most effective means of meeting those needs; and (c) what services their agencies might be able to con- . tribute to an educational program. 2. Teaching sex education classes to three groups of teenage girls, exploring several dif- ferent techniques and media, as well as more and less effective means of publicizing classes. 3. Surveying available films, books, and pamphlets pertinent to such a course. 4, Writing a permanent course outline for a 10-session sex education program based on the information and understanding gained from 1-3, as well as work done in the spring quarter to write a course outline for prenatal care classes. 5. Working with various resource agencies and individuals to establish an ongoing pro- gram which will be carried out primarily by community people, and available to whatever community groups are interested. There has been an effort made to share as much as possible of the information and under- standings gained with individuals who, while not directly involved in the program outlined in the attached grant proposal, are likely to be involved in sex education in the course of their responsibilities. Perhaps most gratifying along these lines was the dialog which took, place when a street-worker from Youth Action, a representative of TWO, of the TWO-U. of C. — experimental school project, and several others " were brought together in a meeting to discuss possible ways of meeting the sex education needs. A discussion of effectiveness of attempted means of publicizing classes; bibliography and revised pamphlet list; course outline; and a re- view of available films including an evaluation of their usefulness is available from the Chi- cago Student Health Organization. Woodlawn Child Health Center The University of Chicago, founded by the Children’s Bureau, has established a compre- hensive child care center in Woodlawn. Free medical care and social services are provided to Woodlawn children up to age 18 years. — Three high school interns and one health science student were assigned to this center. Their duties included acquainting the commun- ity with the danger of lead poisoning and as- sisting Woodlawn residents in finding screen- ing and treatment sources for lead toxicity. They went door to door in the community with | a pamphlet dealing with lead poisoning that was produced by last year’s SHP team in Woodlawn. They also worked with a special committee on lead poisoning established by the alderman who represents Woodlawn in Chi- cago’s City Council. The following portion of a student’s report describes this experience. Guess one can learn about a bureaucracy only by dealing with it—by David S. Sargent (Medicine) My efforts eventually came to focus on the lead poisoning problem in Woodlawn. During the first few weeks of the summer I made nu- merous visits to the homes of lead poisoned children who had been seen at the clinic. One of these cases, a girl who was hospitalized at Wyler Children’s Hospital with lead encephal- opathy, dramatized to me how senseless and potentially tragic this disease can be; I had followed the purely medical aspects as well as the social aspects of this case. Nearly all of the buildings I visited had bla- 63 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 tant violations of the city building code. To satisfy my own curiosity I decided to find out why the building code had not been enforced in these instances. My approach was to phone the building department and ask what violations they found in specific buildings and what was being done about them. This sounds easier than it actually was. My first call lasted about 1 hour; 45 minutes of this time was how long it took them to put me in contact with the person who could give me the desired information. I talked with eight different people altogether, all of whom, except for the last one, sounded equally vague about how I could get this information. The eighth fellow I talked to said he would check their files for the status of the building I was asking about. Although subsequent calls to the De- partment required less time, since I then knew just who to talk to, still, I was amazed by how completely nonchalant and impersonal some of the people sounded. Guess one can learn about a bureaucracy only by dealing with it. A few conclusions can be drawn from this “investigation” which required a large amount of time both on the phone and in the neighbor- hood. The building department seems to be a very slow, inefficient bureaucracy, completely apathetic about the living situation of the thousands of slum dwellers in Woodlawn. Hang ups in the enforcement of the building code appear to fall into two groups. In one case, violations somehow slip by “unnoticed” ; substandard buildings are given a clean bill of health. An example of this situation was pointed out by one very good newspaper article which came out during the summer. Why it oc- curs is unexplained; I was told bv the building department that it is “being looked into.” In the other group, violations have been found in a building and the case is presently being “processed.” Unfortunately, in numerous cases, this processing apparently lasts a num- ber of years. The inspector’s report of viola- tions slowly makes its way to a secretary’s typewriter, on to the Compliance Board, and eventually to the Corporation Counsel which submits the case for court action against the 64 landlord. Who knows how long the court action lasts? The landlord may eventually have to pay a small fine, an amount considerably less than the cost of building repairs, He pays, but supposedly still has to fix up the building. After more inspections, more processing and more court action, the building might eventu- ally be boarded up. While all this is going on, the paint continues to flake, the plaster contin- ues to crumble, and young children continue to eat both the paint and plaster. Massive num- bers of substandard buildings are presently in- habited by families with children, but the building department will not move. There is a more practical side to my efforts on the lead poisoning problem. I have been working with a group called the Chicago Com- mittee Against Lead Poisoning, which was started during the summer by Alderman Despres. Although its overall goal is to erad- icate lead poisoning in the Chicago area, a more immediate goal is to amend the city housing code such that it will be more enforceable with respect to the elimination of peeling paint and broken plaster in Chicago housing. Petitions have been circulated by members of the group, and these will be sent to the mayor as a show of support of the amendment proposed by Al- derman Despres. The amendment is to be in- troduced at the city council in September. All in all, my work with the Chicago Stu- dent Health Project has been very enlighten- ing for me and somewhat productive for the community I worked in. I consider these sum- mer projects very valuable with respect to broadening the views of students in the health sciences. Service to the community is ideally an equally valuable goal; however, it presently ap- pears to be more of an incidental thing. Despite the fact that Woodlawn is so highly organized and that a well-known youth gang considers Woodlawn “their turf,” there was no report by the students assigned here of diffi- culties in working in the community. When asked if there were negative effects of their work this summer they answered that there were none. They did not appear to become en- meshed in black-white confrontations and did ‘pot decry the possibility of SHP students — working in Woodlawn again in the future. THE SOUTHWEST SIDE A number of student health projects were involved with communities on the Southwest Side of Chicago. Most of this area is still pre- dominantly white. However, there are all black communities scattered throughout this part of Chicago. Students assigned to projects in this part of the city worked in both black and white communities. A brief overview of the Southwest Side as seen by several students (David and Elizabeth George and Robert Geohegan) is presented as an introduction to this part of the report. The Southwest Side has been characterized as suffering from the problem of mass paranoia and mass denial The Southwest Side was roughly defined as the area from Lowe (632 West) west to the city limits between Archer and the city limits. The ethnic composition overall is predomi- nantly Irish, Polish, and other European groups, especially Lithuanian, although in fewer numbers. There are small pockets of Ap- palachians and Mexicans. Its eastern edge bor- ders on the black ghetto and it is undergoing racial transition. It is a low to middle income working class area. Men work in factories in construction trades or in lower level white col- lar jobs. Income is lowest in black, Mexican, and Appalachian areas. Generally speaking, in- come rises as one travels west. The health needs of the people in this area should be viewed in the context of this envi- ronment in which they arise. The type and ade- quacy of health services should be analyzed in terms of the broader social, economic, and po- litical forces at work on the Southwest Side. This is important in the areas of both physical and mental health. Little public attention or awareness has been focused on the health needs of an area like the Southwest Side. The ghetto and hard-core poor areas have received a lot of attention (at least in the form of studies) but areas like this . CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 which are one notch better have not been ex- amined. Even the community organizations in the area tend not to recognize health care as an issue. Do the people on the Southwest Side pay 4 higher percentage of their income for care which is less adequate than that received in other sectors of the society? At the same time are working people subjected to more harmful physical conditions than the executives who can more easily afford good medical care? What percent of their income do working peo- ple pay and how adequate is their health care? What is the effect of working conditions to which they are subject? How are community health standards influenced in an area of tran- sition? Why do housing and therefore health standards decline in such an area? How can decline be prevented without an appeal to ra- cism? What are the particular health needs of different ethnic groups? How can greater awareness of these problems be created so that the people of the area can demand what they need? The Southwest Side has been characterized as suffering from the problem of mass para- noia and mass denial. To what extent is this situation caused by social, economic, and politi- cal factors as compared to individual and psy- chological factors. How, for example, does ra- cial fear and hostility contribute to the situa- tion? How are these fears and hostilities built up? Are they simply a matter of individual at- titudes? To what extent are they the product of institutional forces? For example what part do politicians, news editors, and realtors play in causing racism, through the exploitation of racial fear in order to gain votes, sell papers, or make profits on the sale of property? What influence does the ethnic factor have? For ex- ample, how did flight from communism, or loss of status and property upon coming to the United States, influence the mental health of immigrants? What special generational prob- lems have arisen? How does community pow- erlessness via the political machine and other special interests influence the development of alienation and apathy? Lastly how does the factory or industrial situation undermine men- 65 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 tal health? How is a man influenced when he has a lack of major decisional power over the purposes and directions of his.daily work, or when he is just a cog in the machine monoto- nously repeating the same tasks? What solu- tions are required to the problem of mental health on the Southwest Side? Will individual and group therapy provide a long range solu- tion or is basic societal change necessary? The communities are almost exclusively white, except for a housing project on Cicero at the edge of Garfield Ridge. The area is a working class neighborhood. The largest eth- nic groups are Polish, Italian, Irish, and Bohe- mian, and many of the people are third genera- tion. Few of the middle-aged people completed high school. The values of these people reflect their educational level; thus, a couple will con- sider a new car or a well-kept lawn more im- portant than a college education for their chil- dren. Many parents suffered from authoritar- ian upbringing; hence they often fail to dem- onstrate love in the home. They have been suc- cinetly described by one of the local clergymen as “relatively affluent dropouts.” These people feel alienated. They feel that most of the public money being spent for the welfare of the city’s citizens goes to the blacks, the influx of whom they greatly fear. Commun- ity spirit is notably absent. This is reflected in the fact that the only centers of any kind cur- rently in existence are church-sponsored af- fairs; and the few community organizations that do exist were established largely in res- ponse to the race problem. The fact that the people do relatively well materially, with rela- tively little education, tends to make them indi- vidualistic. It is also highly significant that the youth problem is recognized by everybody but the parents. This denial of personal problems is in general manifested by a failure to recog- nize the need for change. In the foregoing the students have not pre- sumed to set forth “answers” but rather to for- mulate basic questions that must be dealt with in finding approaches to the communities’ health problems and needs. Within this context the following reports on individual sites com- 66 prise a description of the students’ work on Chicago’s Southwest Side. Benton House The student’s report that follows includes a brief description about the neighborhood that this settlement house serves. I have come to feel, as have many others, that I belong in only one place if I want to change the world, and that place is in trying to change my own community.—by John Vogel (Medi- - cine) Coming from 4 days of orientation in Pala- tine, I was all set to get into the work of my site. I had chosen to work in a Mexican-Ameri- ean area, less than a mile from Mayor Daley’s home. Nominally, this site was included in the Southwest Side group, but in reality was sepa- rated from the Southwest Side both geographi- cally and ethnically. This subsequently proved to be disadvantageous because we found it very difficult to relate to the rest of the Southwest Side group. The other 20-25 people in the group, although working at different sites, often were able to interact with each other be- cause they all were working, basically, in the same community. Susanna Roberts and I worked at the Neigh- borhood Resources Center (NRC) of Benton House, which is a settlement nearby in Bridge- port, a white ethnic area. The NRC is a store- front at 27th and Normal. Our preceptor was the unit director of the NRC, Dick Hall. He and four neighborhood workers made up the staff of the NRC. Add to this the Latin Kings, a loosely knit gang of neighborhood teenagers, whose main activities consist of (a) hanging around the NRC in the daytime; and (b) nighttime recre- ational activities—drinking, window-breaking, glue sniffing, etc. A really good bunch of kids but with nothing to do. I sometimes wonder if we who do have something to do are any better off, pursuing a structured existence which we might not choose in a less rigid society. To top it off, throw in about 30 (sometimes they appeared to be 80,000) kids between the CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 ages of 2 and 14, Some of them were in the NRC’s day camp, others just hung around be- ‘eause they, too, had nothing to do. All these people thrown together added up to one BIG happy family. The immediate community itself, is not one of abject poverty. Most of the people are poor, but most are employed ( usually underem- ployed) and are eking out a fairly dignified ex- istence. One of the biggest problems in the area is that, having no established community organization and no militant spokesman, it suf- fers in terms of municipal services. Trash cans on corners are rarely seen, there is always bro- ken glass in the rarely cleaned streets, etc. The rest of Bridgeport, well organized and very vocal, receives almost all of the ward’s ser- vices. The adults in the community have been too preoccupied with the teenagers—the vandal- ism, the drinking, ete. Dick saw that this had to be eliminated, as a first step in building a more viable community. Somehow, the kids have to be turned in a more constructive direc- tion, at the same time that issues are raised on which the adults can focus—the more funda- mental issues, such as housing, education, and health. Therefore, Susanna and I could be used to help people to begin thinking about these is- sues by doing something in the field of health to bring it to their attention. At the same time, we all agreed that whatever we did, it should be something that the area people could partic- ipate in so that they could convince themselves that when they set out to do something, they could succeed. The next logical step after this would be the formation of some sort of com- munity organization so that the neighbors could have a permanent base from which they could work whenever they set out to do any- thing, including demanding their rights with regard to city services and other city obliga- tions. After Susanna and I had been there for about a week, there was a meeting of the neighborhood’s “policy recommending commit- tee.” This group had done various isolated _ things in the past, but was basically a nonfunc- tional entity. Dick sent out a notice to about 1000 people (mostly parents of kids in the day camp) and about eight or nine women showed up at the meeting. (The men rarely attend un- less they are pulled in by their wives.) Several things were discussed, including what to do about a run-down building across the street from NRC, the teenagers, and our proposed health fair. The idea of a health fair was well received, and at the end of the meeting it ap- peared that the neighborhood women had de- cided to have a health fair, whereas they had really been presented with the idea and said, “OK.” Although I was not cognizant of it at the time, I was, in effect, acting in a somewhat racist manner by going into someone else’s community, messing it up with something that they had not proposed, and learning from it. In the long run, this health fair will probably ‘have had little effect on the neighborhood, one way or another. But in a more conscious com- munity (e.g., the black community) this type of “messing up” can and does have disastrous consequences. In any case, Susanna and I then began ac- quiring the services necessary to hold the health fair. We received, in general, excellent service from the Board of Health. We were not able to obtain chest X-ray mobile units, but we did get them to send a diabetes detection unit for a fair on a Saturday, and the diabetes units generally do not work on Saturdays. Much of our success at the board of health was thanks to Dr. Jeremiah Stamler. My impression is that the Board of Health, partly because of their stormy experiences with SHP last sum- mer, and partly becaust of their general desire to keep things quiet in poor neighborhoods, de- cided this summer to give SHP people what they wanted, as long as nothing interfered with ultimate city control of poor communities. We also persuaded the Salvation Army to send one of its dentists to our health fair (teeth are a big problem in this area), and the Urban Progress Center at 19th and Halsted supplied a Board of Health physician with equipment for doing lead poisoning testing on children under six. In the neighborhood, various people were busy making arrangements for the fair. Some 67 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 made posters, others ordered hot dogs and pop, ete. The local priest, Father Peter, gave us per- mission to hold the fair in the basement of St. Anthony’s School. Several times we showed movies on first aid, diabetes, etc., which we ob- tained from the Chicago Public Library and the American Medical Association. As the day of the fair approached, the teen- agers got into the act. They helped in various activities, and on the day before the fair, did most of the work as we built the wooden frames which were to house the booths. ’ The fair itself was a huge success. Everyone from the Board of Health showed up with their mobile units. The Salvation. Army dentist showed up. The hot dogs and pop showed up. The fair made a net profit from the games booths we had set up. And lots of people showed up and were screened for diabetes, tooth decay, and lead. poisoning. There were hundreds of kids, who spent almost all of their time play- ing and eating. Our aim of using the health fair as a cat- alyst to get the neighbors to take action on their own proved to be at least somewhat suc- cessful. About a week following the fair, an- other meeting of the Policy Recommending Committee was held. About 25 people showed up. The landlord of the run-down building across the street had been invited, but sent the building’s manager instead. A heated discus- sion evolved, in which the people there formed a special committee to guard the building against vandals, ie., the neighborhood teen- agers. The group as a whole was becoming very enthusiastic about everything going on in their neighborhood. This is the latest informa- tion that I have on what is going on in the neighborhood. Looking back I feel that although I enjoyed the summer thoroughly, and got a real kick out of working with the people in the neighbor- hood, there remains the unavoidable question: Did I do anything to change the basic health picture in that community, or to change the basic socioeconomic picture? The answer to the question is definitely no. And it has made me question the value of SHP as it has been con- 68 stituted. What have we been doing other than messing up other’ people’s communities and learning from them? I have come to feel, as have many others, that I belong in only one place if I want to change the world, and that place is in trying to change my own commun- ity, that is, my medical school. I must try to make my medical school change in ways which will move it toward becoming an institution which serves all of the people, not just a few. Garfield Civic Association This community organization serves an area between Halsted’ and Racine Avenues (800 west to 1200 west) and between 5ist and 55th Streets (5100 south and 5500 south). The pop- ulation is almost all white with a few black and Puerto Rican families. It however borders the black ghetto east of Halsted and south of 55th Street. The area is part of community area 61. This is a nonpoverty area with a median family in- come reported in 1960 as being $6,500 per year. However, 10.4 percent of the families earned less than $3,000 per year, and 6.1 percent of the male labor force was unemployed in that year. Also, 18.3 percent of the housing was in substandard condition. It is predominantly a white working class- low middle income area with some problems very similar to those of their black neighbors to the south and east. There were seven health science students and five interns working on the development of a teenage youth center and the organization of a parent cooperative recreational and educa- tional program for preschool children. The need for a teenage center was clear,” SHP students reported: In an area with many teenagers, there was no movie theater, no soda fountain, no teen social center of any kind. In the summer, neighborhood teens spent their time in Sherman Park, on Garfield Blvd., on Halsted, and on front stoops. In the winter, they played cards. Teenage drinking, drug abuse, venereal disease, and CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 unwed pregnancies are major prob- lems. The high school dropout rate is high; college attendance is very low. The students polled adult opinion on their projected teenage center. . Most people I talked to considered the youth center a fine idea, but many saw problems * * * They thought we would have trouble controlling fights and drinking, that parents would be too lazy to help, that we wouldn’t be able to finance it. But the problem raised by nearly everyone was whether the center would be for whites only. Many claimed blacks and . Puerto Ricans would be sure to come and start fights. break the present pattern in which the brightest kids often drop out of school from lack of interest. Such projects as the newspaper and the li- brary, if successful, could do much to augment the inferior education many of the kids receive in the public and parochial schools. The plans for dealing with the health and social problems of the neighborhood teenagers are also pos- sible, if the center is a success. But such programs would require the sus- . tained effort of the interested health science students. A 10-week summer project would almost certainly not be enough. Of the parents’ cooperative preschool center student Pam Zumwalt writes: We were constantly forced’ to re- think our roles and tactics, and to question whether we should be spend- ing our time helping communities build needed and . community-con- trolled institutions if these then be- The site report by student Polly Young re- lates how the dangers of an “exclusivist” cen- ter, and of “outside” control were averted, to bring the community, at the end of the 10- week SHP involvement, to the threshold of realizing its teen center. Following is Miss Young’s report: The center may never really get off the ground. Lack of community inter- est and support, shortage of funds, or fights between rival gangs could close it. There is a possibility that it comes to worse than just failing: it could become a white power group. Even now, it is dangerous for black people to walk in this community after dark. White teenage gangs frequently beat black and Puerto Rican youths. The community as a whole seems unified only in its desire to keep nonwhites from moving in. The kids and the community could decide to keep non- whites out, by force if necessary. SHO would have no power over any such trends in the youth center. At best, the youth center could really have some positive effects on ..these teenagers. They are as locked came yet another tool to perpetuate white racism * * *All of us increased our own knowledge of the breakdown which occurs in the white community when threatened by racial change, of the moral and tactical questions © which ust be faced in attempting or- _ ganizational work in such an area. More than 50 small children had summer fun and creative experiences at the preschool center, and the hand- ful of mothers interested in maintain- ing the program in the fall found out for themselves how the city of Chi- cago curtails the development of com- munity controlled activities of poor and lower class people. While we didn’t make any impressive and last- ing changes, in these respects our project was successful. South Lynne | goo Ge The only other predominantly white com- - munity in which SHP students worked was the into their social positions as those in ‘the ghetto. It would take expert coun- seling starting with young teens to 69 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 South Lynne area. This community extends from Ashland (1600 west) to Wood Streets (1800) and from 59th Street (5900 South) to 67th Street (6700 South). It is part of community area 67. While the population in the entire area was almost 12 percent Negro in 1960, the particular portion called South Lynne is about 99 percent white of Irish, Polish, and European descent. There are small groups of Appalachian white and- Mexican Americans. The eastern edge borders the black ghetto and is, itself, undergoing ra- cial transition now. Median family income re- ported in 1960 for the entire area was $6,695 per year, with the South Lynne section reflect- ing this same median. The percent of families earning less than $3,000 per year for the entire. area was 12.5 percent population. The percent of unemployed in the male labor force was 5.2 percent, The area is considered to be a non- poverty area and is composed predominantly of a low to middle income working class popula- tion. There were three student teams working on separate projects. These projects included: 1. A study of the location and availability of medical services and the identification of unmet health care needs in the area. 2. Aid to the community council’s title search and real estate survey in a 30-block area, for the purpose of tracing down “block- busting” real estate brokers. 3, Aid in the establishment of the South Lynn day camp—a summer project “to give the children of the area something more to do than wander around the street.” Medical Services and Health Care Survey. _-The team of four health science students compiled a directory of health services availa- ble to residents. The students also conducted extensive interviews with residents and local physicians to learn their assessment of health care facilities and needs. South Lynne Day Camp.—Without indicat- ing the number of children who were in- volved, the students report this as a successful undertaking, within the narrow limits of the objective: a. strictly inner community enter- 70 prise involving some parents as well as chil- dren, serving mental and physical health needs through recreational opportunities. Title Search and Real Estate Survey.—The students report that results of their survey were given to the organization under whose di- rection they worked. A notable by-product of this team’s activity is their paper on “the changing community,” which follows. Here the students have explored their topic in depth, examining and explaining social, economic, psychological, and cultural facets of their sub- ject. Their paper leaves no aspect of the anatomy of South Lynne untouched, revealing it as the very prototype of the “sickest” areas of urban life in U.S. cities today——the communities in transition from segregated white to ghetto black. Speculators, slumlords, and. real estate agents have a heyday.—by Marilyn Stanek (Psychol- ogy), Peggy McQuade (Law), Karen Kaye (Social Work), Katie Sawallisch (Intern) To describe a “changing community” as an area changing from all white to all black is in- complete and therefore inaccurate. Rather the definition should include consideration of the economic and psychological factors involved in the process of racial turnover. We can make such an analysis of South Lynne, especially the area from Ashland to Wood between 59th and 67th Streets. The spec- ter of inundation has haunted South Lynne for several years. About 2 years ago the commun: ity was transferred from the police district. t the west (all white) to the Englewood police department. This not only seemed to mar] South Lynne as the next area to undergo racia change; but also heralded the switch from peo ple-oriented police protection to property-ori ented law enforcement. (This is a common pat tern, however, it is difficult to estimate to wha extent it affects South Lynne.) The real estate industry has also marke South Lynne for change. The “Down’s Ret Estate Report” cited South Lynne as becomin all black in 2 years. Real estate speculato) CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 started buying property in the area in 1967. The activity among the real estate dealers might have been delayed a few more years if South Lynne did not have a reputation for being “soft,” that is, they would not bomb a house blacks moved into. Being a “soft” community is certainly a credit to the people of South Lynne. Unfortun- ately, this area, with the potential for becom- ing a stable, integrated community will proba- bly be an extension of the ghetto within the decade, (It is true that South Lynne has its share of bigots; but effective ties and/or econ- omic necessity override prejudice in many resi- dents. “I’m staying until it turns 50 percent black” is often heard.) One of the main forces pushing for complete racial turnover is the real estate industry. Since the early part of the 20th century the real estate industry has made conscious efforts to maintain two housing markets—one black and one white. Considering the law of supply and demand on which our economy is based the existence of two housing markets is exceed- ingly profitable. That is, if the realtors can manage to limit the housing available to the population or one segment of the population, they can demand higher prices from those peo- ple. The great influx of blacks from the 1920's through the 1960’s has provided that popula- tion. In turn, realtors prey on the prejudices and misconceptions of whites to obtain dwell- ings at a reduced price. This phenomenon is termed “panic peddling.” It ranges from bla- tant appeals to racial prejudice (i.e. “colored are moving in down the block.”) now outlawed _by the fair housing ordinances, to more subtle forms (such as sending a blaek man to the peo- ple living next to a house that is up for sale). Realtors also try to make the neighborhood un- pleasant to live in. They may rent to a mother with 12 children. No judge, in conscience, would evict them; yet, black or white, 12 un- ~- watched children can be a nuisance. Coupled ‘with harassment over the telephone and other But when whites in a changing neighbor- hood decide to sell, they find it difficult, if not impossible, to put their home on the open mar- ket. Banks do not usually give mortgages to those wishing to move to neighborhoods desig- nated as “changing,” “high risk” neighbor- hoods. The owner must sell on contract. For the private owner as opposed to the real estate speculator, this is a losing proposition. The buyer puts down a relatively small amount— not nearly enough for a down payment in the higher cost all white area the seller is proba- bly moving to. Therefore, the latter must bor- row, possibly in the form of a second mort- gage. Thus his housing market becomes some- what limited and he must contend with added interest, Most homeowners find it’ easier to deal through a real estate broker. If they are among the first two or three to sell in a block about to be “busted” they usually get a fair price. But then comes the rush of selling, the housing market is glutted, and according to the law of - supply and demand the prices drop. Specula- tors, slumlords and real estate agents have a heyday. They are free to sell to the black mar- ket at inflated prices. Contract selling is again the most common method, but somehow it is far more profitable for the realtor. Maybe this is due to the realtor’s willingness to foreclose. For, unlike the mortgage in which the debtor owns a substantial interest in the property, the contract buyer pays the interest first. In other words, for possibly the first 10 years he is pay- ing nothing but interest. If he is even 24 hours late his contract can be forclosed. It would be as if he had been paying rent for all those years, Thus the realtor has the down payment and all the contract payments for as long as 10 years plus the option to sell again on contract. Economics plays a part in another facet of - the deterioration of neighborhoods like South Lynne—the movement of small businesses out of the neighborhood and the subsequent decay of the shopping area. The reasons shopkeepers give for leaving the community are varied, but three factors stand out most. First, small busi- nesses are closing all over the country because they cannot compete with large firms. Sec- 71 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 ondly, a small business depends on regular cus- tomers from the neighborhood. The shopkee- per deals with them on a personal basis. Many of these people are leaving; yet white shopkee- pers find it difficult to form the same type of relationship with members of the black com- munity. Lastly, the problem of getting insur- ance is often the last straw—the shopkeeper leaves. We can well understand his distress. The small business operates on a small and not too stable margin of profit; when an area is designated “high risk” the shopkeeper can af- ford neither the insurance nor the risk of broken windows. The loss of these businesses not only gives the shopping area a shoddy, decaying visage; but also makes it difficult for the old people who remain. What was once a 5-minute walk is now a trip to Ford City, requiring two bus transfers—that could put both a physical and monetary strain on the aged. Also when 2 person shops out of the community, shopping becomes a task, not another occasion to talk to one’s neighbors. Yet these old people can be among the com- munity organizer’s greatest resources. They have lived in the community 30, 40, 50 years— their friends are here. Their mortgages are paid off and they can live off their pensions. They are not ready to start again. And many of them simply can not afford to move. Con- tract selling does not supply a homeowner with enough immediate cash for a down payment on a home in suburbia. Yet if they sold through a realtor they would not get their price and he would sell to blacks. This would constitute an act of treason to the people that remained. Also many of those in late middle age have moved from other neighborhoods that have gone all black. Some of these people are fear- ful to the point of paralysis. Others are willing to stand their ground. They are aware of the scare tactics of some real estate firms and sometimes can even name the worst offenders. However, to stabilize a neighborhood young white families are needed. Take South Shore, for example: technically it is integrated; but in some sections all the whites are old. So within 10 years the chances of these areas 12: being integrated are slim. The organizer must look to another source of support. Young mothers often prove invaluable in this context. In South Lynne this group is angry. They are angry that their kids come home with their clothes in shreds. They are angry they cannot send their children to the grocery store with- out fear that the child might be robbed. They are angry and fearful for their children when they hear of both white and black gangs—girls and boys. However, anger and fear do not pre- suppose action. Yet the potential is there and it cuts across the lines that separate renters and homeowners. Still inaction plagues South Lynne. Father Lawlor’s racist block clubs have promised sta- bility. They promised to bring whites into the neighborhood, to stop urban renewal and the extension of the “y,” to regain racial “‘bal- ance” in the schools located in South Lynne. They have reneged on each of these promises ; but still they are a source of hope for a desper- ate poeple * * * * * * Lack of organization in the area has not only contributed to the feeling of aliena- tion, but has also heightened suspicion of each other. A man who has lived down the block from you can be your friend or can be a poten- tial seller—to blacks. In South Lynne he is the latter. Such lack of. trust is a fertile bed for panic peddling. If you do not know the man on the corner, you don’t know if the real estate dealer is telling the truth—has he really sold his home, are blacks moving in at night? Suspicion also reduces the possibility of con- fronting group fears and problems. They can- not confront the real estate brokers and slum- lords who fleece poth white and blacks * * * We hope that we have presented a clear eX- planation of the economic reasons for complete racial turnover in 4 neighborhood. We do not wish to discount blatant racism as a force in the community. There are John Birchers, white supremacists and Nazis in some neigh- porhoods. But most of the people subscribe to the tried and true racial misconceptions perva- sive in America. The roots of these are emo- tional and economic. For the community organ- CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 izer to try to reverse 40 or 50 years of indoctri- nation is difficult if not impossible. The most he can do is play on whatever sane and just sentiments they do hold to mobilize around is- sues that are related to though not directly confronting the institution of racism. That task is left to the young. Englewood Englewood is located in community area 68. Its boundaries are 55th Street on the north (5500 south) ; 75th Street on the south (7500 south); a jogging boundary which runs be- tween State and Stewart Streets on the east (0 to 500 west) and Racine Avenue on the west (1200 west). It was estimated to have a popu- lation of approximately 97,500 people in 1964. At that time, 83.6 percent of the population was nonwhite, a change from 69 percent of the ' population in the 1960 census. The median family income in the community reported in 1960 was $5,579 with 8.4 percent of the male labor force unemployed in that year. Over 14 percent of the housing in the area was substandard at that time. (2) A part of this community is currently in the process of urban renewal. . In a ranking of poverty community areas for mortality, morbidity indicators Englewood was in the first quartile (highest rates) for in- fant and noninfant deaths from influenza and pneumonia; and in the first quartile also for newly diagnosed cases of tuberculosis. It was ‘in the second quartile for deaths from cervical cancer and deaths due to unknown and ill-de- fined causes. (1) While there are two private hospitals in the area, 35.5 percent of its residents needing in- patient admission went to Cook County Hospi- tal, about 9 miles distant from the community. (1) An overview of the community, its organiza- tions, its problems, and the activity of the stu- dents prepared by the area coordinator, fol- Ows: Englewood Area Report.—by Patricia Rice : (Nursing) The active organizations in the Englewood area include: The Englewood Civic Organization—for- merly the Action Center (a) Englewood Citizens Housing Commit- tee (b) Englewood Health Committee The Englewood Community Organization The Englewood Businessmen’s Association The Green Street Association Youth Action Urban Progress Center Miscellaneous Block Clubs. These organizations, their relationships to one another, their major concerns, and their involvement in health-related activities are de- scribed. (a) The Englewood Community Organiza- tion, located in the Englewood Terrace Apart- ments at 64th and Lowe shares office space with the Businessmen’s Association and repre- sents business and professional interests. Both - hospitals located in Englewood are represented in this “community organization.” (b) Englewood Businessmen’s Association is a coalition of business interests located in the 68d and Halsted shopping district. Their major interest currently is the Englewood Central Renewal Project involving creation of a cen- tral mall with peripheral parking lots and re- routed traffic patterns for the 63d-Halsted shopping area. This project was responsible for the demolition of many homes, among them the homes owned by members of the * * * (c) Green Street Association. Originally like a block club, the Green Street Association was developed to fight urban renewal plans calling for condemnation of homes along Green Street, from 63d Street south. This part of the urban renewal plan was necessary to make room for the traffic bypass and peripheral parking lots. Originally the Green Street people attempted to identify areas of mutual interest with the Businessmen’s Association and E.C.0O. “We wanted a better community and a nice shop- ping area, too!” Eventually they took. their case to court and lost. Some of these people are 73 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 still paying out the balance of their contracts for homes they’ve lost. (d) The Englewood Civic Organization— formerly the Action Committee. The group no longer has headquarters, but operates with a president and several active committees. (1) Englewood Citizen’s Housing Com- mittee is collecting data on dispossessed fami- lies, especially those relocated by the Depart- ment of Urban Renewal, re: quality and cost of new location as compared to previous quarters, and whether suitable relocation is, in fact, ac- complished for these people. There is an at- tempt to document individual cases. Followup is undertaken on buildings pre- viously reported to the building department to see if an inspector has visited and whether ap- propriate recommendations were ever made or followed. In terms of lead poisoning, Engle- wood is second highest in the city in the num- ber of coroner-confirmed deaths from lead poi- soning for the last 7 years. A list of suspect housing is obtained and followed up. (2) Englewood Health Committee was es- tablished in the summer of 1967 with the pur- pose of taking positive action to improve the health of the residents of Englewood. It in- cludes in its membership representatives of the Englewood Civic Organization, Englewood Community Organization, The Green Street As- sociation, the Salvation Army, St. Bernard’s Hospital, several of the clergy and profession- als in the area, community members served by the clinic, and SHO. This committee has worked to open the Englewood Community Clinic, now operating two evenings weekly out of the Sal- vation Army facility at 62d Street. (e) Englewood Youth Action is composed of a group of young men actively engaged in working with - the youth groups in the area. Major concerns seem to be the young men and women of the community and the social organ- izations they build. Overt concern with health issues has thus far been limited to tentative de- velopment of a V.D. contro] and treatment pro- gram which is emerging in cooperation with a representative of some other agency. Less ap- parent, but perhaps more important. to the health of the community, has been the empha- 74 sis upon positive self-evaluation and the devel- opment of cultural pride and self-help pro- grams through youth action workers in other communities. Mimimal relationships have been established through the efforts of one of the young women at the Englewood Clinic. Some of the boys have done volunteer work (paint- ing) at the clinic, Others have been treated there on clinic night. An attempt was made to encourage relationships with the Englewood Mental Health Clinie when community resi- dents complained about the gangs at a mental health meeting. (f) The Urban Progress Center is engaged in a variety of educational programs including a lead-poisoning screening program that prov- ides transportation to and from the U.P.C for children to be tested. Home visits are made in an attempt to encourage screening and to fol- lowup the positive tests, Seldom is action ever taken against owners of buildings where hous- ing violations are reported and where poisoned children are found. (g) Relatively inactive block clubs exist throughout Englewood. There is hope, how- ever, that they may reactivate in support of the Englewood Community Clinic through the encouragement of some community women on the Board of Directors of the Clinic. The Englewood Health Committee is the one group currently involved in health planning. This planning revolves around the major health issue in the community, namely the provision of ongoing, comprehensive health care to the citizens of Englewood. (Last year’s SHP report showed the paucity of health care facilities and the fragmented, crisis-oriented services available ‘to the residents.) Questions currently are raised regarding the advisability of a “free clinic,” open on a limited basis, in an area so poor in health care facilities. Does the provision of yet another fragmented service oblige the group beyond the limit of the care they are capable of providing? Suggested di- rections include: (a) Liaison with Cook County Hospital to provide easier access to county facilities for Englewood residents; (6) liaison with com- munity hospitals and private practitioners in CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 order to weave a more comprehensive network of services available locally; (c) purchase of a building that once housed a hospital (now moved to another community) for the purpose of expanding into a clinic-community hospital organization that will exist independently of other community services; (d) use of the health committee and the clinic as an organiz- ing focus from which the Englewood citizens can pressure the city and county to implement the proposed Board of Health Community Clinic in Englewood, and soon! While these larger, directional issues are being discussed, the community representatives also consider details of clinic operation and policy: (a) The application of a “means test”? of sorts in an attempt to weed out those patients who can afford ordinary sources of health care. This was overruled by the community repre- sentatives on the board who seemed to thor- oughly dislike the introduction of the paper- work and the techniques of prying used by other institutions in their community. (This issue was raised by community professionals on the board who feel that more cooperation with community physicians will be obtained if they have some guarantee that patients will not be “spirited away” by the lure of a “free clinic.” Sears Foundation’s investigators asked clinic representatives what precautions had been taken to insure that those treated in the clinic would be truly poor people and not merely those unwilling to pay for private care.) . (b) The ladies are considering selling chicken dinners through their block clubs in order to raise money for the clinic. The major health problem is the lack of available health facilities other than the cri- sis-oriented emergency rooms in the commun- ity. The lack of coordinated health care and comprehensive care facilities was really the basis for the activity at almost all sites in the area. The two hositals existing in the commu- nity seem to behave more like businesses than - service institutions. Hospital participation in the land ownership, clearance, and develop- ment activities in Englewood indicates exist- — ence of a strong relationship between health rights and housing rights in this community. Unfortunately, specific information was not ob- tained about hospital land ownership practices, even though requested. Attempts were made to place students at both hospitals in Englewood; we were success- ful only at one. Here students explored the re- lationship between the hospital and the com- munity by working in the emergency room and interviewing patients during and after the visits to the emergency room. The hypothesis was that Englewood residents would tend to utilize the emergency room as a source of ongo- ing health care. This was. shown to be true; but the extent to which followup care was pro- vided or encouraged and the quality of care re- ceived depended largely upon the efforts or lack of effort on the part of those individuals on duty in the emergency room at the time of the patient’s visit (described more fully in hos- pital site section). Students at the Englewood Clinic worked to provide the goods and services necessary for the maintenance of a volunteer clinic on @ one- to two-night-a-week basis. After several weeks the students visited families served by the clinic and encouraged participation on the En- glewood Health Committee. Those residents be- coming active voiced their feelings about the quality of care avaialbe through already exist- ing community facilities, including the two hospitals. They seemed to use their own experi- ences as background for establishing policy for their clinic. — Students working for the Housing Commit- tee brought information regarding the treat- ment area residents had received from the city, specifically D.U.R., ‘and at the hands of the community power structure, namely, the Busi- nessmen’s Association. Information about con- tract buying practices was compared with data gathered by students in Ashland-to-Western Avenue strip whose residents were currently being “blockbusted” by unnamed realtors. It was apparent that in terms of housing, both the white and black communities were victim- ized; in terms of health, the white community seemed to be better off. SESS 15 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 Information gained at the Mental Health Clinic showed how attempts were being made to unite communities around a mental health facility. Unfortunately, clinic progrms are cur- rently limited to curative-restorative efforts, whereas evidence of mass manipulation of the communities in question suggests a need for preventive programs stressing self-determina- tion for the people of Englewood. It was inter- esting to note that when white people from the western section of Englewood declined invita- tions to use the Englewood Mental Health Cen- ter, the staff of the center were unable to for- mulate an “outreach” type of program. While imbued with appropriate values in terms of the need for positive interaction between the white and black segments of the community, that staff. seems unable to recognize the fact that the different factions represented in the community are not truly one another’s enemies. Their mutual enemies are, instead, the agen cies that control the housing situation, the de- livery of services to the community and the availability of health care facilities to the peo- ple of Englewood. The work the students were involved in at the specific sites just described follows. The Englewood Mental Health Center.— This center has four programs which include a day treatment program, 4 program for adoles- cents, an aftercare program and a schoo] pro- gram for parents and tachers. It is a Chicago Board of ‘Health facility whose jurisdiction is broader than the Englewood community area 68. It is supposed to provide services to the population west of Ashland Avenue as well as east, going up to Western Avenue (2400 west). That portion of the jurisdiction is an almost all white community located in community area 67, known as West Englewood. This is a working class, lower middle income . area, threatened by the expansion of the plack ghetto to its east (See “The Changing Community”). As pointed out in the area coor- dinator’s report, this part of the jurisdiction does not utilize the Englewood Mental Health Center but the center is interested in extending its services into this part of the community. 16 Thus, the agency director requested the white student assigned to the Mental Health Center site to work in the West Englewood part of the jurisdiction. He was assigned to develop and disseminate information about the center’s programs. He interviewed a number of leaders in the com- munity, including ministers and leaders active inthe major community organizatons. His interviews and discussions with these people focused around the following questions: (1) What are the problems facing your com- munity; (2) can the Mental Health Center be of value to your community; (3) what does the community know about the center. The student felt he had made important contacts in the area which would be pursued by the staff at the center. He felt there might be long range positive results in the development of relation- ships with the white community in West. En- glewood that would enable it to take advantage of the center’s facilities and programs. He summed up his recommendations in the following report which was submitted to the staff of the center. South Lynne—Reflections and Recommenda- tions.—by Robert Geohegan (Medicine) It would be easy for the staff of this Mental Health Center to dismiss the South Lynne com- munity as a lost cause. South Lynne people are afraid to come into Englewood to visit the cen- ter. Also, it is very likely that the South Lynne area will change from a white neighborhood to a black neighborhood in the next several years. The staff feels an outpost cannot be estab- lished in South Lynne. The center simply does not have the manpower at the present time to develop separate programs at an outpost in South Lynne. Some of the staff also fee] that setting up an outpost would be catering to a bigoted com- munity. I personally think South Lynne should not be written off as an unreachable community. To call the situation in South Lynne hopeless is to take a defeatist position. This kind of response CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 is the easy way out. But it also would represent the center’s shirking. of its responsibilities. This is especially true since the staff has made little effort to get to know the people and the mental health problems in South Lynne. My first suggestion is that the staff should decide immediately whether the center has a commitment in South Lynne. If a commitment is to be made, I think it should be undertaken as soon as possible and wholeheartedly. The community is already changing and time is an important factor. In spite of the attitudes of some South Lynne people, the fact remains that some of them need help. The community deserves attention and understanding of the center. The recommendations I make for this com- mitment are as follows. 1. The center should send a staff member into South Lynne during the week to do intake work (eg. at a church). The people of the community will more readily go to an intake worker stationed in their own community than to one stationed at the center. In performing intake work with South Lynne residents, the center can get a better idea of the primary mental health needs of the community. Through personal contact, the staff member might also be able to more effectively convince residents to come into Englewood to the center. If necessary, the Intake worker could per- sonally accompany an individual to the center. This intake worker would also engage in any follow up activities with people who have dropped out of programs, ete. . 2, The possibility of having a community organizer working in South Lynne was sug- gested. A community organizer could perform several valuable functions. He could establish further contacts in South Lynne and make ar- rangements for staff members to meet with in- dividuals and organizations in the community. He also could play an important role in setting up workshops with groups in South Lynne such as the clergy. . a . 8 IT would recommend that every effort be made to get South Lynne teachers and parents involved in the school development program which can effectively reach the community in a relatively short time. Through this program, more individuals can be made aware of the center. The seminars and discussion groups might also encourage a dialogue between black and white people. The Englewood Clinic.—This clinic was begun as a result of the efforts of three groups in the summer of 1967. These included the Stu- dent Health Organization, The Englewood Civic Organization and a local branch of the Salvation Army. The best description of this clinic and its participants is contained in the following document prepared by the Engle- wood Health Committee. This committee in- cludes health science students who were, and are, participating in the Englewood Clinic. The Area Involved.—The Englewood Clinic is located at the point at which the south Chi- cago communities of Englewood, Washington Park, and Greater Grand Crossing meet. All three are classified as poverty areas by the Chicago Committee on Urban Opportunity ; all three are Negro ghettos with low levels of in- come and education, poor housing, large pro- portions of the population on public assistance, and high unemployment and juvenile delin- quency rates; in all three, the quality of health care available to the population is low. . Statistical evidence of the poor state. of health prevalent in these communities ‘is pro- vided in the Chicago Board of Health Medical Care Report published in Sptember 1966. Some of the pertinent data from this report is in- cluded on the table on the following page. Other data in this report demonstrate that. both Englewood and Washington Park are among the poorest of Chicago’s poverty com- munities with respect to health care. Greater Grand Crossing, while faring better than these two communities by many criteria, still suffers greatly from inadequate medical care. Available health facilities in_ this area of Chicago are remarkably scarce. There are few physicans in private practice in Englewood. Of 77 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 the two private hospitals in Englewood and cone in Greater Grand Crossing, none provides an outpatient facility and none serves over 10 percent of its community’s hospitalized pa- tients. Public facilities include three Infant Wel- fare Stations, one in Greater Grand Crossing and two in Englewood, which provide only rou- tine prenatal and well baby care. An additional Infant Welfare Station in Englewood provides specialized care for some types of infant disor- ders on a referral basis. There is, in addition, a Mental Health Center in Englewood. Comparative Health Statistics: Englewood. Washington Park, Greater Grand Crossing, Poverty and Nonpoverty Areas of Chicago (1965) fg > 3 a £ : tof 5 e #2 gs §& 8 a Ea bE a z Birth rate? ... 32.9 26.6 22.6 28.9 19.0 Mother under 207 _..------ 19.7 23.3 18.6 20.0 10.1 Illegitimacy -.. 27.7 28.6 23.2 25.0 5.1 Prematurity .-. 144 14.3 15.0 12.8 6.1 Infant death rate: * Under 28 days 25.8 33.1 80.3 25.6 17.0 28 days to 1 year ..---- 15.3 12.7 9.7 Causes of infant death: Influenza and pneumonia 9.8 9.0 6.0 19 2.2 Gastroenteritis 12.9 5.1 and colitis _ 2.0 --- _— 1.8 --- Percent of can- eer deaths from cervi- cal cancer .. 2.7 4.0 8.1 44 18 Broncho- . pneumonia*? . 1.0 --- --- 0.5 --- Syphilis ..---.-- 2.8 4.2 2.2 2.6 _-- Gonorrhea --.- 21.3 27.8 14.2 14.3 14 Tuberculosis -.. 0.9 14 — 11 --- 1Nonpoverty and poverty are combined totals for all the city’s nonpoverty and poverty areas, respectively. 3 Birth rate and infectious diseases are number per 1,000 popu- lation. Mother under 20, illegitimacy and prematurity are percent of live births. . +Infant death rate and causes of infant deaths per 1,000 live births. : : 78 For a great many residents of these three areas—perhaps a majority—the only available source of medical care is the emergency room or the outpatient clinic at Cook County Hos- pital. These facilities are overcrowded and may require up to 2 hours to reach by public trans- portation. The Englewood Health Committee.—The Englewood Health Committee was established in the summer of 1967 with purpose of taking positive action to improve the health of the residents of Englewood. It includes in its mem- bership representatives of the Englewood Civic Organization, the Englewood Community Or- ganization, the Green Street Association, the Salvation Army, the Englewood Mental Health Center, the Student Health Organization, and several of the Englewood clergy as well as other residents of the area. The Clinic Site-—The clinic is located in the Salvation Army Building, at 140 West 62d Street, where there is a furnished clinic facil- ity which was not in use. Use of this facility is being donated by the Salvation Army to the community; it is emphasized, however, that it is a community clinic operated by the com- munity. The facility contains three furnished medi- eal examining rooms, an office, a conference room, a waiting room, and two washrooms. The clinic possesses most of its needed labora- tory equipment and there is additional space for a laboratory and storage of medical sup- plies. Additional rooms are available in the - building for use as offices or examining rooms as needed. Staff—tThe clinic will employ a full time director who will be responsible for the coordi- nation and direction of all clinic services and programs. The director will be selected by the board of directors of the clinic and will be di- rectly responsible to them. A part time secre- tary will be employed to assist the director in keeping records, handling correspondence, and mailings. Volunteer staff present at each clinic session will include one licensed physician, two regis- CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 tered nurses, two senior medical students to perform histories and physicals, two junior medical students for laboratory work, one so- cial worker, and a receptionist. Additional vol- unteer personnel will include lawyers, pharma- cists and nutritionists. Services.—For clinic patients there is a charge of 50 cents per clinic visit. Services to be provided encompass the spectrum of basic outpatient care including routine examinations, treatment of general medical problems, immu- nizations, lead poisoning screening, and eventu- ally general dental care. Diagnostic studies in- clude routine blood counts, urinalysis, tubercu- losis skin tests, and electrocardiograms. Sam- ples for further laboratory evaluation are sent to the Board of Health and cooperating hospi- tals (lead poisoning screening, Pap smears, cultures, etc.). Referrals for hospitalization and more complex diagnostic workup are made to cooperating hospitals and to Cook County Hospital. . Hours.—The clinic has been open every Wednesday night from 6 to 9 p.m. since May 29, 1968. This schedule will be extended to other nights of the week as resources become available and the clinic program expands. Administration.—The policymaking body for the Englewood Clinic is a Board of Directors established by the Englewood Health Commit- tee. The board is composed of representatives of the health professionals involved in the clinic operation and members of the commun- ity (who constitute the majority of the board). Of the nine community representatives on the board, six of these positions will be occupied by consumers of the clinic services. Upon payment of the clinic fee, a patient’s family is regis- tered as a “stockholder” in the clinic. This en- titles the family to attend regular meetings of the board and to elect representatives to serve as board members. Objectives and Philosophy.— 1. To help fill, in a small way, the critical need for medical facilities in the Englewood- ~Washington Park—Greater Grand Crossing area. It is recognized that this facility will be able to serve only a relatively small number of - patients; it is felt, however, that it will per- form a needed service for those people in the area affected most severely by the present shor- tage of facilities: Those at the lowest levels of poverty. 2. To demonstrate that a neighborhood health facility can best be directed and its priorities established by the community people which the facility serves. 8 To furnish health science students and health professionals direct contact with the health problems of a ghetto community and promote in them an. understanding and an awareness of these problems. Referrals—One of the accomplishments of the clinic may be to increase the involvement of the community’s hospitals in the communi- ty’s health. St. Bernard’s Hospital and Engle- wood Hospital—the two hospitals in Engle- wood—have agreed to accommodate patients referred from the clinic for hospitalization under Title 19 or Medicare. Similar arrange- ments will be sought with other area hospitals. Presently, reluctance of these hospitals to treat patients requiring payment from Department of Public Aid, or from Title 19 funds, contrib- utes greatly to their isolation from the com- munity. Patients who cannot be hospitalized at one of the community hospitals are, of necessity, referred to Cook County Hospital. Whenever possible, referrals for certain types of diagno- gis or care are made to existing agencies such as the Board of Health Infant Welfare Stations (prenatal and well paby care), Veneral Disease Treatment Centers, Municipal Tuberculosis Sanitarium Clinics, and the Tuberculosis Insti- tute X-ray detection facilities. Patients To Be Served.—The clinic serves patients from the Englewood district and those sections of the Washington Park and Greater Grand Crossing communities which are near the clinic site. To as great an extent as possi- ble, patients wll be seen on an appointment basis. Walk-ins will, of course, also be seen. Patients may be referred to the clinic from the churches, public schools, and from the Engle- wood Urban Progress Center when they are » 99 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 discovered to require medical care at these in- stitutions. Future Funding —The Englewood Clinic will, in the future, attempt to become self-sup- porting. There are at least two routes by which this may be accomplished: 1. Many of the patients seen at the clinic will be eligible for payment of their medical expenses through public aid, Title 19, or Medi- care. Eventually, it may be possible to finance the clinic entirely through these sources. There are a great number of difficulties, however, in collecting money from the agencies involved including vast amounts of secretarial work, de- lays in payment by the agencies involved, and in many cases, payments inadequate to cover the expenses of the care involved. Thus, for at least the first year, the clinic will have to be supported by nongovernmental funds. 2. The city of Chicago has tentative plans to build a comprehensive outpatient facility on the south side of the city. When these plans reach fruition—probably in the next few years _the clinic may be able to become affiliated with this facility and derive its support from the city. Summary.—The Englewood Health Commit- tee is seeking to establish a low cost medical clinic in an area nearly devoid of medical facil- ities. In addition to providing medical services to some of the area’s indigent population which would otherwise be hard pressed to ob- tain other than crisis-oriented health care, the clinic will provide for community contro] in order to demonstrate that the consumers of medical services may best direct their own health facility and determine their own health priorities; it will help to increase the involve- ment of existing community hospitals in the care of community residents; and it will help to introduce participating health science stu- dents to the medical problems of a poverty area. The students working in the various Engle- wood sites generally felt that the projects were useful but, in their essays, highlighted again their fears. of “imposing” themselves on the community, “inhibiting” community participa- 80 tion by their presence and concern that they had achieved no positive results for the com- munity. Indeed, in many cases, they felt they had no right to be in the community at all. However, there was 4 cautious note of opti- mism in the reports by the Englewood students that perhaps, just perhaps, they had made some positive contribution this summer. A few quotations from their reports describe their reactions: I feel that my summer was well spent * * * I became aware of health problems in the ghetto plus I have learned techniques and means of react- ing to these problems. The Englewood Clinic is the kind of project that is ideal for SHP students and does not necessarily “use” the black ghetto for the learning experience of whites. I predict a tough future for the clinic but if it does survive it will hasten the infusion of governmental money into the Englewood area to improve the health facilities available. My participation in the SHO summer project left me with mixed feelings about its merits. * * * Un- doubtedly, the greatest benefits de- rived from my activities this summer were those which I received in terms of education and insight gained about health problems in this city, and the myraid factors affecting its [un] equal distribution. The knowledge that I gained from talking to com- munity members * * * from newly acquired friends, from relevant read- ing material, and from personal expe- riences has deeply affected my think- ing and attitudes—both profession- ally and personally. * * * The worst aspect of the project was the fraud that I gave as a white per- son acting as a representative of a “community” clinic. * * * T was pain- fully aware of this fact in all my dealings with the community. * * * Despite the amount of personal warmth and interest that a white per- CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 son shows, he cannot help but ini- tially represent an authoritarian figure and all its ensuing evils. * * * I plan to work with the clinic dur- ing the school year and therefore avoid the problem of abandonment that is so often inherent in this type of project, but I still have not resolved the serious problem of fraud. * * #7] can only rationalize that I am offer- ing a service to the clinic that they can use until they can find a true com- munity person to honestly represent their clinic. A sense of the inadequacy of their accom- plishment, an impatience with the role, as one student describes it, of “parachutist mission- ary,” a sense of despair over the community’s unmet health needs, is common to almost all of the team reports. Studied together, their re- ports both affirm and refute the students’ con- clusions. Affirmed, through survey findings and expe- riences with bureaucratic, or lethargic, or out- moded “establishment” agencies and proce- dure, is the tragic disparity of health care needs and their fulfillment in every poverty community. Denied, by the evidence in these same reports, is the students’ frequent conclu- sion that their effort “didn’t change any- thing.” If we recognize that awareness is a precondi- tion for change, then SHP’s teams awakened the beginnings of change for hundreds of .per- sons in whom their activity created an aware- ness: 1. Of their own health care problems, by having to discuss them with an interviewer in a health survey. . 2. Of facilities to serve their health needs, the “tests” that could help determine their state of health, through health fair demonstra- tions, lead poisoning and parasite screening programs, TB and dental checks in preschool centers, etc. -8, Of the possibility of working with others to secure care for mental as well as physical health, in organizing the health fairs, setting” up day camps, planning preschool, or teenage, or senior citizen centers. Recording the impact of her experience at the American Indian Center, medical student Laura J. Simon writes in the report she has ti- tled “Indian Summer”: * * * J yealized that there are really two kinds of prejudice. One kind denies that people are similar; the other denies that they are differ- ent * * *. We are perhaps all too prone to the fallacy that lies at the other extreme, the error of assuming that people are not different. * * * It is unreasonable to expect a Sauk Indian to see American history in the same light as I do living in northern Illinois where his nation once camped. The same government that exterminated his ancestors in the Blackhawk War gave refuge to mine * * * Many times in the course of the summer I was reminded of the differences between the experience of Indians in the city and my own expe- rience. Substitute “enslaved” for the word “exter- minated” (although they were often synony- mous), and we have an insight into the differ- ences between black and white in the United States that validate the need to vest control of the community project in the hands of black, or Indian, or American of Mexican or Puerto Rican descent, urged in so many of the stu- dents’ reports. The SHP reports tell us, in ef- fect, that groups with such different, and bit- ter, memories of official mishandling cannot be expected to trust ‘yg”—the dominant white so- ciety—until we have demonstrated that we trust “them” to the point of accepting their ability and their right to make policies and exe- cute them. There is one commonly assumed difference among the poor, however, which we must note a number of the SHP reports repudiate. It is the assumption that the black community suf- fers more than its socioeconomically equivalent nonblack community from the phenomena of dislocated youth and hopeless, apathetic adults. 81 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 Teenage drinking, drug abuse, ve- nereal disease, and unwed pregnancies are major problems. The high school dropout rate is high; college attend- ance is very low. Many (adults) saw problems * * * - They thought we would have trouble controlling fights and drinking, that parents would be too lazy to help, that we wouldn’t be able to finance it. The description easily fits the stereotype concept of all-black communities like Lawndale or Woodlawn. In fact, it is student Polly Young’s account of the all-white Garfield Park area in which her team worked to establish a teenage center. The SHP experience in the communities con- firms, with the dimension of reality which per- sonal eyewitness alone’ can add, what “cold” statistics have long indicated: That poverty has the same impact everywhere. It suggests that while the need for health care services may be greater in the black community be- cause its deprivation and poverty embrace more people, the need is no less serious in the impoverished or economically “marginal” non- black area. It suggests, finally, that a publicly subsi- dized, universal health care system for the poor and “margina * eommunities, predicated on community control that observes the spirit and letter of equal rights incumbent legally as well as morally upon such a system, can serve to conquer racism. along with the other sick- . nesses that poverty nurtures. Other Reports There were several students working with agencies and groups not directly affiliated with a single community. These were sites whose work affects the lives of residents of the city of Chicago. These included students working on special projects with the Board of Health and with re- gard to the welfare laws in the State of Illi- nois. : : - The Chronic Disease Detection Program.— 82 public health by Since 1967, the Division of Adult Health and Aging of the Chicago Board of Health, under the direction of Jeremiah Stamler, M.D., has conducted a number of disease detection pro- grams. In two public housing projects, the Dearborn and Lathrop Homes, over 500 per- sons were screened in a 14-month program. A followup study on the persons who were re- ferred to sources of health care because of ab- normal results was undertaken by two medical students as part of the Student Health Project in cooperation with the Board of Health’s Di- vision of Adult Health and Aging. The reports of the two students who worked in the project are presented first as an over- view of their work, followed by a description of their findings. This seems to suggest that medical practice in poor neighborhoods has been substantially abandoned by graduates of the medical schools of the United States—by Jack E. Berger (Medicine) My summer placement was at the Chicago Board of Health’s Division of Adult Health and Aging. The project we (Charlie Bass and I) undertook was a ‘research effort to evaluate the effectiveness of the Board of Health’s chronic disease detection screening survey. “This program involves multiphasic testing for indications of chronic disease processes. The object of the program is to elevate the level of catching chronic diseases (which are now the large public health prob- lems, rather than the infectious diseases) be- fore they reach crisis proportions in a given in- dividual. The program provides subsequent re- ferral for those requiring further investigation to existing medical care structures. Several types of testing facilities are oper- ated under this program, such as the station- ary and mobile diabetes testing units. Our at- tention in this project, however, was confined to the multiphasic screening done at the per- manent testing locations in the Lathrop and _ Dearborn Homes housing projects. The testing done at these two locations takes 2 hours of the screenee’s time, and includes the following tests: (1) Blood pressure (taken twice), (2) CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 weight, (3) hematocrit, (4) tonometry for glaucoma, (5) urine protein, (6) urine sugar, (7) ECG, (8) serum cholesterol, (9) glucose tolerance test, (10) Pap smear, (11) VDRL, and (12) chest X-ray (optional). In addition, a short medical history was given by the scree- nees. The history gathered data pertinent to chronic disease such as smoking habits and the presence of any signs and symptoms of cancer. After the results of the tests are available, patients with abnormal tests are designated as “refer for care.” Those with serious problems are sent a letter immediately, informing them of the findings and urging them to see their doctor. Subsequently, the medical social worker phones them to see that they have sought care. If the person has no source of care, she arranges one for them. The less ur- gent cases are followed up after a lag of sev- eral months to allow the screenee time to seek medical care. Although the multiphasic testing program was initially confined to the residents of the above-mentioned housing projects, in the last 3 years this free testing service was made availa- ble to anyone who is over 35 years of age and cares to call the Board of Health for an ap- pointment. The program ig currently operating without public relations of any sort, finding that word of mouth advertising alone is suffi- cient to fill the program with screenees. Some 2,000 persons are currently screened per year. Initially, there were fears by local physi- cians that the program would constitute a gov- ernmental invasion of the traditional preroga- tives of the private medical practitioner. With the passage of time the tension has cooled, per- haps ameliorated by the physicians’ realization that the program was actually providing more grist for the “fee for service” mill. The object of our research, then, was to de- termine whether the chronic disease screening program was actually resulting in the delivery of preventive medical care, on a continuing basis, to those who gave indications of chronic disease processes. In our research we at- tempted to answer these questions: (1) Did the screenees who were classified as needing fur- ther medical care actually contact a doctor or other source of care about the findings of the screening survey? (2) Did this contact result in the diagnosis of a hitherto unsuspected dis- ease process? (3) What type of treatment was instituted? (4) Did the doctor’s diagnosis con- firm the findings of the screening survey? (5) Were the patients actually followed for any length of time? Were they actually receiving “continuing” care? The answers to these questions were made all the more interesting by the fact that a simi- lar followup study of the Chicago Heart Asso- ciation’s Adult Screening in Industry program was being done in DuPage County. In this pro- gram, only the tests pertaining to diabetes and heart disease were done, but nonetheless, a val- uable comparison could be made between the practice of preventive medicine in DuPage County as compared with the city of Chicago. It might be pointed out that virtually all seg- - ments of the urban population were seen in the multiphasic screening program. Most of the people seen at the Dearborn site were blacks, whereas most of those seen at Lathrop were whites. Financially, the persons screened ranged from welfare to affluence, but with lower incomes prevailing. After some initial delay in defining the pro- ject, the research began by examining the pop- ulation selected for our study. The sample con- sisted of all persons screened by the Lathrop and Dearborn Homes sites during the months of November and December, 1967, and January of 1968, This population was chosen so as to be ‘comparable to the population being studied by the Chicago Heart Association as a followup to its Adult Screening in Industry program. This program is similar to the multiphasic testing program with the exception that tests for indi- cations of heart disease and diabetes are the only tests performed. The folders containing the history and test results of each of the 506 screenees in our sam- ple were first gone through case by case. We retained the following information on all those who were referred for care: Case number, name, address, code numbers of abnormal 83 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 tests, name and address of their source of med- ical care. Out of the 506 in the sample some 186, that is about 37 percent were referred for care. Of these, 5 indicated that they received eare from both a private physician and a clinic; 31 claimed a clinic for a medical center ; 20 gave no source of care; and the remainder (130) listing private physicians. The following plan was developed to determine the medical fate of these persons. Each referree would be sent a questionnaire through the mail with a self-return envelope. Each private physician would be sent a letter explaining our project and informing him that he would soon be called for an interview. A considerable amount of time went into finding and verifying the doctors’ addresses and zip codes. Many doctors had to be dropped from the study as we could not find their names or addresses in the tele- phone directory. Others were also dropped for interviews because they practiced outside the city. For those screenees who listed clinics, all of the names of screenees for each clinic were compiled and sent to the respective clinics along with a letter requesting that we be al- lowed to see their charts. Subsequently we phoned the clinics for appointments to look over their records. I found that the medical re- cord librarian was the best person to contact concerning this matter. We had some 24 clinics with one or more screenees listing them as their source of care. The clinic personnel were almost always. very cooperative. The real problem here was that instead of talking with the doctor who was fa- miliar with the patient, we had only a chart at which to look. In one exceptional case (Mercy Hospital Clinic) this was no drawback. In other cases it was very difficult to glean infor- mation from the chart. Most of the charts were poorly organized and nonsequential, but most importantly they were handwritten and practi- cally illegible. Much of the crucial informa- tion, such as treatments and medication given was abbreviated or coded. In our cover letter to the clinics we asked that a person familiar with the charts be available to go over them with us. This rarely was the case. Usually the- charts were pulled and waiting, but I was di- 84 rected to some vacant desk where I could look at them without benefit of help. The secre- taries knew little more about the charts than I did and were no better at trying to decipher the writing. Only an interview with the treat- ing doctor could give us the accurate informa- tion we needed. This presents a real problem with following up persons visiting a clinic or medical center, in that the patients have been treated by a number of different doctors (all with equally poor handwriting), no one of whom would be familiar with all aspects of the treatment given a particular patient. The real solution here is to have well kept, neatly written or typed records. Once we were identified as being from the Board of Health, very few clinics gave us trou- ble about releasing the information, Our policy was to bring the release signed by the patients on screening only when it was requested. While making a visit to one clinic, one of the doctors became quite suspicious when he saw me going through some records. He gave me the third degree until I showed him a sample of the release form and promised I would send the copies of the releases for the patients whose charts I had examined. The releases were mailed the next day. This particular doc- tor had more on his mind than the technical- ties of maintaining confidential information. He was very interested in the attitudes of med- ical students. He proceeded to probe me with such questions as “How would you characterize yourself politically?” and “Are you a Catho- lic?” and “What is it with you guys with long hair?” I did my best to give straightforward honest answers to his questions. For the record my hair covers neither my ears nor my collar. It soon became apparent that the man was a: rock-ribbed conservative who enjoyed having a little fun at the expense of a “pinko” student. After carefully disassociating myself and my views from the Board of Health, we had about 45 minutes worth of discussion and/or argu- ment in which we could agree on approxi- mately nothing. He would not believe that black people had any trouble getting to Cook County Hospital. He said, “The police take them there CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 for free all the time.” He denied that black schools in Chicago were inferior to white schools. On a more fundamental level he said that, “The trouble with the damn niggers is that they are genetically inferior.” I told him that he was misinformed and blatantly racist. He cited his 20 years of experience in working with the “niggers” as ample evidence to sup- port his views. He would not listen to the idea that environmental forces had a profound ef- fect on development of personalities. He felt that “genetics determine 95 percent of every- thing.’ The whole conversation is not worth reproducing here except to show the extent of ignorance and racism in some of the practi- tioners of medicine. This man was neither se- nile nor southern. He held a teaching position in one of Chicago’s medical schools. As far as the physician interviews were con- cerned there was good cooperation in all cases. Many of the doctors were a little wary or de- fensive. Some of this disappeared once they un- derstood what we were doing and that we had the written permission of the patient to obtain the information, we wanted. Some of the defen- siveness on the part of the doctors was proba- bly due to the nature of the questionnaire it- self. There was simply no way to disguise the probing nature of the questions and conse- quently no way to avoid feelings of guilt or defensiveness on the part of the doctors. At the time of the interview almost all of the doctors had the record to be reviewed be- fore them on their desk. A good many of the records that I saw consisted of 8x 50r5x7 cards written on both sides and stapled to- gether in the corner. A few other doctors had their records on official looking forms. Only one or two maintained their records on full 814 x 11 sheets. Most of the doctors referred to the records consistently throughout the in- terview, but in one notable exception the doc- tor answered all of my questions without ever looking at the record although it was right be- fore him. An initial impression that stuck with me very markedly was that a high percentage of the doctors I interviewed were foreign born. In the initial weeks of interviewing I worked mainly on the South and Near West Side—the black and the “poor white” neighborhoods. Here it seemed that at least one-half of the doctors were foreign born. As I began to work on the North Side I found that few, if any, were foreign born physicians. This seems to suggest that medical practice in poor neighbor- hoods has been substantially abandoned by graduates of the medical schools of the United States. This observation seems to be supported by the fact that my partner who worked mainly on the North Side saw few foreign born doctors, and the two medical students doing the interviews for the Chicago Heart Association in DuPage County saw almost none. One of the most revealing experiences of the summer was hearing the experiences of the two medical students working on the pre- viously mentioned survey. Just in listening to their problems I could tell that inner city med- icine was in a different ball park. They were working on the level of finding out what meth- ods were favored by physicians for lowering serum cholesterol. I had only two cases that { ean recall in which a followup serum choles- terol was even done. They noted that almost all of their doctors had group practices with plush surroundings and further that many practi- tioners had their own laboratory facilities. I talked to doctors in modest to ramshackle ' offices, none of whom had laboratory facilities on the premises. In addition the students work- ing in DuPage County were quick to point out — that they saw very thick charts on their pa- tients, most of which were neatly typed, the doctors having dictated them to a secretary. ’ This brings up one of the critical issues that the summer’s work touched upon, namely the difficulty of getting testing done on low income people. Many doctors were quick to point out when I asked if they had had some particular test done, that they wished they could have had it done but, (1) the patient didn’t want to bother with it because he was currently asymptomatic, or (2) the patient had neither the time to make another appointment in a testing lab to have it done, nor the money to pay for it. Thus, if the practice of preventive 85 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 medicine requires testing, the real failure lies not with incompetent doctors, put rather with the entire socioeconomic framework that dic- tates that: (1) Poor people do not think on a “preventive” basis put rather on a “erisis” basis, (2) that they have no money to spend on testing that they see little value in, (3) that they frequently do not take the time to go to a separate facility to have testing done, and (4) that the doctor who practices among the poor either will not or can not make the financial in- vestment in laboratories that would help to ameliorate this situation. One offshoot of this problem is reflected in the fact that several doctors mentioned that they would rather have a patient put on welfare so that at least he can have his testing done. Another consequence of the lack of laboratory testing among the poor is that the Board of Health screening tests take on the role of diagnostic tests on some 0c- casions, On other occasions the diagnostic test ordered by the physician is a poorer test than the screening test. That is, a referral based on a glucose tolerance test, for example, is fol- lowed up with a urine sugar, or perhaps a fast- ing blood sugar only. It seems to me that the problems mentioned here are going to have to be dealt with in a massive and radical fashion before we can expect to see great improvement in the health of the poor. Certainly this will be true as far as preventive medicine is con- cerned. In this case the Board of Health’s effectiveness is dependent upon the total medical milieu in which it functions.—by Charlie Bass (Medi- cine) My summer’s placement at the Chicago Board of Health at first seemed like an excel- lent opportunity to study a structure to deter- mine the powers that be. I was told by my pre- ceptor that the project would take a great deal more time that I had, and that the power structure was a great deal more complicated than I could imagine. As it turned out, all I learned concerning the Board of Health’s struc- ture was what I was told about the rudimen- tary formalized structure and what I saw of its daily operation. This part of my “radical sum- mer” turned out to be a bust. 86 I was left to find a project within the Divi- sion of Adult Health and Aging that would at least be of value to someone, or some. project that seemed of value to my partner, Jack Ber- ger, and myself. The two interns on our site were concerned with the service and the labo- ratory facilities that the Board of Health oper- ates. They thus went their own way to do what they could at the sites where they were al- lowed to participate. We talked with them only infrequently for the rest of the summer. The Board of Health is involved in a chronic disease screening program which works out of two stationary sites, one on the Near South Side and one Near Northwest. This screening seemed like a very important project as it is a first step toward effective preventive medicine. Though the screening is on a small scale, it is at least an attempt at a beginning. It was within this project that Jack and I decided to do our research. If the effectiveness of one system ultimately depends upon the functioning of another inde- pendent system, that one system must check beyond itself to determine its validity for exist- ence. In this case the Board of Health’s effec- tiveness is dependent upon the total medical milieu in which it functions. As effective a de- tector as the screening may be, if for economic, social, or psychological reasons a person does not get care, the detection is a waste. Our pro- ject this summer went beyond the Board of Health into a part of the medical care system, the hospitals, clinics, and private M.D.’s in an attempt to determine the ultimate effectiveness of the screening program. Without going into the details of the project, I am left at present with only general impres- sions gained from physicians I’ve talked to and the records I’ve examined. The most dominant impression I have js of the extreme guarded- ness of the M.D.’s and even their nurses. This attitude is very understandable from merely the point of view of an invasion of privacy by a young individual who doesn’t look exactly clean-cut, but it is even more understandable when one discovers the type of care that is given. Most of the M.D.’s had a great many ra- tionalizations to explain the type of patient CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 care given, most of them probably containing a great deal of validity; nonetheless, these M.D.’s did find it necessary to give excuses thus acknowledging their knowledge that the treatment was less than ideal. About one-third of the cases I investigated seemed to show some effective degree of fol- lowup which ranged from retesting for the suspected disease with the finding of normal re- sults, thus not confirming the Board of Health’s findings, to treatment for the disease suggested by the screening procedure. The other two-thirds can be accounted for by pa- tients having seen their doctors but not telling them about the screening results, patients hav- ing not seen their M.D.’s in the 6 or more months since the screening, and the whole range of rationalizations given by M.D.’s. These explanations ranged from “this person couldn’t afford a new test,” “I don’t consider these results abnormal,” “she is too unreliable to treat the way I would like,” to “you know this type of people” and a whole range of pleasant conversation to avoid giving specific answers to questions. Nothing really new can be gotten from this study that hasn’t already been shown in much more conclusive, dramatic, and meaningful ways. It can be seen that any system to im- prove health which depends upon the present system for dispensing medical care is going to be very severely handicapped and possibly re- duced to total medical-economic ineffectiveness. The two general and oversimplified solutions made obvious from this study are that the health care delivery system must be radically changed or a separate independent system * must be set up. Report on Followup on @ Sample of Screening Program Examinees Referred for Medical Evaluation and Care: 6 Months and 2 to 3 Years After Sereening.—by Charles Bass and Jack Berger This study was designed to followup on per- *Under the direction and with assistance of Willie Cain, R.N., R. Raphaelson, Rose Stamler, M.A., and Jeremiah Stamler, M.D., for the Chicago Health Re- search Foundation and the Division of Adult Health and Aging, Chicago Board of Health. : sons referred for care because of abnormal re- sults in the Chronic Disease Detection Pro- gram of the Chicago Board of Health. It was conducted by two medical students as part of the Student Health Project with the coopera- tion of the Chicago Board of Health, especially the Division of Adult Health and Aging. It was an attempt to answer three basic questions: 1. What percentage of the persons referred’ actually contacted a physician? 2. Is the examinee under care for the abnor- mal condition(s) ? 3, What is the response of physicians and ex- aminees to followup efforts? Two parts to this survey, one concerning persons screened 6 months prior to followup and the other, persons 2 to 8 years before fol- lowup, allowed us to compare the answers for two time periods. The major population under consideration was that tested in the time period between No- ~ yember 1, 1967, and January 31, 1968, at the Dearborn and Lathrop Homes sites. A total of 508 people were screened during this period with 186 referred for care. For this group of 186, data were gotten from both examinees and medical care sources. The examinees were all mailed questionnaires with a letter of explana- tion and a stamped return envelope enclosed. The sources of medical care were sent an intro- ductory letter which was followed by a phone contact asking either for an interview with the physician or a chance to examine the medical records. All sources of care who could not be personally contacted (primarily physicians with unusual schedules or those on vacation) were mailed a questionnaire with a letter of explanation and a stamped return envelope. In the second part of the survey, 460 exami- nees (of whom 152 were referred for care) were chosen at random from older files rang- ing in time of being screened from December 10, 1965, to November 10, 1966. For this popu- lation, both examinees and medical care _ 2The criteria for referral for the major abnormalities discussed were: (1) Diastolic blood pressure of 95 mm. Hg. or greater (2) An abnormal modified glucose toler- ance test, and (3) A specific abnormality on the ECG. 87 eee" — CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 gources were sent questionnaires with explana- tory letters and stamped return envelopes. Copies of all forms are available. The tables below summarize the findings.® Followup of Recent Examinees—Reporting for Care.—Approximately 59 percent of those referred for care reported that they had seen 4 physician after the screening tests (table 1). * Where information was not obtained by the survey techniques but was available from the social worker’s report it was included as indicated in the tables. (An additional small precentage—2.2—an- swered this question negatively. It ig assumed as likely that a large share of the 39.2 percent not answering the questionnaire did not report to a physician after the tests.) The three most frequent bases for referral—elevated blood pressure, elevated plasma glucose (after oral load), specific ECG abnormality—all seemed about equally compelling to examinees as rea- sons for reporting to physicians. About 60 per- cent of persons with these findings reported seeing a physician. Of those with other abnor- esults: Was physician seen? TABLE 1—Followup on @ sample of 186 examinees Te. ferred for abnormal test r Reported seeing M.D. Description of Didn’t answer Reported * Social worker examinee questionnaire Didn’t see M.D. Total via questionnaire report only Test findings: All -----------0 0 13 109 89 20 (N? 2186) --------2-0007 (39.2) (2.2) (58.6) (47.8) (10.8) ee Diastolic blood pressure 95 mm. Nore.—Numbers in parentheses are percentages. 1 Examinee questionnaire. . 3 Some examinees are jn more than 1 test finding group. 88 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 aalities 45 percent indicated they had seen a ource of medical care.* Males in this sample reported seeing a phy- cian in a slightly higher proportion of cases shan did female examinees (62.5 percent ver- sus 56.9 percent, respectively). The proportions of whites and nonwhites re- ported as seeing a physician were only slightly different (60.4 percent and 56 percent, respec- tively). As would be expected, considerably more older examinees reported they sought care when compared to those in the younger age groups (73.5 percent for 60 to 64 year olds versus 49 percent for those 30 to 39). It may be that the older examinees had more symptoms ag a result of the abnormalities, or it may be that their older age has made them more fre- quent and regular visitors to the physician. Is examinee following the recommendations of the physician? . The majority (56 percent) of those report- ing that they had seen the physician also re- port they are following all or part of his rec- ommendations (table 2). These 61 persons con- stitute approximately one-third (32.8 percent) of all those referred. (The actual percentage following M.D. recommendations is probably higher than this one-third. However, there is no way to know what percentage of nonrespon- dents actually received followup care). In about one-quarter of the reporting cases (26.6 percent), examinees stated that the phy- sician made no recommendations for ‘treat- ment. No explanation is given in 17 A percent of the cases, but in 9.2 percent, the absence of recommendations is based on the physician’s decision that the examinee was normal. (In 5 of those 10 cases, the repeat test given was as stringent as the initial screening test. In 5 oth- ers, the test was less sensitive—e.£., urine test for diabetes versus initial modified GTT—or no test was made). Physician Report. Information from the source of medical care was received for 104 ex- aminees (55.9 percent of those referred. for *Such abnormalities include suspicious findings on cervical examination, suspect glaucoma, low hematocrit. TABLE 2.—Followup on @ sample of 186 exami- nees referred for abnormal test results: Are examnees who saw physician following his rec- ommendations? ONS fy: 8 8 Brg bee Bets 38 2 8 Bast gE Eage Sey eS Seek sess Bsse fF geht sees 383s Sane wee SEE ZS5¢ BESS Number ..-- 61 10 19 19 qT Percent of all examinees who saw M.D. .---- 56.0 9.2 17.4 17.4 wae Percent of all referred examinees (N=186) -- 82.8 5.4 10.2 10.2 41.4 Most data in this table are from examinee questionnaires. In a few cases, information ig from social worker followup. care) (table 3). Actually, the percentage of physicians cooperating in followup was slightly higher (68.4 percent), since requests for such information went to physicians in 164 of the 186 cases. In the remaining 22 cases, it was not possible to locate the doctor indicated as being the source of care. Of the 104 persons for whom information was obtained from a source of medical care, 79 were reported as having been seen (table 3). They represented 76 percent of those for whom there is an M.D. report, and 42.5 percent of all those referred for care. The doctors report that 68 of the examinees were under long term care and that 40 of these were receiving treat- ment as a result of the screening referral; i.e., 38.5 percent of those for whom there was an M.D. report, and 21.5 percent of all those re- ferred. One word of caution is needed in inter- preting the report that 68 of the examinees (65.4 percent of those reported on, and 36.6 percent of all referred) are “under long term care.” Apparently, physicians in responding to this question stated that persons were under their long term care even though they were not treating them for any of the abnormalities found in the screening tests, The more realistic estimate of the number under care is the 40 re- 89 —————— CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 ported specifically as receiving treatment as 4 result of the screening referral. Long Term Followup.—tTable ‘4 indicates that there is probably a long range salutary ef- fect of such a screening program, since 24.6 percent of those for whom there is an M.D. re- port are described as under treatment for the screening abnormalities. It also indicates, how- ever, that the attrition in response rate to fol- TABLE 3.—Followup on a sample of 186 exami- nees referred for abnormal test results: Are examinees receiving treatment as a result of screening referral?* Percent of Percent of all examinees ‘with all examinees Number M.D. report referred M.D. report received -- 104 100.0 55.9 M.D. saw examinee --- 19 76.0 42.5 Examinee under M.D.’s long-term care ----- 68 65.4 36.6 Examinee receiving treatment as result of screening referral -- *40 38.5 21.5 Information is from M.D. response- 218 of these examinees reported that the abnormalities for which they were referred. were previously known although not under control. 22 indicated that these abnormalities were previously un- known. lowup requests is great, and this interferes with any accurate assessment. Only 31.6 per- cent of examinees and 53.3 percent of M.D.’s responded to the questionnaires (as contrasted with 60.8 percent and 63.4 percent, respec- tively, for the followup of more recently re- ferred cases). Despite the lapse of 2 to 3 years, 58.8 per- cent of examinee responders reported them- selves to be under treatment for the screened abnormality (table 4). This compares favora- bly with the 54.8 percent of the more recently referred examinees who also reported them- selves as under treatment. Summary and Conclusion.—A sizable per- centage of examinees recently referred for fol- lowup medical evaluation and care (59 per- cent) report themselves as having sought such care. One-third (33 percent) of all examinees referred report that they were under treat- ment and following all or at least part of the doctor’s advice g months after referral. (This percentage is higher—55 percent—if one uses the number responding to the questionnaire as the base, rather than all those referred.) Phy- TABLE 4.—Comparison of followup results in 2 groups of examinees: 1st group, 6 months after re- ferral; 2d group, 2-8 years after referral 6m onths after referral —_—————— 2 to 3 years after referral Persons examined in sample -------- BOR -----neeee Referred for test abnormalities ____-- 186: 86.6 percent of examinees ------ 152: 33.0 perment of examinees. Examinee questionnaires sent: ------ 186; 100 percent of referred -------- 147: 96.7 percent of referred. Examinee questionnaires completed and returned. Examinee reports himself to be under 61: treatment following referral. . Physicians receiving follow-up request 118: 60.8 percent of referred ---- . a 54.8 percent of responders ----- 32.8 percent of referred 164: 88.2 percent of referred ------ 107: 70.4 percent of referred. 48: 31.6 percent of referred. 28: 58.3 percent of responders. 18.4 percent of referred. Physicians responding ----------77-~ 104: 57: 63.4 percent of M.D.’s queried -- 53.3 percent of M.D.’s quer- ied. 55.9 percent of referred -------- 87.5 percent of. referred. Physician reports examinee under 40: 14: . treatment ------------77700 - 38.5 percent of examinees with 24.6 percent of examinees M.D. reports. 21.5 percent of referred -------- with M.D. reports. 9.2 percent of referred. CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 icians independently report that 39 percent of hose they saw after referral were under treat- nent. This constitutes 22 percent of all re- erred examinees. The discrepancies between xxaminee and physician report can be ac- ,ounted for partly by the fact that some exami- aees reported to a physician other than the one isted at screening time, and this listed physi- sjan (the one contacted for followup) counted this examinee as ‘not reporting.” Even after 2 to 8 years, a sizable portion of examinees re- port themselves as still under treatment (58 percent of those responding, although only 18 percent of the referred, since the response rate is low after such a time lapse.) One-quarter of those with M.D. reports are stated to be still under care (again, with a low response rate over time, this accounts for only 9 percent of those originally referred.) The conclusion is that at least a third of those recently examined (and possibly up to 55 percent) do end up under medical care they might not otherwise have sought, for the treat- ment and control of major chronic diseases. Improved methods of followup (including built-in plans for intermittent or periodic fol- lowup) would increase ability to assess whether the salutary effect lasts over the years. It is clear that this type of study did not and could not assess in depth the type of care and treatment received following referral. It is im- portant to register, however, that the screen- ing program is valuable first step in bringing under early control those chronic diseases prevalent in a significant proportion of the middle-aged and older population. Proposed Amendments to the Illinois Public Aid Cole Relating to the Illinois Medical As- sistance Program.—Lawrence S$. Bloom (Law), Ralph McMurray (Law), Margaret Stapleton (Law) I. Introduction This report suggesting specific amendments to the Illinois Public Aid Code represents the implementation of research begun during the 1967 Chicago Student Health Project and . published in the June 1968, issue of Inquiry magazine under the title of “Medicaid in Cook County.” These legislative amendments are de- signed to revise the Illinois Medical Assistance Program in such a manner that it may more adequately serve the needs of those Jllinois res- idents who are unable to meet their medical ex- penses. It should be understood from the outset that the authors are not altogether certain the cur- rent welfare system is the proper framework for an adequate and effective health care plan. Patching up the existing system may do little: good. In fact, it may help further entrench what should really be discarded. But with the prospects for a total rethinking of the problem very dim indeed, it is perhaps prudent now to consider those changes in the current program which will be most beneficial. II. Defects in the Current Program . The basic framework of the current Tilinois Medical Assistance Program is quite simple. Two classes of people qualify for free medical assistance: cash grant recipients of public aid, and those persons whose incomes are sufficient (by Public Aid standards) to meet daily needs but insufficient to meet medical needs. Cov- erage by the program is evidenced by a card which signifies to medical vendors that reim- bursement for various medical services ad- ministered to the holder will be paid by the State of Illinois. Through this system it could be possible to provide necessary health care in a dignified manner to those unable to pay. Unfortunately this is not the case. Specifically, the program: (1) Fails to set reasonable standards and ‘categories of eligibility thereby ¢x- cluding from coverage broad ranges of deserving persons, (2) Fails to include major areas of preven- tive care within the services for which vendors may be reimbursed thereby depriving program eligibles of an es- sential element of good health care and, in the large run, adding to the taxpayers’ supporting burden; 91 (3) (4) CHICAGO STUDENT HEALTH Fails to provide convenient efficient methods for procuring coverage under the program, thereby denying a large segment of our state’s population quick access to the medical treatment afforded them by law, .as well as de- priving them of any measure of medi- cal security ; ; Fails to provide financial incentives and administrative efficiencies to med- ical vendors thereby alienating the medical vendors and discouraging their practice in poverty areas. In a broader scope, the program: (1) Reinforces the degrading image of (2) charity medicine, and Takes little advantage of its oppor- tunity to integrate publicly supported patients into the health care delivery system of the community as a whole. III. Proposed Medical Assistance Program The proposed statutory amendments would revise the medical assistance program to take the following basic form. A. Eligibility 92 (1) (2) (3) All persons and families falling below the HEW “poverty line” for their particular family classification would be eligible for basic maintenance cash grants and hence free medical assist- ance. All individuals and families (here- after refered to as “families”) whose . incomes do not exceed 133 percent of the maximum basic maintenance cash grant allowable to families of similar constitution would be eligible for free medical assistance. Example: Ifa family of four with no income whatsoever would be eligible for a cash grant of $3,600 covering basic needs, a similar family of four which fails to qualify for a cash grant on the basis of need would still be eligible for free medical care if its income does not exceed $4,800. Assets (such as 4 car, savings, life in- PROJECT SUMMER 1968 (4) surance) would not be included in the computation of income. Families eligi- ble on.the basis of income under the standards set out in I(B), above, would retain their: eligibility status so Jong as their liquid assets (savings, stocks, insurance, etc.) do not exceed 50 percent of the maximum income allowable for their family classifica- tion. Necessary assets such as a home, one car and a limited amount of life, health, accident and property insur- ance would be totally exempt from the computation of assets. Example: Using the family of four hypothesized earlier, that family would be excluded from eligibility for medical assistance only if their nonexempt assets in the form of stocks, savings, etc., exceeded $2,400, i.e., 50 percent of $4,800, the maximum income allowed for a family of four. Applicants who do not qualify on the basis of need would nonetheless have the assurance that when their calcu- lated excess income is exhausted for medical expenses, the State of Illinois would be committed to grant coverage for subsequent medical expenses. This would be accomplished by the Depart- ment’s keeping an accurate record of all “rejected” applications, with a no- tation of the calculated excess income or assets available for medical needs. The applicant would then submit re- ceipts of medical expenditures to the Department and if, within a pre- scribed period, these exceed his excess income, 2 medical assistance _eard would automatically be issued and full eligibility granted for the duration of the time his initial application would have covered had it been granted. The Department of Public Aid would be encouraged to devise a plan whereby - those found ineligible for medical as- sistance on the basis of need could. be given State financial aid in meeting CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 a percentage of their medical costs, without first having to totally deplete their excess income. Example: If the family of four sug- gested above were found to have an income of $5,000 and assets of $2,400, eligibility for medical assist- ance would initially be denied. How- ever, if this family were to incur medical expenses in excess of $200 during the 6-month period for which eligibility is now granted, it would then be eligible for coverage for the duration of the 6-month period, Of course, eligibility would be regranted if the family’s financ- ial status remained the same at the end of the 6-month period. Comment: The purpose of these changes is two-fold. First, they increase the num- ber of people eligible for medical assist- ance and grant some measure of medical security to those just beyond the eligi- bility limits. Second, with an enlarged group of potentially “fully paid” patients whose eligibility can be quickly ascer- tained, more and better physicians and institutions might be encouraged to serve poverty communities. B. Medical Services Covered Those services for which medical vendors could be reimbursed would be expanded to in- clude preventive dentistry, physical check-ups and psychological counselling. Comment: Aside from the necessity of these items to provide comprehensive medical care, effective preventive atten- tion may in the long run reduce the costs of the Medical Assistance Program through a reduction in costly remedial services. C. Administration of the Medical Assistance Program (1) While determination of eligibility for medical assistance would remain the function of the Department of Public Aid, the administration of vendor bill- ing and reimbursement would become the responsibility of a separate agency solely concerned with this task. (2) For each individual or family found eligible for medical assistance, the De- partment of Public Aid would each month deposit with this payment agency an amount computed to be the average expected monthly cost of pro- viding medical services to each person covered. Such funds would be irrevoc- ably commited to the payment of Medical Assistance bills. (3) Persons eligible for medical assistance would be allowed to have such monthly payments transferred to private medi- cal insurance of group care plans to cover the cost of premiums required by such plans. From that point on, the medical relationship would be safely between the patient and his chosen medical care dispenser. (4) Vendors who continue to submit vouchers to the State reimbursement agency would be entitled to interest on vouchers unpaid after a month’s period of time. (5) The State reimbursement agency would be authorized to make advance payments to medical institutions which on the basis of past billing can reasonably be expected to submit sub- stantial payment claims. Specifically, institutions which in the past have submitted vouchers over a year period in excess of $300,000 could receive in advance 50 percent of an average es- timated monthly reimbursement, Comment: These changes would take the job of vendor reimbursement out of the Department of Public Aid and make it the responsibility of a professional pay- ment institution. This, along with the interest and advance payment provi- sions, could help restore vendor cooper- ation with the Medical Assistance Pro- gram. Allowing persons covered by the Medical Assistance Program to transfer the funds set aside for their medical 98 CHICAGO STUDENT HEALTH PROJEC needs to private institutions has several advantages. It allows greater control over the management of an individual’s own medical care. It enables him to be- come part of the health care delivery system of the general community. It gives an added push to the development of group care plans in Illinois. And, incidentally, this provision may enlist the support of the powerful insurance lobby in support of the entire legislative renovation. [V. Proposed Amendments to the Illinois Pub- lic Aid Code. (Note: Statutory additions indi- cated by italic) A. Declaration of Purpose Amend Sec. 5-1, second paragraph to read: “Preservation of health, prevention of disease, alleviation of sickness, * * *.” Comments: For. specific preventive care services for which reimbursement shall be made see amendments to Sec. 5-5 in IV (B) of this report. B. Classes of Persons Eligible Amend Sec. 5-2 to include as new sub- sections. 3 and 4: “g, Persons otherwise eligible for basic maintenance grants under Article IV but who fail to qualify there- under on the basis of the full em- ployment of a family wage earner. “4, Persons otherwise eligible for med- icol assistance under Section 5- 2(2) of this Article V but who fail to qualify thereunder on the basis of the full employment of a family wage earner.” Current subsections 3 and 4 should be _ renumbered 5 and 6 respectively. Comment: These amendments are design- ed to include within the Medical Assist- ance Program those families now denied ADC-U cash grants because of the full employment of a father as well as those families now denied categorically re- lated medical assistance eligibility for the same reason. , C. Amount and Nature of Medical Assistance GA SUMMER 1968 Amend Section 5-4 to read as follows: “Subject to the subsequent pro- visions of this Section 5-4, the amount and nature of medical as- sistance shall be determined by the County Departments im ac- cordance with the standards, rules and regulations of the I Illinois De- partment, with due regard to the requirements and conditions im each case, including contributions from legally responsible relatives. “In no event, however, shall the Illinois Department establish in- come eligibility limitations for persons designated in Article V, Sec. 5-2 (2), Article V (new) Sec. 5-2 (4), and Article V (re- numbered) Sec. 5~-2(5) of this Code of less than 138% of the maximum basic maintenance grant allowed the most needy recipient of a similar classification under Articles II, IV, and VI of this Code. “The Department shall devise methods of income evaluation that take into account seasonal and other fluctuations in income with the aim of issuing medical assist- ance coverage to all those who over a year period would qualify on the basis of need for such as- sistance. “Determination of income Un- der the provisions of this Section 5-4 shall include no consideration of the assets possessed by the ap- plicant. The Illincis Department may set standards limiting eligi- bility for medical assistance on the basis of value of assets pos- sessed. Provided, however, that no applicant shall be denied eligi- bility for medical assistance on the basis of assets possessed Un- less the value of those assets ex- ceeds 50% of the maximum income allowed any person or CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 family of a similar classification for medical assistance eligibility under this code. Provided further, that the following assets shall be excluded from consideration: homestead property, one automo- bile, and such amounts of life, health, accident, property and other insurance as the Depart- ment shall determine to be suffi- cient for the various classifica- tions of persons and families eligible for medical assistance under this code. “The Department may devise a plan or plans whereby individuals or families found ineligible under the income and asset requirements promulgated pursuant to this Section 5-4 may nonetheless re- ceive financial assistance toward payment of a percentage of medi- cal expenses incurred.” his application. Each re- port of a disapproved application shall be ac- companied by a writ- ten statement setting forth the reasons for disapproval. If eligibility is disallowed on the grounds of excess in- come or assets, such statement shall specify the nature and amount of the excess. (3) All approved and disap- proved applications shall be kept on file for five years by the County De- partment to which it was submitted. (4) The Department shall recompute eligibility for medical assistance upon submission by a disap- proved applicant of re- D. ra ae and Eligibility Determination ceipts for medical ex- rocedures penses incurred. If with- Amend the Public Aid Code to pro- ‘in the standard period of vide as new Sec. 5-5, the following: eligibility granted ap- “Sec 5-5 Application and Eligi- bility Determination Procedures. “The IUinois Department shall by appropriate rules and regula- tions establish procedures for processing and determining. the eligibility of applicants for medi- cal assistance. Such procedures may take any reasonable form but in any event shall include the fol- lowing provisions: (1) Application for medical assistance may be made at any time regardless of the medical condition of the applicant. (2) Each applicant shall be notified within thirty days of the receipt of his application, of the ap- proval or disapproval of . proved applicants the disapproved applicant shall have expended for medical care funds in excess of his computed excess income or assets, he shall automatically be declared eligible for medical assistance for the duration of the period, and shall be is- sued a medical assist- ance card so indicating.” Note: All subsequent. sections of the existing Public Aid Code should be renumbered to ac- count for the insertion of this new Section 5-5. E. Medical Services Amend the Public Aid Code to provide 95 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 as renumbered Section 5-6 the fol- lowing: , “Section 5-6. Medical Services. “The Illinois Department, by rule, shall determine the quantity and quality of the medical assist- ance for which payment will be authorized, and the medical serv- ices to be provided, which shall include all or part of the follow- ing: (1) inpatient hospital serv- ices * * * (18) other diagnostic, screening, preventive, and reha- bilitative services; (14) psycho- logical counselling; (15) trans- portation * * * (16) any other *« * * healing. “In determining those services for which payment will be author- ized, the Department shall wher- ever possible include those .pre- ventive services such as diagnos- tic physical examinations, pre- ventive dentistry, psychological counselling authorized above which are most likely to reduce the possibility of later remedial treatment. “The Illinois Department * * Section 5-2.” F, Administration 96 (1) Medical Payment Fund Amend Section 12-6 to provide at the end of the current section the fol- lowing: “Phe Medical Payment Fund shall be administered by a Medical Payment Bureau under the direction of a Di- rector of Medical Payments to be ap- pointed by the Governor. The Medical Payment Bureau shall perform such duties as are further designated in this Code.” (2) Payment to Medical Payment Fund Amend Section 12-6.1 to provide as follows: “From State appropriations for this purpose, the Illinois Department shall provide for payment into the Medic Payment Fund * * ” . (3) (4) Payments to the Medical Pay- ment Fund—How Computed—Month- ly Medical Capitation Payments Amend Section 12-6.2 to provide as follows: “The Illinois Department shall de- termine the per capita. amount neces- sary to meet the estimated monthly needs of each person duly authorized to receive medical assistance under this Code for such services and supplies as shall be authorized by the Illinois. De- partment pursuant to Section 5-6 of this Code. Such per capita. amounts may very with the age and classifica- tion of the eligible recipient. The Illi- nois Department shall designate for payment into the Medical Payment Fund the monthly per capita amounts so computed and such payments shall be known as monthly medical capita- tion payments.” Disbursements From Medical Pay- ment Fund Amend Illinois Public Aid Code to in- clude the following new Section 12-6.5: Section 12-6.5. Disbursements from Medical Payment Fund. “Disbursements shall be made from the Medical Payment Fund solely by the Medical Payment Bureau upon authorization by the Director of Medical Payments. The Director of Medical Pay- ments shall authorize disburse- ments only for the payment of duly submitted medical vendor claims for services rendered or for the payment of medical premiums as hereafter authorized. Duly sub- mitted medical vendor claims shall be paid within thirty days of their receipt by the Medical Pay- ment Bureau. All claims not so paid shall accumulate interest at the rate of 1% per month or. fraction thereof. Each person or family for whom a monthly medi- cal capitation payment shall have been credited to the Medical Pay- ment Fund may request that such CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 capitation payment be paid to any corporation, partnership or other association licensed by the State of Illinois to provide medical or hospitalization insurance or to any association of physicians au- thorized by the State of Illinois to provide medical services upon payment of a set premium. Such requests shall be automatically granted by the Medical Payment Bureau and the appropriate funds so disbursed. No medical vendor claims shall subsequently be paid for medical services rendered to those for whom monthly medical capitation, payments are 80 dis- bursed.” (5) Advance Disbursements to Hospitals Amend Illinois Public Aid Code to in- elude the following new Section 12- 6.6: Section 12-6.6. Advance Dis- bursements to Hospitals. “The Director of Medical Pay- ments is authorized to disburse funds in advance of billing to hospitals and other institutions which during the past year sub- mitted valid claims for reimburse- ment in excess of an average of $25,000 each month. Such advance disbursements may not exceed in amount 50% of the institution’s past year average monthly Ddill- ings.” Note: Current Sections 12-6.5, 12-6.6 and 12-6.7 should be renumbered 12-6.7, 12— 6.8 and 12-6.9 respectively. BIBLIOGRAPHY (1) Mark H. Lepper, M.D. and Joyce C. Lashof, M.D., “Preliminary Report on Patterns of Medical and Health Care in Poverty Areas of Chicago and Proposed Health Programs for the Medically Indigent,” 1966. (2) Evelyn M. Kitagawa and Karl E. Tauber, eds., Local Community Facet Book, Chicago Metropol- itan Area, 1960, Chicago: Chicago Community Inventory, 1968. (3) Chicago Housing Authority Report, 1967. Section Ill. HOSPITAL SITE REPORTS Eight hospitals were sites of activity for Student Health Project participants. These in- cluded the four major purveyors of ambulatory health services in the city of Chicago and four other hospitals. These latter four ranged from gmall to medium-sized institutions. One of the major hospitals, Cook County, is the city and county’s only public hospital and was established to care for the indigent. The remaining hospitals were all privately con- trolled, voluntary institutions. All of them were general hospitals. Most of them were lo- cated in, or directly adjacent to, predominantly Negro, poor communities. The types of activities in which the students engaged at the various hospitals included col- lection of data, interviews with patients, obser- vations of health care delivery systems and, in some cases, participation in the daily work routine of specific departments. The work the students did will be described in this section. Their reactions to their experi- ences in the hospitals will be discussed at the end of this portion of the report. Cook County Hospital This public institution is the largest general hospital in the city of Chicago with 2,747 beds. It provides care to the indigent primarily, but has been characterized in certain press articles as “the physician to the Negro” in Chicago. It provides ambulatory services at its Fantus Clinic and the students assigned there worked only in this area. The emergency and admissions area of this hospital sees approximately 1,200 patients each day. About 200 of these are admitted to the hospital, about 200 are referred to Fantus Clinic and the remainder are “seen and ad- vised.” (1) vs The students reviewed all the patients seen . on one day in the Fantus Clinic for residence, age, sex, and race. These data are presented in table 1. (These patients had all been accepted for continuing care at Fantus; patients receiv- ing crisis care in the admitting and emergency area were not interviewed.) Geographic residence in the study was based on the 75 community areas in Chicago. The concept of community areas within the city of Chicago was first delineated more than 30 years ago, through the work of the Social Sci- ence Research Committee of the University of - Chicago, with the cooperation and concerted effort of many local agencies and the United States Bureau of the Census. (2) The data in table 1 indicate that on the day of the survey, patients came to Fantus Clinic from 60 of Chicago’s 75 community areas. However, patients from only seven community — areas accounted for 55.7 percent of all the pa- tients seen that day. Four of these seven areas were on the West Side, geographically close to the hospital and three were on the South Side. As might be expected, since this hospital is primarily established to render care to the in- digent, these seven communities are poverty areas, as defined by the Chicago Committee on Urban Opportunity. (1) In addition to the survey of geographic origin, the students conducted interviews with patients, selected at random, from among per- sons seated in several waiting rooms of about a dozen clinics in Fantus. Approximately 60 pa- tients were interviewed; 86 percent of them were black and all of them had limited econ- omic resources. Less than 10 percent of the respondents were past age 65 years and the re- mainder were predominantly under 45 years of age. . : When asked why they came to Fantus Clinic, a majority of the patients interviewed. re- sponded that they had known about the clinic 99 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 all their lives or had been “referred” to it. Ten percent came because their care was free. The most frequently stated reason given by pa- tients who only used Fantus Clinic and no other source of medical care was that they lacked money. A question probing the patient’s knowledge of the MA-NG* program revealed that 93 per- cent of the patients queried about MA-NG had never heard of this program for the medically indigent. Only one-third of the patients who are on public aid rolls were aware that their “green card” entitled them to seek care at pri- vate hospitals or from private physicians if they so desired. Over 90 percent of the Fantus patients rated the personal attention they received and the medical competence and continuity of eare at the clinic as “good” rather than “generally good or poor.” About 85 percent of the respon- dents thought that physicians at Fantus were really interested in taking care of the poor and a high positive response was also elicited as their perception of the physicians’ interest in taking care of Negroes. About two-thirds. of the respondents felt that conditions at Fantus Clinic were improving and that steps were being taken to improve conditions. Only 17 percent thought that nothing was being done to improve conditions there. When queried as to their preference if they had a choice of free care at neighborhood health centers or continued attendance at Fan- tus Clinic, about two-thirds responded that they would prefer to go to a neighborhood health center. (This is a different response than the one elicited at Presbyterian-St. Luke’s Hospital to a similar question.) The length of time patients had to wait prior to being seen was probed. Waiting time varied from about 1 hour to as much as 8 hours, with 4 hours appearing to be an average waiting pe- riod. The length of waiting time posed a major problem for those patients who were employed since they usually lost an entire day from 1 Medical Assistance—Non Grant which provides pay- ment for eligible patients from public funds even though they are not on public assistance rolls. 100 work. However, apparently patients accept this as inevitable since, upon interview, few per- sons included cuts-in waiting time as one sug- gestion for improving services. When queried about suggestions for improve- ment of health services only about half of the patients had such suggestions. These included: all night emergency services in the neighbor- hoods; better methods of transporting emer- gencies to hospitals (there is no public ambul- ance service in the second largest city in the United . States); making information about costs at various hospitals available to the public; and cooperative programs with outly- ing clinical laboratories so that great travel and time would not be required for tests that only take a few minutes. Other improvements that were suggested related more specifically to Cook County Hospital itself. These included better food, air conditioning, better parking fa- cilities and a time payment plan. The students, in their report, quoted a num- ber of individual comments made by. respon- dents. They ranged from critical to complimen- tary and a few of them are repeated here: On the surface, they’re- making every effort, but still there’s not much being done to improve. Why do people have to come all the way here—20 miles? Why don’t they have services there? They pay taxes. Mayor Daley doesn’t even say why. These people come and sit after coming 25 miles and sit all day. Maybe don’t get any service all day. Why do you have to do it all day? People in pain * * * To get admitted to the hospital takes a Jong time unless you have po- litical connections, even if you have a - doctor’s note. I went and got a note from my alderman and got admitted right away. The system of admissions ~ makes people die, Wait a long time— 2 or 3 weeks. Some people suffer. They are people. They’re sick. No place to go, only the County. Po- lice have failed. They won't touch you without a statement from family doc- - CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 tor. | know one woman who died. But making it possible to extrapolate these data for again I think it’s political. the clinic population as & whole. The card of approximately every 15th patient in the active files (about 15,000 in total) was selected and information recovered from this card. These ecards are filed by unit (chart) number and as- signment of number is completely random. , . , . Fach new patient, presenting to the hospital or Tn comparin® patients interviewed at Fantus the health center sor care, is assigned the next ith a group interviewed at another hospital number from the pool. see section on University of Chicago clinics) 1 interesting difference emerged. The stu- ants report commented on this difference, as yliows: Thus we have considerable difference between Fantus and Billings popula- medical care. | tions, the majority of the former com- The information the project students recov- ing because they ‘have to”, the latter ered relative to geographic origin is presented seeking out a source of care thought in table II. (This table will be referred to to be superior. * * # again since it algo includes the same informa- While it is not valid to make a scientific com- tion for Fantus Clinic and the University of parison between the groups interviewed, the Chicago Clinics.) slinical impression the students gained, as de- The out-patient services of Presbyterian-St. scribed in the quotation, appears to have merit. Luke’s Hospital are utilized by patients living in 64 of the 75 community areas in Chicago. Presbyterian-St. Luke's Hospital However, slightly more than 50 percent of all i. ; patients come from four community areas. One This is the third largest general hospital in of these four areas is the one in which the hos- Chicago with about 850 beds. It has a long tra- pital itself is located and the other three are dition of providing ambulatory. and in-patient close to the hospital, just west and southwest services to populations of limited means, aS of it. well as all other means and groups. Its out-pa- " tient clinics (referred to as the health center) served approximately 99,000 patient visits last year. When visits to its recently opened neigh- No * * * never get me to com- plain, they’ve treated me nice. Can’t be no better. But you do wait, it’s so crowded. I don’t mind waiting 5 it’s a good hospital. The information retrieved from the 1,000 cards selected included the geographic resid- ence of the patient, the age, sex, race, clinic of initial admission, and source of payment for The next largest number of patients from 4 single community area come from a community on the south side of the city. As can be seen in borhood health center are added (approxi- table II, the patients gerved at this hospital mately 35,000 this past year), it becomes the and at Fantus Clinic tend to come from the largest purveyor of ambulatory services among same community areas. These areas are consid- the private hospitals in Chicago. ered to be deep poverty communities and their The students at this site worked solely in the populations are predominantly black. health center physically located at the hospi- The distribution of variables for Presbyte- tal. They were not involved with its neighbor- rian-St. Luke’s Hospital clinic population is de- hood health center located in a community ad- _ scribed in table III. Almost half the active pa- jacent to the hospital. These students under- _ tients are under age 18. Almost 75 percent of took a survey of the out-patient clinic popula- — them are nonwhite and two-thirds of them are tion and they interviewed some patients at the female. Greatest utilization is in the pediatrics end of this survey. and OB-GYN clinics, although the medicine _- The survey of the health center population clinics were the clinic of admission for almost _ was based on a sequential sampling technique 20 percent of the population. : 101 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 Almost half of the population (42.8 percent) had their health services paid for by public funds, i.e., categorical assistance, Medicare or MA-NG. Fifty-four percent paid for their own care based on a low proportion of the actual costs since their financial resources were lim- ited, Approximately 0.5 percent paid for their own care in full. The remainder had other sources for payment of their medical care. In summary, patients cared for in the health center of this hospital are for the most part poor, in great proportion black, and while they come from all over the city, the majority come from areas very close to the hospital. After completing the survey of patients’ cards, the students proceeded to interview pa- tients, selected at random, with a questionnaire similar to that used in Cook County. Forty-one patients were interviewed by the two high schoo! students working at the site. Twenty- one of these were male, 19 of them were fe- male, and for one, sex was not recorded. While the utilization of the clinics is higher among females, the fact that more males were inter- viewed probably reflects the fact that the stu- dents were both young males, and possibly more comfortable in ‘discussion with other males. This may also partially account for the fact that 37 of the people interviewed were black, as were the students. The other four were white and two of them were Spanish- speaking. Nine of the respondents were porn in Illinois and 23 were born in southern States. One pa- tient was born in Cuba, a second in Puerto Rico, and the other seven were born in differ- ent states. Eighteen of the patients had been receiving care at this clinic for less than 6 months while nine had been coming here for more than 8 years. The remaining patients had been coming for periods petween these times. Forty-four percent of them said they came to this institution because it had good doctors and 19 percent came because a friend had recom- mended it. Thirty used no other source of medical care presently, while two used the neighborhood health center of the hospital. The remaining 102 nine patients used other hospitals occasionally. Twenty-one said they had not used any other source of care in the past and 21 stated they knew of no other sources of care. (A number of these patients lived nearby other major hos- pitals in the city.) Nine patients indicated they preferred to use this particular hospital. The responses dealing with their attitudes toward, and perception of, their own and gen- eral health care obviously are biased. When they are seated in the institution from which they seek care and when they are approached by people they consider to represent that insti- tution, their answers may well be guarded or may represent what they believe the institu- tion wishes to hear. In that context, the follow- ing are the responses dealing with attitudinal and perception questions. Thirty-seven of the respondents thought the care they received at this hospital was good and two said it was generally good. The other two did not respond to the question. A similar re- sponse was elicited to the question pertaining to their attitudes about the quality of the physi- cians. Thirty-five thought the physicians were good, two said generally good, and four did not respond. They were asked whether they thought phy- sicians were really interested in taking care of the poor and of Negroes. There ‘was positive response to these two questions with 31 re- sponding that they thought doctors were really interested in caring for Negroes. Only two thought they were not interested in care for the poor with seven holding no opinion, and one not responding. None of the respondents said physicians were not interested in caring for Negroes but seven held no opinion and one did not respond. They were then asked if they thought this particular hospital was interested in caring for the poor and the positive responses dropped to 24, with 14 holding no opinion and three not responding. To the question did this hospital take interest in caring for Negroes, 26 re-_ sponded affirmatively, one said he thought it did not, 10 held no opinion and four did not re- spond. initia inbategicn Pt ter stsemrzetes oe tre CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 The positive responses dropped even more yhen they were asked if they thought private lospitals in general were really interested tak- ng care of the poor or of Negroes. To the ormer 16 said yes, seven said no, 12 had no pinion and six did not respond. Seventeen said hey thought private hospitals were interested n caring for Negroes, five said they thought jot, 16 held no opinion and three did not an- ywer the question. When asked if they would have a preference f the choice were offered them of care in their reighborhood or at this institution, 88 said hey would prefer Presbyterian-St. Luke’s Hospital. When the question was refined to ask if they had a choice of free care in their neigh- vorhood or care at this hospital, 32 still re- sponded that they would prefer Presbyterian- St. Luke’s Hospital. These patients were also asked if they had any suggestions for improving care or service in the health center. Eleven patients indicated that cutting down waiting time would be an improvement. (More than half said they had to wait between 1 and 3 hours for care.) Twenty- two said they could “think of no way” to im- prove the services. They were finally asked whether there were any improvements in health care they would like to see in their neighborhoods. Seventeen responded they would like to see more physicians in them; 22 had no suggestions for improvements. The sample of 1,000 patients, initiated. by the students, is being explored in greater depth for diagnoses and other information, that will enable the planners in the institution to deter- mine more effective and efficient methods of de- livering health care to selected populations. University of Chicago Hospitals and Clinics This facility is located on the south side of Chicago and the clinics are part of the fourth largest hospital complex in the city (661 beds). It is located directly adjacent to one of the most densely populated Negro communities in the city. Students working there conducted a survey of utilization of the out-patient clinics and of the Billings Hospital emergency room. They also conducted interviews with randomly se- lected patients using the same questionnaire as that used at Cook County Hospital. , The period of time for which the review of records was undertaken was not described in the students’. report. They reviewed the records of 346 patients who received care in the fol- lowing clinics: Medicine, OB-GYN, pediatrics, eye, E.N.T., plastic surgery, urology, or- thopedic surgery, psychiatry, general surgery, and neurosurgery. They collected information about the geographic residence of these pa- tients, their age, sex, race, and source of pay- ment for medical care. Table II presents the data for geographic residence. The largest single group of patients (22.5 percent) surveyed came from outside the city of Chicago. The remainder were from 55 com- munity areas of Chicago’s 75, and five of these community areas accounted for 30 percent of the total number of patients reviewed. These five areas are all on the south side of the city, directly adjacent to, or relatively near the hos- pital. Two of them are considered poverty areas and three are nonpoverty areas. The distribution of variables for all the pa- tients are presented in table IV. Unlike the two other hospitals described so far, 71 percent of the patients pay for their own care. Only 15 percent are paid for by public funds, including Medicare. The distribution of variables by clinic is pre- sented in table V. The largest number of pa- tients use the medicine clinics, with OB-GYN being the second most utilized clinic. The dis- tribution by race varies from the patients at- tending the medicine clinics, the majority of whom are white as compared to the OB-GYN and pediatrics clinics where the majority are Negro. Patients utilizing all other clinics are- also predominantly white. The out of city pa- tients probably account for this since the five community areas with the greatest utilization for Chicago patients are either all black or have | large Negro populations. After completion of their survey the stu- dents conducted interviews with patients, se- 108 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 lected at random, from among those seated in the waiting rooms of the medicine, surgery, OB-GYN, and pediatrics clinics. The inter- viewers approached the patients, without in- troduction by clinic staff personnel, and de- scribed themselves as working for the Student Health Organization and the Hospital Plan- ning Council (collection of data in the Univer- sity of Chicago clinics was supervised by the research director of that agency). They de- seribed these two organizations as being inter- ested in knowing how patients felt about dif- ferent hospitals in Chicago. They especially at- tempted to assure the patients that they did not represent a particular hospital, newspaper, school, or doctors’ group. There were 66 patients interviewed. Twen- ty-five of these were members of families with incomes below $5,000 per annum, 831 had in- comes between $5,000 and $10,000 and 10 had incomes above $10,000. There were 44 Negro patients and 21 white patients. About 10 percent of the patients were sup- ported by public assistance sources. However, in all the interviews about 90 percent had never heard of the MA-NG program or Medic- aid, per se. The few who had heard about it knew no more than its name. Fifty-five percent of the patients used no other health resources pesides the University of Chicago Clinics for themselves or their fam- ilies. More than 50 percent of the patients -gstated that they attended Billings because it had been recommended to them or because it had “good doctors.” Waiting time in the clinics varied between clinics. The longest waits were in the medicine - and surgery clinics while there were only short delays in seeing. patients in pediatrics and obstetrics clinics. Those who generally waited longer than 1 hour were the ones who stated that a way to improve the service was to cut down the waiting time or add more staff. How- ever, a number of people did not appear to object to the waiting periods. “Their loyalty to the institution appeared to be on a high level; approximately 40 per- cent indicated they would depend on the insti- 104 tution for emergency care or for other medical reasons regardless of its distance from their homes or other factors. The attitudes of the patients were probed relative to their perceptions of the hospital’s in- terest in caring for poor people, and Negro people. About 20 percent of the patients thought that physicians were not really inter- ested in taking care of the poor and 20 per cent thought that physicians in their neighborhoods were not interested in caring for people living in their neighborhood. About 40 percent thought that private hospitals were not inter- ested in taking care of the poor or in Negroes. When the question was refined as to whether this particular hospital at the University of Chicago was interested in taking care of the poor, all but six responded they thought it was so interested and only two felt that the hospi- tal was not interested in taking care of Ne- groes. The students selected several comments on these latter subjects from the people who were interviewed that are worth repeating there as they project an interesting variety of attitudes. * * * T ean afford medical care and if it’s free it should serve the people who can’t afford to pay for it. Too much attention paid to poor blacks now. They (the poor) don’t know the difference. Too many (Ne- groes) but they have to live, too, I guess. * * * They (the welfare patients) shouldn’t be here if they cannot pay. Public aid should set up a place es- pecially for those people. It’s unfair to let those welfare people come here, I don’t think transportation is too bad and there are all the health stations. The fees are too high. The govern- ment shouldn’t regulate prices but everybody should be able to get good care and the government should pay for schooling of more doctors. As the survey indicated, not only are there major differences petween the patients who utilize the University of Chicago hospitals and CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 the other two described, in terms of income, race, etc., there are also differences in attitudes of patients toward key social and health ques- tions. Woodlawn Hospital This is a small hospital (145 beds) located in the heart of a Negro community on the south side of Chicago. There are no out-patient clinic services and the work performed by the as- signed students included a survey of in-patient and emergency room utilization. The data for in-patient utilization, by com- munity of residence, is described in table VI. The data are for 1 year’s experience. Three community areas account for 37.7 percent of the patients admitted in this 1 year. These are the communities in which the hospital itself is located, the one directly north and the one di- rectly south of its physical plant. One of these (Woodlawn) is a poverty area, the other two are not. Five other community areas account for 18.5 percent of the annual admissions. Three of these are further south of the hospital and two of them are north of it. None is far away geo- graphically. Four of these are poverty areas and one is not. Another 17 percent of the patients come from nine community areas. There were 50 or more patients from each who were admitted that year. Four of these were poverty areas and five were not. Patients from outside the city accounted for an additional 8 percent of the patients. There has been a change in the geographic distribution of admissions from 1965. Medical- surgical services admissions to Woodlawn Hos- pital in February 1968 compared with that in February 1965 revealed that admissions from the Woodlawn area (where the hospital is lo- cated) increased by 70.7 percent from 1965— 8.2 percent in that year and 14.0 percent in 1968 admitted from the area. The change for the rest of the southeast section which Wood- lawn serves was not as dramatic. In this case, 29 percent of the patients admitted in Febru- ary 1965 were from that area and in 1968 37.5 percent were from that area, an increase of 29 percent. . The students reported that they felt the major reason for this change resulted from changes in payment policies of the welfare de- partment, They said: Until 2 years ago the attending physi- cian was not paid for his services to welfare in-patients although the hos- pital did receive payment for hospital costs. With the change in payment policy that occured in 1966, the hospi- tal staff physicians began to refer welfare recipients to the hospital. * * * They felt other factors were: An increase in the resistance of Cook County Hospital toward admitting patients transferred from other hos- pitals and an increased reluctance of the emergency room physicians to transfer border line cases has re- sulted in a rise of admissions to Woodlawn Hospital] from its emer- gency room. * * * The final point they make as to reasons for the change, is: An administrator with a greater awareness of a need for a responsible attitude toward the community, as- sisted by a hospital staff with a changing outlook, may also have con- tributed substantially to bring about the increase in admissions from the community surrounding the hospital. The study of emergency room patients con- sisted of observations of the functions of the emergency room and telephone interviews of 30 patients who had been treated there. The reac- tion of the students was that there were two major problems in emergency room function. First, a large percentage of the emergency room visits were not genuine emergencies and secondly the inability of many of the patients coming to the emergency room to pay for their medical care resulted in problems for the pa- tients. 105 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 The first observation is, of course, one that many emergency rooms in urban centers are concerned about, i.e., their utilization as a phy- sician to the nearby community(ies), instead of their utilization as true emergency centers. In their second observation, the students noted that the great majority of emergency room patients were either on public assistance or were unable to pay for their care. In the lat- ter case, if a patient was not on categorical as- sistance or Medicare, a financial deposit was required prior to admission unless he was ex- tremely ill and absolutely could not be trans- ported. In less extreme cases, patients’ without a source of payment, were generally trans- ferred to Cook Country Hospital if the trans- fer was accepted (as it usually is). Here again, this situation is repeated many times in hospi- tals around the city, and doubtless in other cit- ies around the country. The students conducted telephone interviews with 80 patients. Twenty-two of the 30 questioned chose to come to Woodlawn because it was closest to their homes. Twenty-five thought it was a good hospital. Nineteen patients stated that they had private doctors, while 11 did not. Eleven of the 19 said that they went to their private physicians regularly. They were also asked for their opinions as to the best place for health care and 12 thought Woodlawn Hospital was, five thought Cook ' County was and only seven thought a private physician was the best source of health care. Four of the remaining six had no opinion on the subject. Thirteen of the patients reported they paid for their medical care themselves and three had insurance coverage for such costs. The remain- ing 14 were eligible for public funds including Medicare. Apparently, loyalty to the health purveyor of choice, even when the choice is made pri- marily by geographic location, remains high. This appears to be true for this small hospital as well as for the major ones referred to pre- viously. 106 Michael Reese Hospital This hospital is the largest private hospital (938 beds) and second largest hospital in Chi- cago. Its out-patient clinics serve approxi- mately 115,000 patient visits per year. The hospital is located on the edge of a black and poor community. Indeed, at one time the hospital itself was part of such a community. However, urban renewal changed the character of the neighborhood immediately surrounding the hospital. Now much of the land is used by educational and medical institutions, including Reese’s expanded facilities, and the remainder of the immediate community consists of high rise apartment buildings for middle and upper middle income population. Students at this site reviewed data on clinic utilization by community area. They also worked in the pediatric out-patient clinic where a new mode of delivery of health care had been instituted in the immediate past. (New, in the sense that it was a change from their previous mode of delivery.) In addition they surveyed charts in the emergency room, again reviewing for utilization data by areas of residence. The students undertook a review of 500 charts of patients seen in the outpatient clinics (excluding pediatrics) in June of 1968. Unfor- tunately, they did not conduct a citywide tabu- lation of the clinic’s population. Instead, they collected the information pertinent to the num- bers from four community areas close to the hospital. Their figures indicated that 205 (41 percent) of the 500 charts represented people living in those four areas. A separate survey of 217 charts in the pediatrics clinics showed that 91 (42 percent) of these patients came from the same four areas. In 485 emergency room records, 274 (56.5 percent) patients were from the four areas. It is apparent that an impor- tant segment of the population served by the ambulatory facilities of this hospital reside in the four community areas adjacent to the site of the hospital. One of them is the one in " which the hospital itself is peripherally }o- cated; the other three are just southeast. and southwest of it. CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 The students also reviewed in-patient admis- sions for the community areas from which they came. They reported that of 1,791 dis- charged patients, only 10.2 percent came from the four community areas discussed. The students who worked in the pediatrics clinics described changes made by the hospital administration which emphasize the delivery of preventive care as well as continuing to de- liver crisis or symptom-oriented care. The new organization of the pediatrics clin- ies was described as based on an appointment system. Patients were screened and referred to the appropriate source of care. They were then assigned a specific physician whom they are supposed to see each time they come. Blocks of time in the appointment system are left un- scheduled so that physicians may also see walk-ins, A telephone service (TOT line) is now available to parents. The parent may call in at any time of day or night. A nurse moni- tors this telephone and acts as a screening officer. She determines the nature and serious- ness of the problem, acts in a reassuring fash- ion, if indicated, and makes a judgment as to the disposition of the problem. Another innovation for this unit is a termi- nal collection of fees system. Previously, pa- tients paid for each service at the point where or when the service was rendered. If more than one service was rendered the patient paid more than one time. The current system per- mits the patient to pay once at the termination of all his clinic services. The physical environment has been made more attractive and comfortable; more equip- ment is available; and additional nonprofes- sional staff “have been employed to expedite processing of patients.. While this learning experience seemed to be a positive one for the students nonetheless they were critical of problems that still remained to be solved. Several quotations from their re- ports would be in order: * * * One of the greatest diffi- culties that this program began with and is constantly hampered by is the background of a staff which is accus- tomed. to working within a frame- work of administration-centered med- ical care when the new orientation and structure of the clinic is patient- centered* * * however, the persist- ance of the old attitudes in the staff prevents there being any significant change in the attitudes of the patients being served * * * there hasn’t been a tremendous change in the parts of the system which the patients find ir- ritating, e.g., waiting time, hurried care by doctors, treatment by the staff, bewilderment and lack of communication * * *. Much of the discontent remains because the new system is a new stone in the same old setting. Patients must still wait for lab reports, X-ray results, shots, pharmacy services * a However, the strengths of the new approaches are also described: “There are at least three great virtues * * *. First, the clinic is ca- pable of and is providing better and more dignified care to more people be- cause of increased manpower, longer hours, and the physical changes ‘* *, Second, the clinic provides an ex- perimental milieu in which not only new methods of providing care can be studied, but also the fairly new concept of studying methods in phy- sician education * * * finally, this clinic, and in particular, the new com- prehensive care clinic provides an excellent model * * * of some of the new concepts in private or rather gen- eral practice * * *. All of the students at this site were compli- mentary to the staff and administration of this institution as being a progressive, enlightened group who were seriously concerned with de- livery of health care to poor populations. Provident Hospital . This is a hospital with a predominantly 107 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 Negro staff and almost all Negro patients. It is located in the heart of one of Chicago’s largest Negro ghettoes. It is a small hospital with 204 beds which has been struggling for many years to maintain itself. It has had to close its out- patient facilities for lack of funding as well as having been forced to close its nursing school and internship and residency programs. De- spite many obstacles and lack of support it continues to provide care for a substantial seg- ment of the black population. The students at this site were involved in service roles as well as observation and data collection. The health science student worked in the blood bank facilities and occasionally assisted the technicians when they had heavy work loads. The high school students partici- pated in a number of unskilled jobs in the hos- pital. The students also worked in an educational program in the community disseminating in- formation about lead poisoning. The residents of this particular community are involved in a campaign for passage of an amendment to the city housing code that will provide some safe- guards against lead poisoning. However, no major involvement on the part of the hospital for a lead toxicity detection program was feasi- ble. The suggestions for closer relationship of the hospital with its surrounding community are quoted from the student’s report: I know only to give it enough money to expand its facilities, reopen its clinics, reestablish its nursing school, attract residents and interns and then younger doctors * * * put residents of the community on its board and on. its policy determining committees * * * EMERGENCY ROOMS "Mercy and Billings Hospitals While students actively participated in inter- views with patients using emergency rooms in six of the hospitals, specific data about some of the parameters of the populations. was recov- ered for only two of them. These were the 108 emergency rooms of Mercy and Billings Hospi- tals. Billings has been described previously in the section on the University of Chicago Hospi- tals. Mercy is a church-related (Roman Catho- lic) institution of 355 beds. It has out-patient clinics as well but no students were placed there. It is located on the near south side of Chicago in what was a poor Negro community. Urban renewal has changed some of the char- acteristics of the community but the hospital is still most closely adjacent to all black, generally poor communities. At Mercy Hospital, during one week in Au- gust, 1968, every third patient who used their emergency room was tabulated for community area of residence, age, sex, race, source of re- ferral, time of arrival, diagnosis, disposition, and source of payment for care. Similar data were gathered for the Billings emergency room using one week in April, 1968 as the base. Data for area of residence of patients using both facilities are described in table VII. Data relative to variables appear in table VIII. The largest numbers of patients from any one community area using Mercy were from the community of Bridgeport. This part of the city is composed of people of different ethnic backgrounds but is all white. It is primarily a working and middle class community and is lo- cated slightly south and west of the hospital. A large proportion of its residents are communi- cants in the Roman Catholic Church. (It is also the home of the mayor of the city of Chi- cago). The next largest number came from the all black communities of Grand Boulevard (CA 38) and Douglas (CA 35) both of them to the south of the hospital. Unlike the population utilizing the Univer- sity of Chicago clinics, the largest number of patients coming to Billings emergency room were from Woodlawn (25.5 percent), the area directly south of the hospital (across the Mid- way). The second largest group came from Hyde Park just north of the hospital. It would appear that in the utilization of these emer- gency rooms, geography is still a major factor. That many patients use the geographically convenient emergency rooms as doctors’ offices CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 is supported by the data relative to diagnoses of patients, disposition of cases, and time of ar- rival at the facility. (See table VIIL.) In both hospitals’ emergency rooms, the majority of patients were treated for general medical prob- lems and sent home. The next largest group was referred for care to the hospitals’ out-patient clinics and the third largest group were re- ferred to other hospitals or doctors. In both hospitals, fewer than 10 percent of the patients geen were admitted to the hospital for care. Time of arrival at the emergency room indi- cates that their experience is the same as that in many urban emergency rooms. The peak load is after 5 p.m. and prior to midnight. This would seem to support the contention that pa- tients tend to come to such facilities when transport is more readily available at the end of a work day or when some source of care is more readily available for children left at home. ‘ The source of payment for medical care was , not available for the Billings patients. It would have been interesting to note whether the source in Billings emergency rooms, with its substantial numbers of patients from Wood- lawn, was different from the source of payment for patients who use the University of Chicago clinics for ambulatory care. The majority of the patients seen at Mercy (59 percent) were insured and the second larg- est group paid for their own care. Only 19 per- cent were supported by public funds. St. Bernard’s Hospital This hospital is a 229 bed Roman Catholic Church related institution located on the south side of Chicago further south than the others reported on so far and slightly west of them. Students working in their emergency room described themselves as “participant observ- ers.’ The major objective as they defined it was to observe and gain impressions of what happened in the emergency room. A second ob- jective was to interview patients to. determine the patients’ impressions of what happened in an emergency room. They elected not to use a structured ques- tionnaire for the latter task since they felt there were too many forms a patient had to fill - out in the course of hospital routine without _ adding another. Some patients were inter- viewed in the emergency room area but others were interviewed by telephone or at their homes. This latter technique was selected to determine reactions after the stress situations that brought the patient to the hospital had been removed or ameliorated. When the stu- dents conducted interviews in the hospital area they sometimes wore white uniforms and per- mitted the patients to view them as hospital staff. However, in some cases they simply de- scribed themselves as Student Health Organi- zation students with no vested interest in the hospital. Their feeling was that their image in the patient’s view did little or nothing to change the nature of the responses. The patients interviewed in the hospital were quietly accepting of the interview and coopera- tive. One of the employees pointed out subse- quently that the patients were very humble and fearful while in the hospital setting. How- ever, once the site of the interview was the home of the patient, the students met with great suspicion and distrust and had much dif- ficulty in locating and interviewing the pa- tients. The students at this site also acted as “pa- tient advocates.” This was defined as assisting the patients in any way they could. They helped patients find their way to the services needed; they intervened with an administrator on behalf of a patient who felt he should be re- funded a fee since no service was rendered him; and they helped a patient to another source of care when he was referred to it. Having learned some things themselves about how to move through the maze of a hospital system, they were able to ease the paths of patients without similar knowledge. There was one other emergency room in a hospital in Chicago which was not originally selected as a site. However, a student was there on the night shift to informally observe their emergency room procedures. This was a hospi- 109 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 tal which contracted with a corporation to em- ploy physicians to staff the emergency room. While some of these agencies provide good emergency room staffing, it was the observa- tion of this individual student that this parti- cular one did not. The student felt that with the difficulty of obtaining qualified physicians, most of those working a night shift did so as a second posi- tion. Therefore, in his opinion, they are fre- quently very tired and there is an underlying hostility to patients, especially those whom they feel are not genuine emergencies. He thought that there was no ongoing relationship between such a physician and his patient and that this affected the type of care rendered the patient. In the observer’s view: “The staff never attempts to deal with problems considered outside its province. It is only interested in reaching decisions about the follow- ing * * * (1) Discovering the chief complaint of the patient; (2) render- ing symptomatic relief as well as first aid and supportive care in true emer- gencies; this facility renders ‘“ad- vanced first aid,” (3) determining whether it is absolutely necessary to admit indigent patients. Most indi- gents are sent to Cook County * * *. In general, indigents receive an ab- solutely minimal amount of care.” The student indicated that this hospital’s pa- tient area is in excellent physical condition and on very busy nights the area is often filled with patients. The atmosphere, at night, he found to be generally friendly. There appeared to be a rigidly structured relationship pattern with little or no overlap of function, between the different strata of personnel, i.e., physi- cian, nurse, technician. One of the reasons for this the student thought was that the physi- cians were under the supervision of the outside contracting agency, while the hospital adminis- trator supervises the other personnel. He felt there was evidence that the adminis- trator is interested in improving efficiency of 110° the area and that the hospital is much con- cerned with its public image. Student Reaction At the end of the summer’s ‘work each stu- dent wrote a report on his activities during the project. There was a uniformity of reaction among the students at all the hospital sites. In each case the students reported that they had had an important learning experience per- sonally; in almost all cases the students ques- tioned whether they had contributed anything to their site or to the project as a whole. Even- those who felt they had made some contribu- tion considered it to be a negligible one. An ob- jective review of all the report, indicates how- ever, that their microcosmic, subjective view is not wholly accurate. It is understandable, but not accurate. As has been.stated elsewhere, this was a 10- week project. In almost all of the hospital sites, a period of from 1 to 8 weeks was de- voted to orientation of the students. The last week was a windup week. This left 6 or 7 weeks for the students to actually become in- volved in the work at their site. Some of the students recognized that this time dimension limited their effectiveness but others appeared to have had higher goals than might have been realistic. Uniformly the students were critical of the modes of delivery of health care that they ob- served in. the institutions in which they worked. (All of their experiences were limited to ambulatory service areas.) Their comments ranged from friendly, respectful observations to hostile declarations. Some selected quotations from a few reports might highlight the range of critical comment: * * * We choose not to evaluate such a * * * center on the basis and in terms of its own inherent inade- quacies however, for we have not the medical, institutional, or practical re- sources to justify such a discourse, nor can we underestimate the professional competence and vigor with which these inadequacies are now being at- CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 tacked. We choose rather to air a more general commentary that re- lates these inadequacies to the more general problems which confront med- icine today and to those more per- vasive ones deeply rooted in the whole fabric of our society * * * * * * We spent sometime trying to determine what forces constrain the emergency room to be inadequate. This attempt has been generally un- successful * * * In retrospect, we ally the case * * * The underlying at- titude of the night staff toward the patients is one of hostility * * *. The staff is especially hostile toward pa- tients who enter the facility without true emergency needs * x #7 One other comment: * * * The doctor’s divorce from the community is mirrored by the com- munity’s reaction to it. The mothers I talked to are adamantly opposed to taking their children there xe FF, have devoted our time to the most im- portant of the answerable questions, but it is the unanswerable questions One statement, more general in nature, is a creditable summation of the views of the stu- dents: which are most interesting * * * we have had complete cooperation from the hospital, and are on a friendly basis with the administration and emergency room personel. * * * * * * We became aware of some of the advantages and disadvantages of the small inner-city hospital. Among the advantages were a greater feeling of “belonging” experienced by hospital employees and patients, and an administration shielded by a mini- mal bureaucracy. Among the disad- vantages were that many of the ser- vices were inefficient* * * * as they involved. expensive equipment infre- quently used, and the difficulty in at- tracting young physicians with larger institutions nearby * * *. There were several unfriendly comments. Some of these were as follows: * * * Tf patients receive good med- ical care it isn’t so much due to the dedicated staff * * * but to the in- tervention of the administrator * * * Health care planning seems to have rarely . taken account of the felt needs of the patients who are to be served. When the patient popula- tion is generally white middle class there are fewer “problems” —the health planners themselves being of this milieu, have the same expecta-. tions and concepts of health care, health and disease. When the patient population is, for example, Appa- lachian white, Mexican, Puerto Rican, poor urban black, middle class black, ete. it is entirely possible that the white middle class standards and ex- pectations of health care, concepts of disease, the role of the doctor etc.— all that which is built into the typical urban hospital or neighborhood health center—do not conform to those standards, expectations, etc. of the patient population. The result is very possibly a relative failure of the program.” Summary : “ Students working in hospital sites acted as ~- one individual. It is a right, not some- observers in emergency rooms and out-patient thing ; administered condescendingly clinics to learn how health care is purveyed to se" primarily poor, black populations. At a number * * * * The patients may wait up of sites, they collected data relative to patient to 3 hours on a busy night, especially utilization of clinics and emergency rooms for if the physician is tired, which is usu- area of geographic origin, race, sex, and other We object to the fact that medical care should depend on the humaneness of 111 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 variables. They acted as patient advocates in that they had successfully completed their as- some cases and participated in service roles in _ signed tasks in most instances. They had made others. Uniformly, they were critical of modes a contribution to several institutions in the of delivery of health care services to the popu- work they undertook. In all cases, they felt lation observed. They felt that there was little that their summer’s experience in the Student or no impact resulting from their presence in Health Project had been a profound learning the summer project. one for them and that its impact upon them Actually, when they detailed their experi- would have important implications for their ences in their respective projects, it appeared future career goals. Table I.—Outpatients attending Fantus Clinic, Cook County Hospital, by community of residence, July 24, 1968 Sex Age Race Community Male Female Under15 15 to 44 45to64 66 and over White Negro Other 1A Rogers Park A -------------- 1B Rogers Park B ------------- 2 West Ridge ----------------- 8A Uptown A ------------------ 8B Uptown B ------------------ 4 Lineoln Square ------------- ----77 5 North Center --------------- 6A Lake View A -------------- . 6B Lake View B ---------------- 7A Lincoln Park A -------- ---- 7B Lincoln Park B ------------- 8A Near North A --------------- 8B Near North B -------.------- 9 Edison Park ---------------- 10 Norwood Park --------------- 11 Jefferson Park .-------------- ---77- 12 Forest Glen -.--------------- 18 North Park ----------------- 14 Albany Park .--------------- 15 Portage Park --------------- 16 Irving Park -.---------------- 17. Dunning -------------------- 18 Montclare ------------ Lean nee 19 Belmont Cragin -------------- woeee- 20 Hermosa -------------------- 91 Avondale ------------------- 92 Logan Square ---------------- 28 Humboldt Park -------------- 94 West Town ----------------- 95 Austin .--------------------- 26 W. Garfield Park 27 +E. Garfield Park ------------- 98 Near West Side -------------- 29 North Lawndale .------------- 80 South Lawndale -------:------- 31 Lower West Side 82 Loop. .------------------7-777 112 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 Sex Age Race Community Male Female Under15 16 to 44 46 to 64 65 andover White Negro Other 33 Near South Side ------------- 2 3 2 1 _..--- 2 _---- 5B uH---- 34 Armour Square -.------------ 2 1 1 Q eee eee ee ree 8 ----- 35A Douglas A .----------------~ 1 1 4 i----- Yo -eeeee were ee Q _.-+-- 35B Douglas B .------------------ 15 19 8 16 7 3 2 31 1 86. Oakland _.------------------- 12 8 3 8 7 2 1 19 ------ 37 Puller Park ----------------- 3 q 2 5 QB late eee eee 10 _----- 98 Grand Blvd. .:---------------- 55 51 22 44 25 15 8 101 2 389A Kenwood A ------------------ 1 1 1 1 eee ee eee 1 1 _.---- 39B Kenwood B ------------------ 6 6 3 7 1 1 2 10 .----- 40 Washington Park ------------ 24 81 8 26 13 8 1 53 _----- ALA Hyde Park A --------------- 1 1 __---- 1 _----- 41 ------ Q .---- 41B Hyde Park B ---------------- 1 5B .---- 4 1 1 _.---- 6 _----- 42 Woodlawn .------------------ 24 20 11 18 12 8 ...--- 44 .----- 48A South Shore A -------------- 2 5 ------ 3 3 4 _----- 6 1 43B South Shore B --------------- 3 " 3 4 2 1 1 9 _.---- 44 Chatham ._-.---------------- 8 8 4 5 3 4 2 14 _.---- 45 Avalon Park -..------------- 2 1 1 Q@ 2-2 ewer eee 8 _----- 46 South Chicago -.-.----------- 5 5 1 6 1 2 2 7 1 47 Burnside _.------------------ Yo eee ee eee eee wee 1 eee. wee 1 .----- 48 Calumet Heights ------------- ------ 1 _Loue. 1 eee eee 1 .----- -+---- 49 Roseland _.-.---------------- 4 3 3 2 2 6 _----- 50 Pullman __------------------ --rro eee weer rete FL South Deering .....-vcce---- ceeeee ceeees ceceee cesses vases women gn Eo West Side .......:-seeeecee-- weeeee corse costes veneers creer cose guy TT Bd West Pullman .....------- ceeeee corte wereez cree wre Tg 54 Riverdale _..---------------- 8 6 4 7 2 1 1 18 _----- 55 Hegewisch -_----------------- do eeeee ewe ee eee | re 1 _----- 5G Garfield Ridge --------------- ------ Q ___--- Q .- eee ween rete Q _..--- 7 Archer Heights ....---------- eeeee cores cesses cores vg 58 Brighton Park --------------- ------ Q@ 1. ------ Q _._--- 1 1 _----- BO McKinley Park .....000------ --eeee cereee crests cree emg 60 Bridgeport --.--------------- 3 2 1 Q __.--- 2 4 41 .----- 6i. New City 2-..--.------------ 1 5 1 4 .---- 1 1 B _.---- 62. West Elsdon _--------------- Yoon eee were 1 .----- 1 .eeeee eee ee 63 Gage Park _..----------ene weeeee ceeeee cress cee fA Clearing o-oo eceeeeeeeeevee weeeee, cece ceeets cree cesses 65. West Lawn _.--------------- ------ : 1. we eee 1 .----- --+--- 66 Chicago Lawn -.------------- ----7- 2 1 _----- 1 ---ee- 1 1 .----- 67 West Englewood ------------- 15 11 8 14 4 .---- 4 92 ..--.- 68 Englewood .----------------- 26 47 11 42 15 5 6 66 1 69 Grand Crossing -------------- 17 18 7 12 5 6 2 27 i 70. Ashburn ...----2.------------ ------ Yo weeeee eee eee Lu ---- Lo ceeeee weer 71 Auburn Gresham ------------ 7 1 8 3 2 1 2 12 ..---- 92 Beverly ..------------------- Q oe eee ee ree 2 Q ee eeeeee 73 Washington Heights - -- ------- 2 3 2 8 _.---- 1 , Td Mount Greenwood 0-2-0 ceeeee cress cores crete Tg 75 Morgan Park ---------------- 3 6 2 3 3 1 .----- 9 __---- Total ._.------------------ 536 514 241 462 220 126 159 864 27 ‘Potal percentage ----------- ------ 777777 28 44 21 12 15.1 82.3 2.6 1138 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 TABLE I1.—Community area of residence, outpatients attending Fantus, University of Chicago and Presbyterian-St. Luke’s H: ospital Clinics 1 3 4 g a e 8 a a « B aad £ Eu 5, as Hs , tf Ha B58 ge a 2 $6 @88 3 Community area (number and name) & ps niare & Community area (number and name) Bi By Eas B 1 Rogers Park -.------ 2 2 1 5 40 Washington Park ... 55 13 14 82 2 West ridge -...------ 1 3 0 4 41 Hyde Park -.-.----- 8 29 1 38 3 Uptown --.-.------- 9 1 1 li 42 Woodlawn -.--------- 44 27 18 89 4 Lincoln Square --.-- 0 1 6 q 43 South Shore -------- 17 23 4 44 5 North Center _.----- 2 0 0 2 44 Chatham ----------- 8 14 19 41 6 Lake View ---.-.---- 8 3° 2 13 45 Avalon Park -------- 3 2 1 6 7 Lincoln Park -------- 4 0 6 10 46 South Chicago ------ 10 6 1 17 8 Near North _..----- 29 1 21 51 47 Burnside ----------- 1 0 1 2 9 Edison Park .------- 1 0 0 1 48 Calumet Heights -.--- 1 7 5 13 10. Norwood Park ------ 1 0 0 1 49 Roseland _---------- 8 9 7 24 11 Jefferson Park ------ 0 0 1 1 50 Pullman ..---------- 0 0 2 2 12 Forest Glen -------- 1 0 0 1 51 South Deering ------ 0 4 0 4 18 North Park -...---- 0 0 1 1 52 Bast Side ---------- 0 1 1 2 14 Albany Park -------- 2 2 3 q 538 West Pullman ------ 0 4 2 6 15 Portage Park ------ 8 2 2 7 54 Riverdale ...--..---- 14 1 “2 17 16 Irving Park -.-.--.-- 2 1 3 6 55 Hegewisch .--------- 1 0 1 2 17 Dunning ------------ 1 1 3 5 56 Garfield Ridge ------ 2 1 4 7 18 Montelare ._.------- 0 0 0 0 57 Archer Heights ---.-- 0 0 1 1 19 Belmont Cragin ---- 0 0 2 2 58 Brighton Park .----- _ 2 3 2 7 20 Hermosa ..--------- 0 0 0 0 59 McKinley Park ------ 0 0 2 2 21 Avondale -..__..---- 2 i 2 5 60 Bridgeport --..------ 5 1 6 12 22 Logan Square ------ 13 0 14 27 61 New City ----------- 6 3 8 17 28 Humboldt Park .--.--- 12 i 14 27 62 West Elsdon -------- 1 2 1 4 24 West Town -------- 22 5 31 58 68 Gage Park -.-.------- 0 3 3 6 25. Austin _..------.--- 16 1 85 52 64 Clearing ----------- 0 1 0 1 26 W. Garfield Park -.-. 538 0 92 145 65 West Lawn --------- 1 0 1 2 27 ast Garfield Park -. 72 1 137 210 66 Chicago Lawn ~.---- 2 5 4 11 28 Near West Side _--. 117 2 150 269 67 West Englewood -..- 26 4 20 50 29 North Lawndale --.- 109 3 123 235 68 Englewood ---.----- 13 6 40 119 30 South Lawndale ---. 5 1 12 18 69 Grand Crossing - ----- 80 20 = 15 65 81 Lower West Side __.. 6 0 17 23 70 Ashburn ..---------- 1 5 1 q 82 Loop ...------------ 6 1 4 11 71 Auburn Gresham ..-.. 14 9 14 37 88 Near South Side ---- 5 1 4. 10 72 Beverly ..-.-------- 2 2 0 4 84 Armour Square ---- 3 1 4 8 73 Washington Heights - 5 q 6 18 85 Douglas ....-------- 86 5 12 58 74 Mount Greenwood -- 0 1 0 1 86 Oakland _._.-------- 20 1 4 25 75 Morgan Park .---.- 9 4. 5 18 87 Fuller Park _--_---- 10 0 4 14 Out of City --.----- 0 718 40 118 88 Grand Boulevard .... 106 6 31 148 . —_—__—__—_ 89 Kenwood ..---.----- 14 4 6 24 Total ..------- 1,050 846 1,000 2,896 114 1 One day’s experience, July 24, 1968. 2 Unknown time period. % Sequential sampling total active clinic population. CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 TABLE III.—Presbyterian-St. Luke's Variables Number Hospital Clinic Population . Medical assistance—no grant -..--------- 9 Variables Nombar Other sources -----------------7777707777 18 Age: Total ..-----------e cc 1,000 0 to B years -.------------------0000 0077 165 6 to 12 years -.-------------------00-077 152 . . . — 18 to 18 years .....------------7---2---- 130 TABLE [V.—University of Chicago clinics 19 to 34 years _------------------0700077 248 85 to 64 years _----------------7-0707707> 221 Number Percent 65 years and older --------------------77 84 Age: Total ...-----------eeee cece 1,000 0 to 16 years ------------------ 56 16.2 Sex: 17 to 40 years ---------------- 182 38.1 Male _...----------------o eee 339 41 to 64 years ----------- nano 116 33.6 Female ....-------------e- eee 661 65 and over ---------------77- 39 11.8 Not known -------------*--7777 3 8 Total _.--.------------2cr rrr 1,000 eo Race Total _.--------------000 0077 346 100 White _.._------------ee ence 233 Race: - Negro .-------------------7 000 722 White .---------------7707 7 193 55.7 Spanish-speaking ---------------------77- 36 Negro -------------077-7 70007 139 40.1 Other ...-------------- eee eee 9 Other ..---------------7--00077 12 3.5 Not known ---------------7-7777 2 6 Total ...----------------e 1,000 —_— Initial clinic of admission: Total ...------------7 rrr 346 100 Medicine ..-.---------------- 00 195 Sex: Pediatrics _------------------- 007-7077 358 Male ....-----------9-0-- 7777 185 39.1 Surgery .-----------------00 106 Female ..--------------7-07777 211 60.9 Surgery subspecialties ------------------ gi ee Obstetrics and gynecology ------------------- 216 gource of naymaut womens eee ae 100 sta hese (adult and child) ---------------- a Medicare _...---------0-----777 38 11 eae Other public fund ------------- 15 4.3 Total ..--------------e- eee 1,000 Insurance ------------------777 26 15 Source of payment for medical care Self-payment ------------------ 247 71.8 Self (full pay) ----------------------7777 5 Not known ----------------0777 _ 20 5.8 Self (part pay) ------------------700-7 540 san ”SC*SCO Public assistance ------------------*-777> 428 Total .-----------7 7707777 846 100 TABLE V.—University of Chicago clinics: Distribution of variable by clinics Age Name of clinic Total 0 to 16 years 17 to 40 years 41 to 64 years 65 years and over Not known Medicine ..._------------ 107 0 28 52 26 1 Pediatrics ...------------ 18 18 0 0 0 0 Obstetrics and gynecology - 62 11 87 14 0 Surgery ----------------- 16 0 7 7 2 0 Neurosurgery ------------ 3 0 1 2 0 0 Plastic surgery ---------- 5 1 3 1 0 0 Urology ----------------- 14 1 6 5 2 0 Orthopedics surgery ------ 24 3 14 6 1 0 Bye _.------------------- 25 8 9 5 3 0 Ear, nose, and throat ---- 26 4 6 15 1 0 Psychiatry -------------- 22 1 16 5 0 0 Dermatology ------------- 13 1 2 4 6 0 Nutrition ...------------- 5 0 0 5 0 0 Unidentified... ----------- 6 0 2. 4 0 0 Total ..----------- 346 48 (13.9) 131 (87.9) 125 (36.1) 41 (11.8) 1(.8) 115 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 Sex Name of clinic Male Female Medicine ..---------------- 52 55 Pediatrics _.-.-------------- 8 10 Obstetrics"and gynecology .-- 0 62 Surgery -.------------------ 5 11 Neurosurgery -------------- 0 3 Plastic Surgery ------------- 4 1 Urology ------------------- 8 6 Orthopedic Surgery -------- 11 13 Bye ..--------------------- ii 14 Ear, Nose and Throat ------ il 15 Psychiatry ----------------- 15 q Dermatology --------------- 7 6 Nutrition .-..--------------- 0 5 Unidentified .--------------- 3 3 Total __.------------- 185 (39.0) 211 (61.0) Race Name of clinic White Negro Other Medicine -------- 61 38 8 Pediatrics .------ 4 14 0 Obstetrics and 18 42 2 gynecology. Surgery --.------ 13 3 0 Neurosurgery --- 8 0 0 Plastic surgery -- 4 1 0 Urology --------- 7 q 0 Orthopedic 13 11 0 surgery. Eye _.---------- 13 9 8 Ear, Nose, and 20 6 0 Throat. . Psychiatry ------ 22 0 0 Dermatology -.-- 10 2 1 Nutrition ------- 1 4 0 Unidentified ----- 4 2 0 Total .---- 198 (55.8) 189 (40.2) 14 (4.0) Source of payment Medicare Other public Insurance Self pay Unknown Medicine ...-------------------- 7-77-7777 OF eee eee ere 80 ~~ —------- Pediatrics ....-------------eeenecececeee 18 OB-GYN ..-.--------------- eee ec 15 26 19 2 Surgery .-----------------------0-000 70> Q Leet ee weer 14. ---+--- Neurosurgery ...-----------------eene ee ee 8 nae eee Plastic surgery ..--------------------ee 5B oeeeeee Urology .__------------------- 02-00 1 eee eee wee 18 .------ Orthopedic surgery ----------------------- Lo cee eee eee 98 et eee Bye ...-------------- eee 9 lace eee eee 23 -.----- Ear, Nose and Throat --------------------- | 1 9 wwe ee Psychiatry __...-----------------n erect 92 — _ae nee Dermatology -.---------------*--------77- a 9 nner en Nutrition ....-.---------------eneceeeee Beene eee Unidentified _....---------------------- ee cr 6 oe eee Total __.-------------------------- 38 (11.0) 15 (4.8) 26 (7.5) QAT (71.4) 20 (5.7) 116 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 TABLE VI—Woodlawn Hospital: Inpatient admissions July 1, 1967 to June 80, 1968 Number of Community area (number and name) admissions Percent + 1 Rogers Park ---------- 16 0.4 2 West Ridge ------------ 7 2 8 Uptown --------------- 26 17 4 Lincoln Square -.------ 1 03 5 North Center --------- 0 _--- 6 Lake View ------------ 14 4 7 Lincoln Park ---------- 11 3 8 Near North ----------- 18 3 9 Edison Park ---------- 0 a 10 Norwood Park -------- 2 .05 11 Jefferson Park -------- 2 05 12 Forest Glen ----------- 1 .03 18 North Park _.---------- 3 08 14 Albany Park ---------- 3 08 15 Portage Park ..-------- 3 .08 16 Irving Park ---------- 4 lL 17 Dunning -.------------ 0: a 18 Montclare --...-------- 0 wees 19 Belmont Cragin -------- 3 08 90 Hermosa -------------- 0 _— 21 Avondale ...----------- 1 .03 22 Logan Square --------- 5 A 2%. Humboldt Park - ------- 3 .08 24 West Town .----------- 7 2 25 Austin .--------------- 12 3 26 West Garfield Park ---- 3 08 27 East Garfield Park ---- 10 3 93 Near West Side -------- 18 3 29 North Lawndale ------ 10 3 30 South Lawndale ------ 3 08 81 Lower West Side ------ 5 al 82 Loop. ----------------- 1 03 83 Near South Side ------ 7 2 34 Armour Square -------- 56 15 35 Douglas -------------- 44 1.2 86 Oakland -------------- 56 15 87 Fuller Park ----------- 60 1.6 88 Grand Boulevard ------ 117 3.1 39 Kenwood -------------- 129 3.4 40. Washington Park ----- 84 2.2 41 Hyde Park ------------ 845 9.1 42 Woodlawn ------------ "641 16.9 43 South Shore -.-------- 450 11.8 44 Chatham -..----------- 93 2.5 - 45: Avalon Park ---------- 58 1.5 46 South Chicago -------- 133 3.5 47 Burnside .--.--------- 37 1.0 48 Calumet Heights ------ 81 8 49 Roseland -------------- 88 2.3 50 Pullman = -------------- 46 1.2 51 South Deering. -------- 80 8 62 East Side ------------ 22 6 53 West Pullman --------- 21 6 54 Riverdale -.----------- 22 6 Number of Community area (number andname admissions Percent! 55 Hegewisch ------------ 74 aA 56 Garfield Ridge -------- 8 2 57 Archer Heights -- ------ 2 .05 58 Brighton Park -------- 5 1 59 McKinley Park -------- 1 .03 60 Bridgeport ------------ 14 4 61 New City -.----------- 48 1.3 1 8 62 West Elsdon ---------- 03 63 Gage Park ------------ 08 64 Clearing -------------- 9 2 65 West Lawn ------------ 14 4 66 Chicago Lawn ----- tee 84 2 67 West Englewood ------ 62 1.6 68 Englewood --.---------- 180 4,8 69 Grand Crossing -------- 143 3.8 70 Ashburn -------------- 26 7 qi Auburn Gresham ------ 90 2.4 92 Beverly -.------------- 8 2 73 Washington Heights --- 45 12 74 Mount Greenwood --.--- 10 3 75 Morgan Park ---------- 24 6 Out of City ----------- 815 8.3 Unknown ..---------+---- 2 .05 ee Total _.------------- 3,800 100.4 1 Rounded to next larger number. TABLE VII.—Community Areas Of Residence: Patients Seen In Emergency Rooms of Mercy and Billings Community area (number and name) Billings Mercy 293 Humboldt Park --------------- 1 hee 23 Near West Side -------------- 2 1 29 North Lawndale -------------- 1 _-- 80 South Lawndale -------------- 1 2 81 Lower West Side -------------- _— , 2 38 Near South Side -------------- a 4 34 Armour Square --------------~ 1 8 85 Douglas -----------------77777 --- 10 86 Oakland ---------------77-7777 8 1 87 Fuller Park ----------------7- 1 _— 38 Grand Boulevard ------------- 6 12 39 Kenwood .-------------7777777 4 4 40 Washington Park ------------- 4 --- 41 Hyde Park ---------------77" 10 Lee 42 Woodlawn .------------7-77777 84 5 43 South Shore ---------------777 6 2 44 Chatham ----------------7-7777 6 2 45 Avalon Park ---------------777 6 _-- 48 Calumet Heights -------------- 2 1 49 Roseland ---------------"77777 2 1 50 Pullman .---------------757777 2 —— 55 Hegewisch .--------------7-77~ a-- 1 56 Garfield Ridge. -------------7-7- _-- 1 57 Archer Heights -------------- 1 2 117 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 118 Community area {number and name Billings Mercy Variabl Rc blr Percent ariable r 58 Brighton Park ---------------- 1 --- . , - 89 McKinley Park .-------------- _. 4 Time of arrival at Emergency Room 60 Bridgeport (eee eee eee eee i 16 9 am. to 12 noon ---- 10 22 16.5 6i New City 1 1 12 noon to 5 p.m. ---- 27 25 18.8 ts Gawe Park ose eeeeeee 1 5 p.m. to 12 midnight 42 35 26.3 Oy West Hnplewood ..-0--------= O Midnight to 9 a.m. -- 19 27 20.38 est Englewood -------------- 3 5 Unknown ; 2 24 18 68 Englewood -------------------7 9 3 OWN -~- ~~ ---- anne 69 Grand Crossing --------------- & 4 Total ...---------- 100 133 99.9 71 Auburn Gresham ------------- 6 2 Diagnoses: 72 Beverly ---------------7700777 1 --- General medical prob- 57 77 57.9 Out of City ------------------ 4 4 lems. Unknown -.-------------77777 8 1 Lacerations ---------- 24 20 15 Fever __.------------ 8 3 2.3 Total ---------77-77 0 183 100 Broken Bones ------- 3 4 3 Gunshot wound ------ 1 1 7 os . Dermatology --------- 1 1 7 TABLE VIIL.—Emergency rooms: Distribution Psychiatric problem -- 0 8 2.3 of variable for emergency rooms, Mercy Drug reaction and Billings accident 0 1 7 Rape ._------------- 0 1 7 Mercy Billings Removal of sutures -- 0 2 1.5 Variable Number Number Percent Comatose ----------- 1 0 _ Age: Obstetrics and 3 0 --- 0 to 16 years -------- 36 35 26.3 - gynecology. 17 to 40 years -.------ 43 63 ATA Dental ..------------ 1 0 a-- 41 to 64 years -------- 17 27 20.8 Unknown -.--------- 1 20 15 65 years and older -- 4 5 3.7 ee Unknown _.---------- 0 3 23. _rotal ---------22-- 100 188 99.8 Disposition: Total _.---------- 100 133 100 Sent home ---------- 49 68 51.1 Sex Referred to these hos- 30 24 18 Male -..------------- 50 55 41.8 hospital clinics. Female. _.----------- 50 18 58.6 Referred to other hos- 18 15 11.3 Ee pital or M.D. Total ------------- 100 138 99.9 Admitted to hospital. 8 13 9.8 Race: Left without being 3 3 2.3 White ...----------- 28 16 12 seen. Negro -------------- 35 17 87.9 Left against advice -. 9 2 15 Other --------------- 1 0 a Unknown .-.--------- 2 8 6 Unknown ------------ 41 0 — ro tn Total .----------- 100 133 100 Total ------------- 100 - 188 99.9 Source of payment for medical care: Source of referral: Insurance _.--------- 59 Friend or relative ---- 56 67 50.3 Self Denon 19 Self crc ib 48 36.1 Public funds. -------- 15 Police or fire depart- 29 11 8.3 Medicare 4 ve or fire top er nn Unknown ----------- 3 Unknown ----------- 0 q 5.38 nknown ror Total .----------- 100 Total _-.-.------- 100 133 100 “A Section IV. The Students Participants in the Student Health Project during the summer of 1968 included those in college, in postgraduate study in the health professions, other graduate study and high school students. For ease in reporting, the col- lege and graduate students will be referred to as the health science students; the high school students will be referred to as interns. | THE HEALTH SCIENCE STUDENTS One hundred and twenty four health science students participated in the summer project. This section will define some selected character- istics of the students, their backgrounds and some of their views to provide the reader with a few insights into the kinds of students who elected to participate in the summer project. Some of these characteristics are self-ex- planatory and no comments are offered: Characteristic: Percent of 124 studenta Characteristic: Sex: Male _._..--------------------700 0 56 Female __-..------------------77 77777 44 Total ..-----------------oo rr 100 Age (in years): Under 21 _.------------ ee eee ee eee - 1 91 to 23 _-.------------------- or 59 94 to 26 _.-.-------------- 09 23 27 and older --------------------7777 7 Total ..----------------- oc 100 Race White _..._..-----------------500 7777 83 Black ...-----------------e0 9-0 17 Total ...----------------r oro 100 Almost 60 percent of the students were pre- paring for careers in the health professions. Another 2 percent were in premedical under- graduate programs. Five percent were in social work schools, some of whom will probably enter the field of medical social work, The re- maining one-third of the students were distrib- uted through a variety of related fields. Field of study: Percent of 124 students Health professions ---------------------77 59 Medicine (38 percent) Nursing (14 percent) Dentistry (2 percent) Allied health (5 percent) Law __---------een eco ee 1 Social sciences -------------------7777 777 Humanities ..-------------+---7-0- rte Social work _.-----------------00 fcr Other professions ---------------*------7>~ Premedical programs --------------------- Natural sciences. .---------------------7-7 Not specified -..------------------77-7777 he Dh OM OO While the majority of the students attended colleges and universities located in Chicago, a substantial number (36 percent) came from schools around the country. That distribution is as follows: Locations of colleges or universities: Percent of 124 students Chicago ..---------------7 rer 55 University of Chicago (18 percent) University of Illinois (16 percent) Loyola University (10 percent) Chicago Wesley Memorial Hospital (School of Nursing) (8 percent) Roosevelt University (2 percent) Northwestern University (1 percent) Chicago College of Osteopathy (1 percent) Kent College of Law (1 percent) Other Chicago colleges (2 percent) Other Illinois -.--------------------777777 2 Other States and areas ------------------ 36 California (6 percent) Michigan (4 percent) New York (6 percent) Pennsylvania (4 percent) Tennessee (3 percent) Missouri (2 percent) Utah (2 percent) District of Columbia (1 percent) _All other States (8 percent) Not presently in school ------ cane eeeeeeeee- 4 Not specified -.------------ woeeeeerceeeee 4 Total _..----------- eer eee 1017 ———— 1 Due to rounding. 119 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 The students were queried as to their par- ents’ religious preferences and their families’ annual income. A substantial number of them did not respond to either question even though most of them had responded with some degree of faithfulness to a number of questionnaires. Whether they specifically chose not to answer these two questions is not known. Religious preference: Percent of 124 parents Protestant ...-------------------00 0000077 80 Jewish __-----------------2 rr 24 Catholic _..------------------- 70-0777 17 Other preference’ __-----------------7-777 q No answer .-----------------0- 7 22 Total -...--------------- oe 100 1{Ineludes those whose parents preferences differ for each parent, as well as those with other or no religious preferences. While it is not possible to determine the af- fluence of the students’ homes, since neither the size of their families nor the nature of their financial obligations are known, a cur- sory review indicates that a majority were from homes where the family incomes cur- rently are above those of the United States population as a whole. The following table pre- sents the comparison between incomes of the students’ families and income of U.S. families. Percent Percent families of US. students in families Annual income brackets bracket 1 in bracket Under $5,000 ----------------- 7 83 $5,000 to $9,999 --.----------- 22 42 $10,000 to $14,999 -.------------ 30 17 $15,000 and over -------------- 41 8 IS Total ..---------------- 100 100 198 students answered question, 26 did not. The differences between the students’ family incomes and U.S. families may be even more marked at the upper brackets. Data were not avaiable for U.S. families in specific categories above $20,000 and $25,000 respectively. How- ever, this information was available for the students’ families. Of the 41 percent whose in- comes were in a range above 15,000 per year, 16 percent were between 15,000 and $19,999, 14 percent were between $20,000 and $25,000 and 10 percent had incomes’ over $25,000 per year. Twenty percent of the students did not respond to this question either from lack of 120. knowledge or perhaps a refusal to divulge this information just as a large percent did not an- swer queries about religious preference. How- ever for the 80 percent who did answer, it would appear that the students in the summer project could generally be considered to come from relatively affluent backgrounds. In questionnaires administered to the health science students, a number of queries probed their attitudes on a variety of subjects related to health and health issues. They were also asked to describe their reasons for participat- ing in the summer project and what, if any- thing, they learned from the summer. Only 87 of the health science students re- sponded to the queries so that the data to be presented pertain to those students who re- sponded and represent approximately 70 per- cent of the participants in the summer project. The reasons for their decision to participate in the summer project are presented first, based on eight suggested reasons for them to rank in order of importance to them. A point system was designed and their responses to this question were tabulated on that basis. Ac- cording to the assignment of points, the follow- ing are the reasons in order of primary impor- tance as to why the respondents participated in the summer project. TABLE L.—Ranking of possible reasons (or goals) for participating in the summer pro] ect according to most important reason Goals 1, To learn about health problems of the poor. and the delivery of health services to them. 2, To help poor people get better medical care and medical services. 3. To help initiate and continue political action for social change in & poverty area. To acquire a better understanding of welfare problems. To earn money. Fo work in Chicago. To work with other health professionals. To be with friends. > eA oe A desire to learn about the health problems of the poor was by far the most important rea- gon for student participation. The point dif- CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 ferential between that as the first reason and the next three reasons was substantial. Rea- sons two, three, and four, helping poor people get better medical care, helping initiate action for change and acquiring a better understand- ing of welfare problems were fairly closely clustered as the next major reasons for par- ticipation. The last four reasons were of far less importance and were relatively closely clustered. The students were asked whether they had learned much, some little, or nothing about 16 variables as a result of their summer exper- ience. The responses to this question are shown on table II, with the items eliciting the greatest degree of positive response listed first. More respondents said they learned a good or great deal about the quantity and quality of health care and housing conditions of the poor, 66, 61, and 58 percent respectively, than they learned about any other of the listed condi- tions. In fact, only 16, 18, and 15 percent, respectively learned little or nothing about these factors. Respondents also felt they learned a signifi- eant amount concerning organization of medi- cal care services, professional practices and community attitudes toward health care. For example, only 30 percent of those who an- swered the ninth ranked item—innovations in health care for the urban poor—indicated they learned little or nothing about it. When specific health problems of the poor and their attempts to deal with them are con- sidered, the percentage of respondents who learned a good deal or a great deal declines rapidly. Only 28 and 22 percent, respectively, felt they learned a good deal about lead poison- ing and nonprofessional health carers. Only 13 percent indicated they learned much about malnutrition among the urban poor and only 12 percent learned a good deal about folk medi- cine among the urban poor. The students felt they learned little or nothing about mental ill- ness, heart disease, and cancer respectively. It is probable that the small percentage of stu- dents who learned a good deal about these par- ticular disease entities worked at sites whose major interest was in these areas. Learning more about the health problems of the poor and delivery of health services to them was ranked as the most important reason for par- ticipation in the summer project and the data indicates that this goal was accomplished. The fact that they learned little or nothing about specific disease entities (mental iliness, heart disease, and cancer) is probably to be ex- Percent of respondents who learned— A good or Littleor Total number Rank Item great deal Some nothing equals 87 1 The quantity of health care received by the poor ---- 66 18 16 87 2. The quality of health care received by the poor ------ 61 26 13 82 3 Housing conditions of the urban poor -------------- 58 27 15 18 4 The organization of health services for the poor in an urban setting. 56 22 22 17 5 What professional practice is like in poverty areas -- 49 24 27 86 6 Organization and problems of city hospitals --.-.-_.--- - 48 19 33 86 1 Community attitudes toward health problems -------- 46 80 24 83 8 Community groups concerned with health issues ---- 43 31 26 81 9 New innovations in health care for the urban poor -. 39 31 30 81 10° Lead poisoning among the urban poor -------------- 28 23: 44 83 41 New health careers for nonprofessionals ------------ 22 29 49 87 42 Malnutrition among the urban poor ---------------- 13 21 66 77 13 ‘Folk medicine among the urban poor -------- eee ee 12 20 68 80 14. Mental illness among the urban poor --.----------- 2 28 70 82 15 Heart disease and stroke among the urban poor ---- 1 11 88 76 16. Cancer among the poor -.--.------------- oleae ee 1 4 95 14 121 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 pected. It would seem unlikely that health sci- ence students, most of whom spend their entire academic year studying the etiology and effect of pathology would become involved in this ex- perience—a community health project—for that purpose. Answers to the question, “To what extent was your involvement a learning experience?” provided the information that 80 percent of the respondents felt they learned a great deal this summer. Another 10 percent said it was something of an educational experience for them. Only 10 percent felt they learned little or nothing as a result of their participation in the summer project. The impact of their experience relative to their career objectives was probed. They were asked, “To what extent do you think this sum- mer’s experience will relate to your career ob- jective?” More than 90 percent said a great deal or some relationship existed between their summer’s experience and their career objec- tives, Only 7 percent felt there was little or no relationship. Only 31 percent responded positively when asked, “To what extent did your work increase the health consciousness of the community in which you worked?” About the same percent- age (34) felt that the community in which they worked during the summer had benefited some or a great deal from their presence. This correlates with their responses to the question, “To what extent were you successful in achiev- ing your objectives this summer?” In this case, . only half of the students felt they had been successful in achieving their summer’s objec- tives. Since second and third in importance among their goals were to help poor people get better medical care and to. help initiate action for change in poverty areas, it would seem that they felt the summer had fallen short. of their hopes for accomplishing these goals. - Six alternatives were given them as specific ways of improving the health status of poor people. They were asked to rank these in order of what they considered the most effective way of improving such services. Points were again 122 assigned and the following is their ranking of effective plans. TABLE I1—Specific plans to improve health status of the poor 1. Remove all economic barriers to health and medical services. 2. Create more medical care centers in poor neighbor- hoods—in convenient locations. 3. Improve the quality of health care actually. given to poor people. 4. Increase the employability of poor people—provide more jobs for them. Improve housing conditions for the poor. 6. Raise the general level of education of poor people. st Actually there was a small point difference between the items they ranked first and second ~ as most effective plans for improving health status. The last four items were clustered not far behind the first two ways they considered most effective for changing the health status of the poor. TABLE IV.— Community priorities (as the students perceived them) : 1. Increased employment opportunities. 2. Improved housing. 3. Development of ethnic power. 4, Enlargement of educational opportunities. 5. Liberalization of health care. The first four items were relatively closely clustered in point values but the fifth item liberalization of health care, was considerably behind the first four in the view the students had of community priorities. In summary, the health science students were mostly white, from affluent homes, and at an advanced level of education. They appeared . to be idealistic, enthusiastic and eager to play a constructive role in assisting those they consid- ered Jess privileged than themselves and in learning more about them. The summer’s experience did not meet the goals of some. For others, there was a feeling of accomplishment. For almost all of them—the summer had been a valuable educational expe- rience. For many, it may have a substantial in- fluence on their lifetime goals. . CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 THE HIGH SCHOOL INTERNS There were 74 high school students or 1968 high school graduates in the summer project. The information presented in the following is based on questionnaires which they filled out. Characteristics of the high school interns are almost completely the reverse of those de- scribed for the health science students. The age distribution of the students was dif- ferent, obviously. Perhaps, some of the diffi- culties that existed can be attributed, in part, to a “generation gap” between teenagers and students in their mid-twenties. This thought might provide a moment of amusement to those past 80 years of age. Age (in years): Percent of high school students 4 __..-__.----_------+------------+----- 1 16 .....----------------------------- +--+ 9 16 ..-...---------------- +--+ 2 -------- 41 WW __--------------- +--+ ee eee 28 18... --------- + - ---e = -------- 11 19 __. 22 eee ee oe 6 20 __._..------------- 2 ++ - 2 -- --- == 3 Total ..__..--------------------------- 99+ 1 Due to rounding. There were more females among the high school interns and fewer males, almost exactly the reverse of the ratio for the health science students. Sex: Percent of high school students Male _._._.._----.--------------+-+------- 44 Female ..___.._-_------------------------ 56 Total _.....-.-------------------------- 100 Racial and ethnic background were com- pletely different as well. Race or ethnic backgrownd: Percent of high school students Negro ...--.---------------------------- 86 White _..___.-_...----------------------- 5 Spanish-speaking ---..--------------------- 6 American Indian _...--------------------- 8 -100 While 88 percent of the health science stu- dents were white, 86 percent of the interns were black. The differences in sex, race, and age surely must have contributed some ele- ments to the difficulties where students encoun- tered them in their working relationships. Probably, the most important single factor in- fluencing difficulties was the racial difference. However, the high school interns who re- sponded to questions concerning their feelings about the health science students on their indi- vidual projects showed highly selective reac- tions to the other students. In a few cases, par- ticular health science students were character- ized as racist by the interns. In a larger num- ber of cases, the interns were friendly but crit- ical of their health science coworkers. In the majority of cases the interns indicated respect and affection for the health science students with whom they personally worked, both black and white. Since responses to the question- naires were confidential, the high school stu- dents probably stated their opinions honestly. It is worth discussing these relationships further since there were references in the text of the students’ reports which highlighted dif- ficulties in specific areas. The following ex- cerpts from black interns’ questionnaires are quoted to describe their feelings about the health science students in several instances. Two of the questions asked were: (1) What did the intern like best about the health sci- ence student(s) with whom he worked, and (2) what did the intern like least about their colleagues. The students comments below are grouped by interns who like their health sci- ence partners; interns who liked them but were critical of them as well; and interns who disliked their health science partners, some- times intensely. Each set of quotations is from a single intern’s response: Liked most: “Her sincerity in willing to do something about the infant mortality cases in [name of community]. Her sense of responsibility to do the job well and on time. Her hope to keep the pro- ject going rather than stop at the end of the weeks of payable work.” Liked least: “Nothing—And believe me I’d tell.” Liked most: “He was a very understand- ing person. Treats you with respect. He doesn’t act like he’s any better than you. He’s alright.” Liked least: “Nothing.” 128 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 Liked most: “She was swell to get along with, a good worker and no problems arose between us. We worked practi- cally hand in hand.” Liked least: “No comment because there is nothing I didn’t like about her. Liked most: “We all worked together as a group. One didn’t go any higher than the other. Each of us did the same work.” Liked least: “Everything about the health science students was just wonderful. We got along together, ate together and fought together when the time came.” The remarks of interns who liked their health science students but were critical of them as well follow: Liked most: “Their pleasing personali- ties, honest opinions, willingness, help- fulness, honesty, and most of all, con- sideration for others.” Liked least: “I think the whites should learn to be more willing and ready to learn from the blacks about their prob- lems and less domineering and supervis- ing in such instances. Take orders in- stead of giving them.” Liked most: “At the [name of site] the HLS.S. were really involved and I feel that they became aware of the real problems.” Liked least: “There was one I really didn’t care for and he happened to be black. He would call me in the middle of the night to find out what I had done during the day.” Liked most: “Some of the health science students were ready, the others weren’t worth talking about. Some were willing to help, the others just came to work.” Liked least: “Some were lazy, self-con- cerned, helpless, hopeless and dirty.” These were the hostile comments: Liked most: “I only liked one of my three health students and that one was black. The reason why I liked him is because he is a very nice and considerate person with a wonderful personality in my eye sight.” 124° Liked least: “One calling us niggers and the way they took leadership in hand and pretended that we were still slaves.” Liked most: “Nothing!” Liked least: “We wanted to work in the black communities where help is really needed, They (H.S.8S.) worked in [name of area] and on the north side. This proved to me that they didn’t care about the health care of black people and that they wouldn’t make good doctors. Be- cause doctors are concerned about the health care of human beings BLACK OR WHITE.” [Emphasis the stu- dent’s] . Liked most: “She helped me to under- stand the white race and all their little tricks better.” Liked least: (1) She was a spoiled brat that always wanted her way. (2) She thought that she was actually doing something in our community. (3) She also was a terrible flirt. J don’t have any more room to finish.” Finally, there was an amusingly ambivalent response. Liked most: “I liked his ability to see things from all sides before making a judgment or decision. His fairness was also appreciated by me.” Liked least: “Personally, I couldn’t stand him though I think he believes I like him. There was something about him, which I haven’t discovered yet that rubbed me the wrong way. We got along beautifully though.” And a terse response: Liked most: “Transportation.” Liked least : “Temper.” And one different kind of criticism: . Liked most: “They were all right, except one in [name of community].” Liked least: “He was always thinking.” The proportion of friendly, indeed warm and affectionate, comments was much higher than the critical or hostile ones. Therefore, while the race issue loomed large in some instances, whether race was really the issue may be open CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 to question, although it undoubtedly played a part. Rather, the human condition is present and the individual personalities of the partici- pants is highlighted in the interns’ comments. This may have been the factor which was most important in any difficulties which existed be- tween the groups. The differences between family income of high school students and health science stu- dents also are great. While 70 percent of the health science students came from families whose incomes were over $10,000 per year only 10 percent of the interns’ families were in this category. And at the other end, 38 percent of the interns’ families had incomes below $5,000 per year while only 7 percent of the health sci- ence students’ family incomes were in this bracket. There were also interesting differences be- tween income of U.S. families as a whole and families of the interns. These are as follows: Percent Percent families of U.S. black interns families 1 Annual income brackets in bracket * in bracket Less than $3,000 .------------ 11 17 $8,000 to $4,999 ..-..--------- 27 16 $5,000 to $9,999 _.__.--------- 52 42 Over $10,000 ...------------- 10 25 100, 100 160 students answered question, 14 did not. Since 86 percent of the students were black, family income data for only the Negro interns was compared with family income data for nonwhite U.S. families and again interesting differences are present. The comparison is as follow: Percent Percent families of non-white black interns U.S. families - Annual income brackets in bracket 1 tn bracket Less than $3,000 .-.-------- 10 37.3 $3,000 to $4,999 _._..-_.---- 26 25.2 $5,000 to $9,999 ......------ 56 - 29.2 Over $10,000 ..------------- 8 8.3 100 100.0 152 students answered question, 2 did not. It would appear that the interns’ family in- comes were not representative of nonwhite families in the United States as a whole. While it can hardly be said that an income between $5,000 and $10,000 per year is affluent, it seems that black high school students in the summer project generally were somewhat better off than their peers around the country. The last characteristic which will be men- tioned is that of the career aspirations of the interns. Almost all of them have career goals that require education or vocational training beyond the high school level. While their goals are undoubtedly subject to change, perhaps even a number of times, they worth describing here, First the grade-level distribution of the interns indicates that more than 80 percent of the respondents are new in the junior and senior years of high school and 10 percent had been accepted at colleges or junior colleges for the fall. At this stage in their educational prep- aration they are probably thinking seriously about their future careers. Over half of the respondents (56 percent) said they intended to go on to college and an- other 14 percent said they planned to go to junior college. While some students were unde- cided or did not respond to the question, only one student wrote that he did not plan to con- tinue his education beyond high school. Al- most all of them planning for higher education stated they would have to receive financial aid or would have to work to finance a college edu- cation. Only three of the interns indicated that their parents would be responsible for financ- ing them through college. A first career choice was stated by 54 interns while the remaining nine who filled out the questionnaires were either undecided or did not specify a career interest. The choices of the 54 are as follows: First Career Choice: Percent of students Health professions --.--------------------- 46 Medicine (24 percent) Nursing (18 percent) Allied health (9 percent) Teaching/education -..------------------- 15 Social work _..------------------+ "9-7-0077 9 Computer science technology -------------- 5 Other professions’ -..-.------------------ 13 Other careers* _.--.---------------------- 12 Total _....------------- eee eee 100 1 Other professions includes law, engineering, sociology, etc. 2 Other careers includes military, business, forestry, foothall, ete. 125 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 As is apparent, almost half of the students said they planned to pursue a health career and half of these indicated a desire to become ‘physicians, What effect their summer experi- ence had upon their career choices is not possi- ble to guess since comparable information was not sought prior to the start of the summer project. In summary, the high school interns were mostly black, from lower middle income homes with high aspirations for the future. Their 126 questionnaire responses showed them to be idealistic, enthusiastic, and eager to play a con- structive role in helping themselves, and their people, to achieve status and dignity in society. That their summer’s experience had an impact upon them cannot be stated with any certainty, however, a number of them plan to continue work on projects started this summer. Their exposure to health issues and health system has made them more aware of the important role health plays in their everday lives and in the lives of the communities in which they reside. Section V. LIST OF PARTICIPANTS AND SITES Health Science Students Stanley Aeschleman Patricia Bailey Trene Baker Sara Joan Bales Charles Bass Susan Bennett Jack Berger Sandra Berkowitz Ronald Berman Temistocles Betancourt Reginald Blanks Lawrence Bloom William J. Bridbord Barbara Britts Ira Buchalter May Ann Caswick Jeanne Corbett Grace Dammann Ronda Marie Davis Troy Doetch James E. Drake Carol Eckman Karen Edwards Bruce G. Fagel Howard H. Fenn Andrea Gay David R. Gendernalik Robert W. Geohegan Jeffrey Neal Gingold Emily D. Gottlieb Franklin B. Gowdy Margaret Guertin Michael J. Guice Steven A. Hadland Nancy Hall Theodore B. Handrup High School Interns Emillo Acevedo Danny Anderson Jessica Anderson Willie Barney Joseph Brown Pamela Brown Midacrito Cano Betha Carr Maryln Carter Yvonne Christman Eliza Clark PARTICIPANTS John H. Heiligenstein Joan R. Hilbrick Edwin C. Holstein Robert Holt Charles M. Jenkins Leslie Johnson Kathleen A. Johnston Deborah Lee Kahn Karen Kaye Marie G. Leaner Charles Levitan Walter Lowe Patricia A. Lowery James Lowry Jeanne Lowry Paul Mansheim Irwin Miller Eliyn Millman Margo A. Montry Dean Morgan Christopher Murlas James McCulloch Irene McDonough P. MeGauley Ralph McMurry Terry McMurry Margaret A. McQuade Rosalyn L. Netzky Pamela J. Osborne Dean Lee Overman Lee Pernell Douglas D. Peterson Larry K. Powe James Puryear Michael P. Ranahan Stephen P. Rand Gerry Clark Larry Craig Alice Cruz James Easter Lewis Edwards Joe Lopez Enderle Sibyl M. Ferrell Trude Fullman Robert Graham Marsha Ann Hackner Juanita Harvey Lewis Resnick Susanna H. Roberts David Sargent Druce M. Scheff Carolynn Schore Sue C. Schulman Michael Yale Schwartz Laura J. Simon Mark Simons Suzan Simons Catherine Slade Jean E. Snodgrass Susan Soboroff George Spinka Suzanne Stallings Marilyn Stanek Margaret Stapleton Porter Stewart Ronald Stewart Hugh Stinnette Robert Tanenberg John Trefil Sandra Vernardo John P. Vogel Kurt Wahle Michael Wartman David Lee Weiss Gerald Wilburn Barry Williams Linda Williams Mary M. Williams Roscoe Woosley Jane Wuchinich Polly Young Raymond Zablotny Pamela Zumwalt Sonja Henderson - Willie Hill Georgia Houston Lee Irving Raymond Johnson Charles Jones Debra Kelly Barbara King Dan King Lucy Lane - Christopher Latham 127 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 Howard L. Lee Pearl Helen Martin Jose Manuel Molina Patricia Diane Morris Valerie McKenzie Rachel Clark McKinzie William McNary Juliette Nelson Gregory Norman Lorine Patterson Susan Peterson Lola Porter Abraham Lincoln Center 700 East Oakwood Boulevard Preceptor: Mrs. Hilton American Indian Center 1630 West Wilson Preceptor: Tony Madjekoy Benton House Neighborhood Resources Center (Mexican Outpost) 2624 South Normal Preceptor: Mr. Dick Hail (Director) _ Black Women’s Committee 4300 Cottage Grove Preceptor: Jackie Robbins Casa Central 40 North Ashland Preceptor: Reverend Alvarez Chicago Board of Health Chicago Civie Center Preceptor: Dr. Stamler , Concerned Citizens of Lincoln Park 2512 North Lincoln Avenue Preceptor: Sherry Levine Cook County Hospital Out-Patient Clinic Preceptor: Dr. Bernstein Dearborn Homes-Booth House 2961 South Dearborn Preceptor: Mr. Cotten Drug-Abuse Program (Operating out of Association House) 2150 West North Avenue Preceptor: Mary Williams Englewood Action Committee of the Englewood Civie Organization 140 West 62d Street Preceptor: Rev. Richard Lawrence (of the Action Committee), Mrs. June Dolnick (of Engle- wood Citizens Housing Com- mittee) 128 Gwendolyn Ramsey Mavies Randle Anthony Samuel Roberts Katherine Sawallisch Bernard Seals Francine Shane Gwendolyn Shane Naomi Shine Darryl Speer Rose Marie Steward Carol Stewart Leon Talbot Alfred Taylor SITES Englewood Clinic 140 West 62d Street Preceptor: Doug Peterson (Rev. Richard Lawrence President of Englewood Action Committee) Englewood Mental Health Center (Board of Health) 852 West 63d Street Preceptor: Mrs. Adele Levine Erie Neighborhood House 1347 West Erie Street Perceptor: Evelyn Lyman, R.N. Garfield Civic Association 5600 South Racine Preceptor: Mrs. Rita Skeffinton (East) Garfield Park Mental Health Clinic 4458 West Madison Preceptor: Mrs. Moon Greater Lawn Family Care Center 2701 West 68th Street Preceptor: Dr. Jim Reese (Director) Hospital Planning Council 79 West Monroe Preceptor: Pierre DeVise Latin American Defense Organization (LADO) 1306 North Western Preceptor: Obed Lopez Lawndale Association for Social Health (LASH) , 3346 West Roosevelt Preceptor: Bob Taylor, Joe McDonald, Dr. Eric Kast Marcy Center : 1539 South Springfield — Preceptor: Mrs. Betty Dobbins Martin Luther King Memorial Clinic 3312 Grenshaw . Preceptor: Dr. Snyder Medical Center YMCA . Lucius Taylor Paul Taylor Daniel Thompson Richard Tinsley Debra Wash Drexel Weathersby Veronica Weathersby Janet Williams Sandra Williams Ernest Winkfield Valerie J. Woods Deborah Young 2067 West Roosevelt Preceptor: Hosea Lindsay Michael Reese Hospital 29th and Ellis Preceptor: Dr. M. Creditor Neighborhood Service Center (Howell House) 1831 South Racine Preceptor: Jose Morales Olivet Community Church 1448 North Cleveland Preceptor: Charles Marz Presbyterian—St, Luke’s Hospital Preceptor: Bruce Douglas, D.D.S. Provident Hospital 426 East 51st Street Preceptor: Mrs. Cobb, Director of Volunteers Robert Taylor Health Clinic Ida Noyes Hall, University of Chicago St. Bernard’s Hospital 6337 South Harvard Preceptor: Sr. M. Shephard, Supervisor of Emergency and O.P.D. St. Leonard’s House 2100 West Warren Preceptor: Earl Durham . South Lynne Community Council 1737 West 68d Street Preceptor: Mrs. Donna Scheidt (Housing Chairman) Rev. James Scorgie (Youth Chair- man) : South Lynne Day Camp, Thoburn Methodist Church 1708 West 64th Street Preceptor: Rev. James Scorgie Tri-Faith Employment 1861 West Wilson .: Preceptor: Chuck Geary | CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 Trumball Park Community Center Preceptor: Rev. George Morey Woodlawn Hospital 10530 South Oglesby Woodlawn Child Care Center 61st and Drexel Preceptor: Mrs. Tikalsky 936 East 63d Street Preceptor: Mr. Jacobs-Hospital United People Preceptor: Dr. Madden Administrator 1354 West Wilson Ye U.S. GOVERNMENT. PRINTING OFFICE: 1970 0—355-233 129