On
MH _ - Community Health Services/*/New York City

MH - New York City

MH - Students, Health Occupations/*//

KW - 20C

CN - Greater New York Student Health Project////

CN - Albert Einstein College of Medicine////

CN - Montefiore Hospital and Medical Center////

CN - United States. Division of Regional Medical Programs////

TI - The:Student Health Project of Greater New York, summer 1968./G

iM - [Bethesda, Md.]/Health Services and Mental Health Administration/[1969]

CO - viii, 155 p.

GN - Sponsors: Albert Einstein College of Medicine of Yeshiva University and
Montefiore Hospital and Medical Center.

GN - Project supported in full by the Division of Regional Medical Programs, Contract
no. 43-68-1515.

CP - O2NLM,O8HMS,01SSY:WA 546:AN7:G5s::1969

CA - WA 546 AN7 G5s 1969:02NLM,O8HMS,01SSY

Y1 - $/1969/

LP - Eng

LA - Eng

MT - CORPORATE NAME MAIN ENTRY

RO - O:MED

RO - C:MED

RO - M:KRC

DA - 710614

MR - 831204

LR - 831222

RI - rev

EL - FULL LEVEL

IT - MONOGRAPH

UI - 1267146
 

GREATER NEW YORK STUDENT HEALTH PROJECT
summer 1968 . |
THE STUDENT HEALTH PROJECT
OF
GREATER NEW YORK
summer 1968

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

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

U. S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE
Public Health Service
The Division of Regional Medical Programs
Health Services and Mental Health Administration
This project was supported in full by.
Contract No. 48-68-1515
FOREWORD

While medicine in this country advances by giant steps in the area of
increasing scientific and technical knowledge, it plods along in extending
the fruits of these benefits to all Americans. Today comprehensive com-
munity health care is an idealistic pipedream, compared with the realities
of a stopgap system of health care which is scanty, episodic, and frag-
mented. A major reason for these deficiencies and inadequacies is the
lack of incentive and interest among health professionals in attacking
these problems. In their formal curriculum the vast majority of students
in the health professions do not gain an appreciation of the needs of the
medically underprivileged or the difficulties that are faced by health
practitioners and health facilities in poverty areas. The patient is observed
by the student merely as a disease or clinical entity—as a fragment of his
society being distinct and separate from his environment. The health stu-
dent by spending his long years of training isolated from the community
which he will serve loses his social idealism and remains blind to many of
the basic causes of ill health: environmental deprivation, loss of income
and jobs, and poor housing. Tomorrow’s health practitioners must under-
stand these causes if there is to be any large scale improvement in stand-
ards of health care. First hand experience with the urban community and
the urban health problem is the best way to gain this understanding.

The purpose of the Student Health Project of Greater New York was
twofold: to increase the education and understanding of health profes-
sionals by providing experience in dealing with the social problems and
health needs of the poor, the social conditions which engender these prob-
lems, and the difficulties in alleviating them; and to engage students in
beneficial projects that will have immediate and long term effects on the
community, on the educational process, and on themselves. Such long term
effects can be achieved only through the fostering of resources within the
community and through encouraging flexible student attitudes necessary
to develop the new health models needed to define and improve the delivery
of health services.

iii
PREFACE

This report represents a distilling of the hundreds of thousands of
words written as biweekly or final reports or transcribed from tape-rec-
orded meetings and interviews during the course of the 1968 Greater New
York Student Health Project.

The 1967 Bronx Student Health Project report and similar reports
of other Student Health Organization summer projects have tended to be
compendia in the truest sense of the word, with essays by the participants
printed in their entirety or organized in such a way that the reader has
had to search through pages and pages of information, impressions, and
opinions for specific points he may have been seeking. An effort has been
made here, through judicious editing and organization of the excerpts
into specific categories of discussion, to provide a more useful source book
of information about the summer experience for future planning of Stu-
dent Health Projects or similar efforts. ,

Although perhaps less “readable” than previous reports because
essays have been fragmented and stripped of most of the “poetic impres-
sionism” that students tend to write, the format of this report should, it
is hoped, enable the reader to go straight to a caegory of interest and get
a sampling (but not a random one) of student and community co-worker
experiences and opinions on that topic without having to read the entire
report. Of course, breaking down the material into so many categories
produced the disadvantage that some categories overlap in content. We
tried to assign excerpts as precisely as possible, but in some of the larger
excerpts (especially where the writer’s flow links several related topics),
it was necessary to assign the category on the basis of the “main thrust”
of the entire excerpt rather than its specific points. (Many of these papers
will appear at the front of discussions as “position papers” that set a
tone for the rest of that section.) Thus, the reader should be aware that
although he may be primarily interested, for example, in student views
on “patient advocacy,” he should also cross-reference himself to related
categories such as “white students in black communities” for perspectives
on the problem that may be stated in a different context. The “main
thrust” criterion was applied also to several excerpts whose significance
seemed, upon further consideration, to be more relevant to a category other
than the general grouping in which it would seem to belong at first glance,
e.g., BW’s description of his fund-raising activities for Newark’s New
Well addict rehabilitation program was finally placed under “Student
Health Project Role in Agencies and Hospitals” rather than under
“Agencies” or “Drug Addiction” because it seemed a better example of a
suitable (and successful) student role than a description of ‘either the
agency or the problem of drug addiction.

Another thing that has to be pointed out is that much of the material
finally used in the report reflects a mood of dissatisfaction that pervaded
vi.

the project throughout the summer, and which caused participants to focus
on their problems in meetings, reports, and interviews. Not all the partici-
pants were unhappy with their summer experience or with the Student
Health Project in general, but it appears that they were not as moved to
write about their successes and satisfactions as were those who had bitter
bones to pick. Thus, the report is biased in the sense that “usable” material
came primarily from the latter group. Overall, however, the editors feel
that the report does reflect the conflicts in and among participants as to
the meaningfulness of the summer. It should be noted here that those
Greater New York area health science students who constitute the regional
Student Health Organization “steering committee” voted recently not to
sponsor any more Student Health Projects of this kind. They concluded
that any future summer projects will have to be locally planned and ad-
ministered projects growing out of on-going activities of the Student
Health Organization or other groups at each medical, nursing, or dental
school.

Our apologies to those who may feel that what they had to say has
been distorted by quoting out of context, and to those whose observations
and opinions could not be used. Even after careful selection of what we
felt was the best of the material submitted, the first draft of the four major
sections of the report was almost 500 typewritten pages and had to be
further cut in a somewhat merciless fashion. Anyone who feels strongly
about his views being distorted or slighted is encouraged to consider sub-
mitting his ideas to one of the SHO publications such as Current.

Profuse appreciation goes to all those who helped pull this report
together, especially to Mrs. Marylyn Gore, Project Director, for many
helpful suggestions after reading the ponderous first draft, to Miss Jody
Williams of Albert Einstein College of Medicine (who handled much of
the project’s cumbersome administrative work during the summer) for
invaluable advice and efficient liaison with the funding agency, to Mrs.
Joanna McDonough, our excellent editorial assistant, and Mrs. Ruby
Hough, our manuscript typist, who stuck with us through the long winter
months and showed patience and understanding even when our demands

‘ became overbearing.

W. M. SMITH,
Amy T. SMITH,
March 1969.
Contents

PART 1: THE DREAM

The Task _.______.____-------------_-_ +--+ ------ ----
The Motivation ___.______------------------------------

PART 2: THE REALITY

Introduction ____._._._-_._..-------------- eee
Views of the Community __._.______._..-----------------
Health Care Delivery _....___._.-------------------------
Attitudes _________-_____--.----- eee +e
Medicaid, Medicare ______-.------------------------------
Dental Health ___._...__-._.__._-..----------------------
Lead Poisoning __....___.------------------------------
Drug Addiction ..._...---------------------------------
Family Planning __.__.----------------------------------
Housing ___..___..-------------------------------------
Legal Services __..-------------------------------------
Agencies ______---_------------------------------------

PART 8: ROLES IN CONFLICT

Introduction __..___----------------------------------- _
Students as a Force for Change ...-._--------------------
The Student Health Project and the Community ---..-------
White Students in Black Communities --------------------
Community Education and Training Programs --------------
Community Organizing _._.--.----------------------------
Student Health Organization Service Projects -.-.----------
Patient Advocacy ....__-----------------------+--------
Student Health Project Role in Agencies and Hospitals a
The Neighborhood Youth Corps -----.---------!----------
Community Workers _-----------------------------------
Faculty Advisors .__------------------------------------

PART 4: OPINIONS ON THE ORGANIZATION

Introduction ____._.------------------------------------
Greater New York Student Health Project Structure --------
Local Project Structure ...__-------------------------~----
Funding _____..__--------------------------------------
Student Fellow Selection _.._.--.------------------------
Interdisciplinary Team ----------------------------------

PART 5: EVALUATION

Introduction __._._..--.----------------------- Leelee
The Student Health Project as a Learning Experience ------

eH

10
18
29
33
33
34
34
37
38
40
41

vii
viii

What Next?—Suggestions for the Future __---------------- 129

Recommendations _...---------------------------------- 184
APPENDIXES .
A. Listing of Participants ---.--------------------------- 189

B. Health Resources in the Harlem Area ------------------ 148
Part 1:

THE DREAM

THE TASK

This section contains the project proposals
distributed to prospective participants at the
Orientation session. They were used by many
students to determine which area they finally
chose to work in.

Although most of the statements suggest
that substantial project planning and precep-
tor arrangements had been worked out, in fact
much of the foundation laying remained to be
done in several projects at the time students
were expecting to “go to work.” That the sum-
mer thus turned out to be a “use your own ini-
tiative” opportunity was extremely frustrating
and discouraging for many students who had
expected otherwise, as well as community
workers and Neighborhood Youth Corps teen-
agers, who were probably even more job action
oriented than the students.

In general, those projects in which specific
task definition and firm preceptor arrange-
ments had been made before the summer began
(e.g. Brooklyn’s King’s County Hospital and
St. Mary’s Hospital physician assistant pro-
jects, and Harlem’s school health referral pro-
ject) were most successful in terms of concrete
achievements, whereas more open-ended pro-
jects in which students had to “feel their way”
proved less successful (e.g., Brooklyn’s Model
Cities project, Harlem’s pediatric care center
advisory committee, Lower East Side Medicaid
cutback study).

But even good advance planning was not al-
ways sufficient, as evidenced by difficulties ex-
perienced in Brooklyn’s Youth In Action pro-
ject and Newark’s frustrating relations with
the Martland Hospital and medical school ad-
ministrations. Even in Harlem, where good
pre-project planning had enabled an early
start a month before everyone else began, Stu-
dent Health Project workers experienced sev-
eral weeks of frustrating slowdowns of the

school health referral activities due to less
than enthusiastic cooperation by some Depart-
ment of Health administrative and school
health program personnel.

It should be noted that “concrete task fulfill-
ment” as a measure of project success may not
be a valid criterion to judge project achieve-
ment since considerable disagreement existed
from top to bottom in all the project areas as
to what the Student Health Project task was
supposed to be: providing an educational expe-
rience in community medicine for health sci-
ence students versus helping a finite number of
persons get better health services versus bring-
ing about changes in health care delivery sys-
tems in the area. Certainly, however, each pro-
ject was both successful and unsuccessful to
some degree in each of these objectives.

Some subprojects were judged sufficiently
successful on a programmatic basis that at-
tempts were made to continue them year-
round. At the end of the summer, the students
requested that several thousand dollars of sur-
plus funds be reappropriated for distribution
to the Bronx project to continue the Unwed
Mothers project storefront, to the Newark pro-
ject to keep their advocacy storefront office
open, and to support a benefit show for the
New Well, a narcotics addiction rehabilitation
agency, and to the Harlem project to buy black
children’s books for clinic waiting rooms, and
to pay salaries to three of the community
mothers who had been trained to do school
health referrals (the Harlem project leaders
eventually obtained a $48,000 grant from the
Ford Foundation to keep their program going).

The Lower East Side Project

Students working with the Lower East Side
Project will be placed with members of the
North East Neighborhood Association, its dele-
gates or subcommittees and the NENA clinic

1
GREATER NEW YORK

(a total health care clinic to be run jointly by
the medical and Lower East Side communi-
ties). As consultants to community members
concerned with the problem of health care on
the Lower East Side, students will gain a
knowledge of community attitudes about
health care as well as of existing facilities
serving health needs and related areas. There
will be no door-to-door interviewing as factual
material can be obtained from the various
agencies serving the area.

Community attitudes will become apparent
as students develop working relationships with
community members. Students and community
people will develop a program of health educa-
tion responsive to community needs and priori-
ties vis-a-vis health services in the area. The
structure of the program and the type of
health education needed to improve health care
in a poor community will be determined by stu-
dents and community members during the
summer. The program will stress the role of
the professional student as a consultant whose
activities are to be directed by the community.

Specific activities will be determined by the
needs of the community and prevailing circum-
stances. Particular assignments will be made
on the basis of knowledge of the individual
student gained during Orientation. Students
will participate as fully as possible in commun-
ity life, and housing will be obtained in the
area for those students who so desire.

Interplay between students with discussion
about roles, impressions, and difficulties will be
encouraged and the importance of the project
as a group activity will be stressed. By the end
of the summer, each student will have a good
knowledge of health problems and community
life on the Lower East Side, of the community

members they will work with, and of each

other.

The Newark Project

During this past summer’s 1967 disorders,
Newark City Hospital had the distinction of
being the only hospital in the United States to
be fired on by snipers. These shots were indica-
tive of the general dissatisfaction with the care
given Newark citizens by the hospital. The
New Jersey College of Medicine has just as-

2°

sumed the control and management of this hos-
pital. The College’s goal is to improve the
health care delivered by the hospital. The Ne-
wark Project will attempt to upgrade local
health care and community opinion of the hos-
pital through (1) “patient advocacy,” (2)
clinics, and (3) improved student understand-
ing through exposure to the needs of the com-
munity.

(1) Patient Advocacy: Emergency Room—

Outpatient Department:

Students will work here (a) assisting the
patients who are receiving health care and
other social services which may be available;
(b) helping achieve total patient care which
may not always be immediately possible be-
cause of the mechanics or the attitude of the
hospital operation; (c) obtaining complete,
meaningful records of accidents and the condi-
tions which produced them.

(2) Clinies: Student Health. Organization

Evening Clinic for Chronic Diseases:

Members of the Student Health Organiza-
tion have already organized an evening clinic
at the NCH outpatient department. It is staffed
by five internists and two surgeons as well as
several students who do the initial history-tak-
ing and screening and also necessary lab work.
This will be expanded during the summer to a
nightly or weekly schedule.

(3) Student Hxposure:

stetrics

Development and use of a questionnaire for
maternity patients at Newark City Hospital.
Prenatal death rate in Newark is three times
that of the State of New Jersey—some of the
reasons are: (a) Out-of-wedlock children get
less care; (b) Care may be unavailable.

The questionnaire will investigate:

family size,

living conditions,

problems of pre-natal care,
nutritional problems.

In conjunction with the information ob-
tained by the questionnaire, the students will
focus on environmental problems. An outcome
of this might be establishment of a storefront
prenatal clinic or some realistic health-care fa-
cility.

Community Ob-
SUMMER

The Brooklyn Project

The Brooklyn project for this summer in-
volves working through five different agencies
or institutions. Participants on the project may
be able to work with more than one of these
agencies.

(1) Pediatric Outpatient Clinic of Kings

County Hospital:

Students will act as physician-assistants to
help save physician time. Specific duties will
include: (a) Interpretation of instructions for
patients; (b) relaying of information on nutri-
tion, hygiene and accident prevention to the
patients; (c) performing routine medical pro-
cedures; (d) history-taking, with the aid of a
questionnaire to determine the entire medical
status of each family. A major responsibility
will be the training of community persons for
paramedical positions.

(2) St. Mary’s Hospital:

Students will act as physician-assistants as
in (1). In addition, they will work with the
Crown Heights Health Council in developing a
Health Rights and Resources Handbook for
the community residents.

(3) Bedford-Stuyvesant Youth In Action:

With the assistance and supervision of the
organization’s professional staff, students will
interview clients with problems related to jobs,
medical care, legal aid, housing, job training,
and nutrition. They will help secure the neces-
sary services from existing agencies and per-
form follow-ups on all patients. Involvement in
family counseling and group discussion ses-
sions will also be an integral function of this
project. Tutoring and homework study pro-
grams are also planned.

(4) Brownsville Community Council:

Students will assist doctors in counseling on
contraceptive techniques, showing films and
conducting discussion groups. With the aid of
Neighborhood Youth Corps teenagers, pro-
grams of hygiene instruction in the commun-
ity, a health cleanup program, and a survey of
existing medical facilities are anticipated.

(5) Central Brooklyn Model Cities Program:

Details still to be worked out, but a compre-
hensive survey of health needs and resources
available to the residents of Bedford-Stuyves-

1968

ant, Crown Heights and Brownsville neighbor-
hoods is contemplated, in addition to other
functions.

The Harlem Project

On the basis of last summer’s program at
Public School 175, a plan for this summer’s
Harlem Student Health Project has been de-
signed, incorporating the knowledge gained
and cooperation began with community resi-
dents last summer. The new project will in-
troduce an adequate, readily financed, referral
program. Harlem is an area noted for large
numbers of inhabitants unconnected ,with any
health agency and for the fihire* of school
health programs even to recognize the health
problems of the students. The 1968 Student
Health Project will train community people to
function on a year-round basis as health
workers in the schools and as referral experts
within the school community. The backbone of
the project is the establishment of small
groups of parents who will meet with the
health worker to discuss health care as a vital
community issue. These health-conscious par-
ent groups will. begin to deal with redefinition
of health germane to local community needs,
will establish babysitting and escort services,
will act ag a nidus for further community edu-
cation in nutrition, birth control, and pre- and
postnatal care.

Several local elementary schools and their
Parent-Teacher Associations will serve as the
project population. The PTA’s with their ac-
tive participation will be the sources for the
community contacts, for health worker train-
ees, for homes to be used as meeting places, as
guides for answering pertinent health ques-
tions, as health committees to evaluate health
problems, as guides for SHP workers, and to
serve as an advisory group for the Pediatric
Comprehensive Care Center. Cooperation with
the original PTA group has been expanded
during the academic year and additional PTA’s
have pledged their participation.

The project will be. introduced at school
teacher-project staff meetings with the cooper-
ation of the principal of each school. An evalu-
ation of the role of the school health nurse—
her problems and needs—will be undertaken

8
GREATER NEW YORK

with her participation. Communication, with
an eye toward improving school health-care
programs, will be maintained with the head of
School Health Programs of the New York City
Department of Health.

Thus, health science students working in the
Harlem SHP will work in the community with
families, will deal with the referral problems,
and will develop with community support the
year-round bases for the project. A large pro-
portion of the project staff will be housed
in Central Harlem.

The education of the health science student
will come from a door-to-door, person-to-per-
son summer’ involvement in the problems
Harlem’s health care system, and his contribu-
tion will be his effort to deal with these prob-
lems in a short-term sense and to help create a
long-range plan to solve these problems in
ways that will be useful to the community. The
opportunity to work and live in the Harlem
area should lead toward a contribution to
creating a better level of health in the com-
munity.

Participating institutions include Knicker-
bocker Hospital, the Harlem Health Center,
Harlem Hospital, members of the Columbia
University School of Public Health and Ad-
ministrative Medicine, and the Harlem Health
Council.

The South Bronx Project
(1) Patient Advocacy:

Eight student fellows will work closely with -

community organizers from four storefronts in
defining the health needs of a circumscribed
slum neighborhood in the South Bronx. The
fellows will make home visits, accompany pa-
tients to local clinics, monitor followup care,
distribute information on health care facilities,
and prepare a Health Rights and Resources
Handbook. Each fellow will be accompanied in
his daily work by a member of the Neighbor-
hood Youth Corps. Special assignments will in-
clude a supervised study of medical patients,
and planning a biology and medical science

course in the newly organized Morrisania Com-

munity College.
(2) Child Health:
Four project fellows, including one dental

student and one nursing student, will organize
a child health survey in cooperation with four
neighborhood day care centers for children
ages 6 to 16. Project fellows will be responsible
for arranging discussion groups and films on
health issues for community residents and
their children. They will also teach first aid to
the Day Care Center counselors. The health
survey will be made with the help of third and
fourth year medical students.

(3) Mental Retardation:

Two student fellows will work with a com-
munity organization which has been given a
grant for a summer day camp for mentally re-
tarded children. They will help organize com-
munity support for submitting a larger grant
proposal for a permanent mental retardation
center.

(4) Unwed Mothers:

Two student fellows will work with a com-
munity worker at the Neighborhood Medical
Care Demonstration to organize a group of
unwed mothers for the purpose of obtaining
legal rights in housing, education, health prov-
isions; obtaining good health care for them-
selves and their children; gaining confidence to
function as dignified human beings; and fur-
thering educational opportunities. The student
fellows will work closely with salaried com-
munity preceptors in motivation, guiding, and
teaching.

THE MOTIVATION

The application essays of students who
wanted to work in this summer’s project were
important criteria in the selection process. In
reviewing the application essays (as well as
final reports) of accepted students after the
project ended, it could be seen that students
came to the project with many different moti-
vations.

Although most students expressed more than
one reason for wanting to participate, by far
the largest essay category, consistent with
what seems to have been a primary objective
of the SHP leadership, comprised those stu-
dents who expected the summer to provide a-.
learning experience, a chance to understand
the people of the ghetto and their problems, as
an extension of their professional educations.
SUMMER 1968

The second largest category consisted of stu-
dents who desired to offer specific service-ori-
ented skills (e.g., health education programs)
or just had an undefined desire “to help poor
people get better health care.”

Other motivation categories included those
who expected to achieve some degree of self-ac-
tualization by “giving of themselves,” and
those who hoped to compensate for the failings
of our society vis-a-vis the poor (or to assauge
their guilt in this regard).

Interestingly enough, only a few of the ac-
cepted applicants indicated in their application
essays an interest in effecting changes in
health care delivery systems and institutions
through politically oriented activism. Yet, this
surfaced as a burning issue early in the sum-
mer that split many of the projects right down
the middle, and was the cause of much of the
frustration experienced by project participants
that was expressed at the Final Conference
and in their final reports. Only one applicant
mentioned a need for the $900 stipend, but this
too turned out to be a matter of considerable
concern to many of the students as the summer
progressed.

The following excerpts illustrate not only
the variety of motivations, but also the range
of sophistication regarding the summer’s possi-
bilities that participants brought to the pro-
ject.

Participation in a Student Health Project
seems to me to be crucial in my education
* * * 4 unique opportunity to learn what I
otherwise never could.

* * * T- would hope to learn a new perspec-
tive on health care: a little insight into what
life is like for the urban poor, some under-
standing of where health fits into the priorities
of the community.

I want to build my education during medical
school along relevant lines * * * and I want to
work closely with a community before profes-
sionalism puts too much distance between us
* * * T want to make sure that community
health is the foundation of my education, not
the capstone.

My own education is the primary reason I
want to work on a project this summer, but not

the only one, I want to do something that will
be of service to the community.— K.B., Medi-
cal Student, Bronx.

The experience will help me become a better
individual and perhaps enable me to under-
stand my environment better. I will learn from
working with other members of the team as
well as with the individuals I am trying to
help. This will help me in deciding whether I
want to go into the field of public health after
I graduate.—J.L., Nursing. Student, Lower
East Side.

Besides bringing to the people my back-
ground and knowledge, I will be learning much
from them. I will learn much about myself and .
others. It is one thing to read and hear some-
thing, but another thing to actually know what
it’s like to be poor. It will be quite an experi-
ence and the personal satisfaction I hope to get
out of it will be exactly why I went into nurs-
ing—not for the money, but to help people.—
J.0., Nursing Student, Newark.

Working in such a project should be very
valuable in formation of my personality—
broadening my understanding of life and
awareness of problems of others. My primary
goal is having some effect on the poor living
conditions and inequality problems. of the peo-
ple on the Lower East Side.

* * * T believe there is a great need for
showing people how to help themselves, rather
than taking the attitude of condescension by
“helping” them, which has been proven unsuc-
cessful. ‘

Aside from the vast intangible benefits, the
financial aid would be of great assistance in
the coming school year.—B.G., Nursing Stu-
dent, Lower East Side.

My main reason * * * ig to learn—about the
ghettos and the people there, about the power
structures presently in existence and ways to
change those structures, about health services
in the city (or lack thereof), and how those
served would like to see health care changed.
—IB., Medical Student, Bronx.

I felt the job afforded one of my last oppor-
tunities for a “dose of liberalism,” so to speak.

6
GREATER NEW YORK

It potentially offered insight into the problems
of the disenfranchised that a hospital setting
will never offer. The desirability of working as
part of a community health team also caught
my imagination. I felt that the role of a medi-
eal student in a project might, in some small
way, differ from that of a nurse, social worker,
lawyer, etc. This too, I thought, would broaden
my outlook concerning possible solutions to
community health problems. A third lure of
the position was the opportunity the job of-
fered for community contact, though I must
admit that my concept of my role in commun-
ity interaction was nebulous even before I be-
gan.—J.R., Medical Student, Brooklyn.

* * * T have not had the experience to know
what real poverty is. I feel that I should have
the experience of working in a poverty area
and becoming more familiar with what cul-
tural and racial. factors prevent individuals
from living a healthful life. I want to come to
the level of these people to see their problems
more clearly, discuss these problems with the
people and other members of the health pro-
ject, and work on possible solutions to the
problems. I think I will be able to have a fuller
understanding of how I, as a nurse, can help
these people achieve the standard of living
they deserve. * * * I would be able to share
my experience with my classmates in nursing
schoo] when I returned in September, so they
too could learn more about how to help the
poor with their health problems.—L.D., Nurs-
ing Student, Newark. ,

Medicine is a full-time job in its strictest
sense. Yet, to turn away from the full man
(Le., in and affected by his society) is too strict
a definition of medicine. Consequently, I wish
to study, observe, and “get the feel of” what

_ affects man. This, I believe, will enable me to
diagnose the cause and alleviate the effect.—
J.C., Medical Student, Lower Fast Side.

The Orientation had impressed on us the im-
portance of the job. We couldn’t even call it a
job; it was more of a mission in understanding.
Our goals were many. Some of us wanted to
find out what life in the slums was really like,
Some of us wanted to find out what was ailing

6

our society and try our hand at curing our “so-
cial disease.” My goal was to give of myself
and in doing so find out what I was really
made of. I wanted people to tell me how I could
be of some use; I wanted to understand the
people of the community and wanted them to
understand and believe in me.—D.Y., Medical
Student, Brooklyn.

There is nothing worse than a hypocrite or
martyr in the ghetto. Bad enough I’m white
and middle class. I’m enthused by the idea of
really offering these people something con-
crete, of doing something they can’t now do for
themselves, or working with them to begin
something that won’t end with the summer.—
P.G., Sociology Student, Harlem.

I like working with people and caring for
the sick. However, I feel that hospital nursing
is too confined for the kind of care many peo-
ple require. * * * By going into a person’s
home you can see the type of problems he has
to face every day. * * * I would like to try to
help in finding a solution to a few of these
problems and I feel I could be of some service
because I want to help. On the selfish side,
working with people in poverty areas would
benefit me. It would enable me to once again
see the nursing profession as I did before I
chose to enter it. Finally, as a Negro, I havea
strong desire to help my own people.—A.C.,
Nursing Student, Newark.

It has long been my goal to assist less for-
tunate persons in obtaining human dignity by
helping them to secure equal. justice under law
and a decent standard of living, which includes
all necessary medical care as a right not a pri-
vilege.

* * * T consider this project an opportunity
to help and not a job or a task.—-N.W., Law
Student, Newark.

When I found out that I had been accepted
for a second summer with the Student Health
Project, I was both excited and optimistic
about the summer to come. I was anxious to
build upon last summer’s experiences, using
my knowledge to accomplish something defi-
nite. Last summer I had not expected to accom-
plish anything, and I was pleased with. what
SUMMER 1968

little I was able to do. In contrast, this summer

I had higher expectations, partly because of .

my experiences last semester in leadership and
group dynamics * * *—V.V., Nursing Stu-
dent, Bronz.

Working in the SHP last summer was an en-
lightening and exciting experience for me. I
learned more about the reality of medical care
as it exists for the majority of Americans in
those few short weeks than in my 2 years of
medical school,

* * * T felt that perhaps this summer, with
some of the initial learning process * * * be-
hind me, I might be able to do a lot more than
last year.—M.M., Medical Student, Brooklyn.

I have a brother-in-law who is a “social
work” minister * * * and who has effected
significant change * * * through similar
grass-roots activities * * *

I feel that the SHO projects are significant
efforts to bring about important changes in the
health care people in these communities have
been receiving. I want to be a part of this ef-
fort.—W.S., Medical Student, Halrem.

I think I should be a part of this project, not
because I am any more qualified than other ap-
plicants to do community organizing, or to
work with poor and minority groups in the so-
lution of their particular problem, but because
as a law student I am trained in “social engi-
neering”—the ordering of institutions of soci-
ety under the law. I want to do more than sim-
ply alleviate suffering for a summer. I want to
change the institutions that have so far been
unable to do the job.

* * * T want to hasten the day when such
projects are no longer necessary, and working
on this project will provide me with invaluable
practical experience, which I hope I can utilize
to help bring about long-run changes in the
law.—R.H., Law Student, Brooklyn.

“The present medical curriculum at Cornell
places little emphasis on ghetto problems and
solutions, so as an SHO participant I would be
filling a gap in my medical education. Further-
more, I might be so affected by the program
that I could work effectively toward changing

the curriculum to include instruction and expe-
rience in community medicine.

* * = T am concerned with health problems
of the poor and uneducated. SHO asserts the
right of every man to comprehensive health
service; I completely support that assertion
and I consider it my duty * * * to do every-
thing to provide effective health programs for
all people.—L.B., Medical Student, Harlem.

* % &* My experience would also enable me
to encourage Stanford to set up an SHO sum-
mer program of its own to serve the needs of
the Palo Alto community.—B.W., Medical Stu-
dent, Newark.

* * = T feel the commitment to offer assist-
ance to that part of the population which has
generally gotten the nation’s digested food-
stuffs as daily fare. * * * The experience I
would get from this project is of the sort that I
would be able to use in my day-to-day contacts
with other fellow students and attack their
motivations and purposes and try to interest
the great uncommitted. In my professional role
I believe this summer’s experience would be a
big step in defining for me exactly what I want
to do in the health field —D.T., Student Coor-
dinator, Newark.

As a white person, I share with my society
the guilt of having manipulated the “poor.”
*.* * T want to give all the life I’ve got to un-
ravel the tangled mess that exists—B.M.,
Nursing Student, Brona.

* * * T felt quite hypocritical since my po-
litical and social convictions were distant from
our nation’s practices and I was not doing any-
thing to express my dissent.

* * * SHO filled this discontent that was
growing more and more in me. The work I am
doing seems to be at least a step in the right
direction.—L.K., Medical Student, Brooklyn.

For me, working directly with the underpri-
vileged would be one small way of putting good ©
intentions into action.—V.S., Dental Student,

Bronx.

I am aware of the sad fact that my profes-
sion has devoted its energy almost entirely to

7
GREATER NEW YORK

middle class patients, and as a psychologist I
hope eventually to move things out into the
communities where help is most needed.

* * * The main reason for my wanting to
be part of this program is simply that I would
like to do something worthwhile this summer
* * * T have not felt particularly effective this
year, sitting in the library studying while so
much immediate concrete work has to be done.
I also cannot help but feel totally frustrated
with the condition of this country today. At a
time when positive action is needed I would be
particularly grateful to get out and do some
tangible and helpful work.—M.I., Psychology
Student, Harlem.

I have long been disturbed by the relegation
of the individual to a mere cog in society’s gar-
gantuan machine. Indeed, in 4n age when we
tend to appreciate humanity only as an amor-
phous mass, medicine should reassert the need
for appreciation of the individual’s worth. Yet,
it appears to me that organized medicine has
often lost sight of this goal. Poverty may be an
abstraction, poor people are real. Medical
school can be a terribly discouraging enter-
prise for a student who sees medicine as more
than a mere “profession.” * * * I would like
medicine to be a means for deepening my un-
derstanding of people and for my rendering a
genuinely useful social service.—D.S., Medical
Student, Lower East Side.
Part 2: THE REALITY

INTRODUCTION

After 3 days of “Orientation” to the summer
ahead (held at an upstate New York resort),
the SHP student fellows and community
workers officially arrived in the five ghetto
communities of Greater New York City on
June 27, 1968, eager to begin implementing
their formidable task proposal.

Bedford-Stuyvesant, typical of the communi-
ties in which the Brooklyn SHP was located,
has a population of 190,000, 85 percent of
whom are black. The median family income is
far below that for the city as a whole and the
unemployment rate of 7.2 percent is more than
double the national average. The usual slum
pattern of inferior, inadequate housing,
schools, sanitation, and recreation facilities
prevails. The majority of inpatients are seen in
the massive, 3,000-bed Kings County Hospital,
outpatients using any of the hospital’s 32 over-
crowded clinics. There are woeful shortages of
community practitioners, dentists, and. home
care services. Essentially similar statements
could be made for the Brownsville community,
served by Brookdale Hospital, and the Crown
Heights community, served by St. Mary’s Hos-
pital.

Newark, a city of 405,000, can claim the
highest of any national crime rates, the high-
est national incidence of tuberculosis, alcohol-
ism, venereal disease, and drug addiction. Its
health profile reflects the ignorance, bitterness,
and despair of a-large segment of the city’s
population which had hoped to escape the
blight of the decaying rural South. Newark
has proven, instead, to be a blind alley whose
only exit is often through inward self-destruc-
tion of explosive violence of varying degree.
Health services in Newark are provided
mainly by Newark City Hospital (Martland),
which lies in the center of the Central Ward,
one of the city’s largest ghettos. The area has

lost almost all of its neighborhood practition-
ers.

The South Bronx, which is just a short drive
from down-town Manhattan, has traditionally
been a rapidly changing community of immi-
grants. At present, it is a Negro and Puerto
Rican area which has few private medical
practitioners. Its hospitals and health centers
are overcrowded. There is a high infant mortal-
ity rate in many health districts, and lead poi-
soning of infants, rat bites, and drug addiction
are great community problems.

Health services in the South Bronx are pro-
vided by ambulatory care centers in Morri-
sania Hospital, Lincoln hospital, and by many
new neighborhood service centers for mater-
nity care and mental health. Most inpatient
services are provided by the hospitals men-
tioned above. One of the great innovations in
primary medical care for this medically indi-
gent area is the Neighborhood Medical Care
Demonstration (NMCD), funded by OEO as a
demonstration project. This center has been a
great help in changing the pattern of health
care delivery. North of Central Park, New
York City changes its complexion. It becomes a
teeming ghetto of closely packed houses, lit-
tered streets, and alienated citizens—Harlem.

. Summer in this neighborhood means the swel-

tering humidity and scorching heat of poorly
ventilated apartments forcing youth into their
playgrounds on the streets. The freedom of
summer turns into an endless ballgame or wad-
ing pool filled by gushing water hydrants.

Although Harlem has the high unemploy-
ment and crime rates characteristic of other
depressed areas, one of the most troubling as-
pects of life is the inability of youth to im-
prove their fate. They receive few aids to im-
provement and have many chronic health prob-
lems, some of which are direct results of their
environment, ce
GREATER NEW YORK

Harlem is served by Harlem Hospital,
Knickerbocker Hospital, private practitioners,
and practitioners of folk medicine. This area
has one of the highest infant mortality rates in
New York City. Lead poisoning and rat bites
have traditionally been health hazards for
those who live in the ancient housing of this
predominantly Negro community.

The Lower East Side has traditionally been
the home of immigrants. Puerto Ricans and
Chinese now makeup the larger part of the
community but there are still many Jews, Ne-
groes, Ukranians, and Italians. The median
grcss income is approximately $2,000 less than
the average for the city. Drug addiction, alco-
holism, and crime are the main problems in
this neighborhood, where many inhabitants
speak little or no English. The public schools
have been abandoned by those families who
can afford to do so. As much as 10 percent of
the total labor force many be unemployed at
any one time.

Health services are provided by 106 private
practitioners, more than 40 of whom work in
the Wall Street area and in effect do not pro-
vide medical care to the inhabitants of the
Lower East Side. In recent years the Gouver-
neur Ambulatory Care Unit of Beth Israel
Hospital and the Judson Health Center have
delivered the bulk of primary medical care. In-
patient services are provided by Beth Israel
Hospital and the mammoth Bellevue Hospital.

Although many of the SHP workers had
some prior understanding of The Reality of the
health care delivery deficiencies in these com-
munities (at least from a professional point
of view), the awakening of many participants
to the realities of life in a ghetto environment
and the circumstances of health care delivery
from the patient’s side of the admitting desk
constituted the first stage of the “learning ex-
perience” ‘that was, perhaps, the most signifi-
cant of the summer.

VIEWS OF THE COMMUNITY

Brooklyn

At the beginning of the summer I had certain
ideas about the problems existing in the Bed-
ford Stuyvesant community. For the most part,

10

these views have not been changed but, rather,
reinforced. I have come to consider the urban
ghetto another country: an isolated colony of
the United States, dependent upon the U.S.
economy for its essential needs, at the same
time not being a part of the mainstream of so-
ciety nor sharing on an equal basis the wealth
existing in this great Nation.

Like most colonies, Bedford Stuyvesant is
economically underdeveloped; furthermore, it
is exploited by those who have control over its
existing economy. This economy is one which is
setup in such a way that it takes the small
monetary resources which do exist and drains
them from circulation in the community. Like
other economies of the world, the affluence of
the people in an urban community depends
upon how much money enters the community
and how many times that money exchanges
hands within the community. Money can enter
in the form of payment for goods and services,
wages, interests, and rents. ‘

For the most part, communities like Bedford
Stuyvesant are unproductive: no industries
exist and no goods are manufactured in the
community. Therefore, money does not enter
for payment of goods. On the contrary, money
leaves in the form of payment for essential
goods produced outside of the community by
nonresidents. The obvious solution to this
problem is to bring more industry into the
community, Such industries should be owned
and run by residents and should provide essen-
tial goods for residents and/or nonresidents.
(This is presently being done on a small scale
in the clothing industry. )

In the case of interest, we see another vehi-
cle for the exit of money from the community.
There are few creditors, if any, in Bedford
Stuyvesant; there are, however, a great many
debtors.

Rents represent a large drain on the com-
munity’s monetary resources. I, for one, think
that rents should be taxed away, thus abolish-
ing landlords from the face of the earth.
Rents in the pure economic sense are money
paid in return for which no goods or services
are given. (A perfect example of this are rents
paid by Nebraskan farmers to individuals or
SUMMER 1968

corporations completely removed from the
land.) The land was here long before any land-
lord came into existence; furthermore, the
land will be here long after the last of the land-
lords has turned back into dust. I believe that
no mortal being has the right to claim that he
owns so much as 1 square inch of soil on the
face of the earth. Rents and the ownership of
land is purely a European concept. In Asia and
Africa people live on and work the land but
the landlord-tenant relationship is unheard of.

Slumlords are the same type of landlords
as those who rent land to tenant farmers: they
accept rents; they provide essentially no ser-
vices; they don’t keep the buildings in good
condition; often they don’t provide heat or hot
water, proper garbage disposal, or elimination
of rats, roaches, and other health hazards. The
few services their tenants do receive are pro-
vided by the city, not by the landlords to whom
they pay rent and from whom they should re-
ceive services for said payment.

Article 7A is a law which has been setup in
New York to deal with this problem. It prov-
ides for the withholding of rents from land-
lords who fail to supply required services.
The rents withheld are used by the city to
provide the services to which the tenants have
a right and which the landlords have not seen
fit to give. At the present time, however, this
law is not being applied on the scale necessary
to deal with the problem.

Wages are the major route for the entrance
of money into the Bedford Stuyvesant com-
munity. The problem is that these wages are
not enough to support the economy of the com-
munity. One reason is high unemployment, an-
other is the type of employment available. The
jobs which are available to the population, for
the most part unskilled and uneducated, are
usually low-paying. .

If the economy of the community is to be
strengthened, more money must enter. One
way of doing this is to raise the total wages of
the community, which can be done by creating
new jobs to meet the level of knowledge and
skill already in existence. At the same time, if
education and vocational training are ‘im-
proved, residents will be able to move into bet-

ter paying jobs. “To get a good job, get a good
education.” Education and vocational training
represent major tools for improving the econ-
omy of any economically underdeveloped area.

The rendering of services represents a po-
tential means of keeping money circulating
within a community. But this is another area
which represents a drain on the community re-
sources. One of the larger services provided is
the sale and distribution of essential goods in
the community—food and clothing. This serv-
ice is provided by large corporations and mer-
chants who are, for the most part, nonresi-
dents. These are the men who drive down from
the suburbs in the morning and leave at night,
often exploiting the community residents by
selling poor quality goods at high prices.

In recent years, programs have been started
to encourage community residents to enter into
small businesses, largely in the merchant field.
Such programs, however, will continue to have
limited success unless residents are provided
with the knowledge necessary to run a small
business. Once again, the issue is the need for
adequate education.

At the present time there is an attempt
being made by residents to provide themselves
with a service once rendered by nonresidents,
often in a discriminatory manner: taxicab serv-

‘ice. The medallion cabs are licensed by the po-

lice department—the gypsy cabs are licensed

‘by the people. “Black Pearl means Black

Power.” Indeed, if Black Pearl, the private .cab
service association, wins its fight to exist, it

- will have a beneficial effect on the economy.

The existence of the gypsy cabs serves to keep
money circulating among residents of the com-
munity. .

In this report, I’ve concerned myself with
problems other than health problems existing
in Bedford Stuyvesant which, when solved,
will elevate the community into the main-
stream of American society. I cannot deny that
health-care delivery is a problem in the com-
munity. However, its solution will not upgrade
the status of residents of the community. They

‘realize this, and therefore health care has ‘low

priority. I recognized this at the beginning of
the summer and chose to work in the Youth In

11
GREATER NEW YORK

Action education program rather than in a
health problem area.

The students working in the YIA homework
study program were criticised for devoting
their full time to this program. The basis of
this criticism was that the project was not ori-
ented toward health. I trust that the people
who felt this way are now beginning to realize
that health is not of high priority among the
problems of the urban ghetto, just as it is not
in other economically underdeveloped parts of
the world.

In such areas the problems to be solved first
are economic ones. Western countries have often
solved the health problems of undeveloped coun-
tries long before they have even begun to think
about socioeconomic difficulties. One result has
been a population explosion which makes it
that much harder to solve economic problems,
Indeed, in most instances the economic progress
has been nullified by the population explosion.

Another solution offered by the Western
countries has been foreign aid, charity and
handouts, all of which have no positive effect
whatsoever on the economic development that
would eventually eliminate the need for aid
and reduce the dependency of the undeveloped
areas on the Western world.

The same sort of Christian ethic which has
shaped the relationship of the West to the un-
derdeveloped areas of the world has shaped
the approaches the Federal Government has
chosen to solve the problems of the ghetto.
Such programs as medicaid, welfare, and other
assorted handouts are all very beautiful ideas,
but. in the end they. don’t even scratch the sur-
face of the problems which exist. If all the
health problems of the urban ghetto were
solved: tomorrow, the only significant change
would be that there would be a lot of healthy
people throwing bricks and bottles at police-
men and firemen.—R.J., Medical Student Brook-
lyn. .

In working in Brownsville, one must take
into consideration something not found in
other ghetto areas; Brownsville is a very unor-
ganized community; there are many deserted
houses all over that were burned out and are
waiting to be demolished. In Harlem on a Fri-

12

day night you will see people having fun. In
Brownsville people walk along depressed with
their heads held low, many nodding from their
last fix. There is little spirit in this community
and that is why working here is difficult. There
are no chapters of CORE, SNCC, or other. na-
tional organizations Thus these people are not
aware of much more than their immediate
personal needs.—D.K., Medical Student Brook-

lyn.

Brooklyn

For too long we have been satisfied with
charity where rights are involved. The legal
profession has been a major offender in this
area, but there is reason for optimism in recent
decisions of the courts. The problem of the
poor is that they do not have enough money.
That is not their only problem, but their other
hangups are shared with their more affluent
brothers. The solution is not to provide the
poor with goods and services, food stamps, wel-
fare, or free medical care at special clinics, but
to get money into their hands. They should
have the same opportunity to squander their
money on what many would deem less benefi-
cial services as anyone else, for who is compe-
tent to tell another what is worthwhile and
what is not? It is paternalistic for the affluent
society to decide what is good for those who
are not affluent. The poor are not free, for
their only choice is between starvation and ac-
cepting largess with strings attached. Our wel-
fare laws date back to the Elizabethan Poor
Laws, when being poverty stricken was akin to
being a criminal.

Paternalism in society has the same conse-
quences as paternalism in the family——the son
must rebel against the father before he can
feel himself a man. We are seeing the results
of this policy in the rising crime rate and
urban riots, at a tremendous monetary cost to
society. Those who do not rebel become depen-
dent, docile, unwilling to change, lest they some-
how run afoul of some welfare regulation
and have their relief check reduced. As for the
rest of society, it gets its money’s worth in the
psychological satisfaction of. moral indigna-
tion, and retains its ability to discriminate
against the poor. They are kept in ghetto
SUMMER 1968

areas, in public-housing projects. They do not
have access to the same professional, educa-
tional, and- social opportunity as their affluent
neighbors. The legal aid society, the county
hospital, and all other agencies which require
a means test are separate from the agencies or
facilities used by those with money. The Su-
preme Court has held that separate is inher-
ently unequal in regard to education and race.
Perhaps the same reasoning applies to poverty.
Discrimination on the basis of rich and poor
may violate the equal protection clause of the
14th amendment.

Furthermore, abolishing this discrimination
may save tax dollars. If everyone had money,
then everyone could be sued and would be in-
surable, and many crimes could be converted
into torts. A burglar, arsonist, or murderer
could be sued for damages by the victim, thus
killing three birds with one stone: the “erimi-
nal-tortfeasor” would be punished, the victim
would be compensated, and society would be
saved the expense of keeping the man in
prison. The few really dangerous people could
continue to be dealt with by custodial treat-
ment, but with more due process guarantees—
preferably as mental patients. There are other
costs that would be saved. The waste involved
in relocating slums by urban renewal, sending
city dwellers to the suburbs, building freeways

to bring them to and from the city, then hav-

ing to deal with the resulting smog problem,
and then watching the same thing happen over
again in another place is costing more than an
outright gift of a minimum standard of living
to every poor person. And the human cost in
terms of physical health, and emotional inse-
curity is difficult to calculate.

Just how this minimum amount of money is
provided is a decision for the legislature. It
may be done through a negative income tax, or
through recognition of a right to employment,
either with government or indirectly with pri-
vate enterprise. The latter should include the
choice of quitting and taking another job. An
additional means would be to enact legislation
requiring full disclosure by merchants, loan
companies and landlords, and granting treble
damages to any person who deals with them

without having the qualities of the product or
the terms of the contract fully disclosed. Such a
statute is fully consistent with modern theories
of tort liability, in which the risk of liability is
placed upon the party most able to insure
against the risk.

The problem is not with the poor, it is with
the institutions and the laws. People, even poor
people, can see what is in their own best inter-
ests. No one else can do that for them. What
one can do is try to educate, persuade, and
make available, Certainly there is less need for
public health services if everyone can afford
his own doctor.—R.H., Law Student, Brooklyn.

I don’t imagine community people feel very
much about health care one way or the other.
It’s a sort of episodic thing. You go when you
need to go. Some people are regulars, according
to the nurses. They come to the hospital like
some people go for walks or play mah-jong or
go to the movies. That is not to say that they
are malingerers, but only that St. Mary’s Hos-
pital is as much a part of their daily existence
as anything else in the Brooklyn community.
People want care and do, for the most part,
have confidence in doctors as a breed who
know their business, but they do not often per-
ceive the professional’s ideas on better health
care as being great improvements. Taking the
time to answer questions on a medical history
form may help the doctor, but it is not always
welcome to the patient who has to go home to
the other kids—-M.H. Sociology Student,
Brooklyn.

The basic problem I found this summer in
Brooklyn is that the medical problems from
which the poorer communities suffer are less
important to them than problems of survival.
A toothache isn’t important if you’re starving.

. Even with medicare and medicaid it is costly
for a ghetto mother to obtain care for her kids.
Often babysitting services are needed and
transportation to the hospital is time-consum-
ing. Accounting for the costs of a babysitter or
a taxi can be a big order for many families.
The result is that medical care is neglected
until a serious problem arises. .

In poverty areas, where people are more con-
cerned about money for food and clothes and

13
GREATER

things like that, health care has to take a sec-
ondary position because it is not as immediate
a need, This is the problem in Brooklyn. We
find that to a lot of the residents, health care is
equated with emergency room care, There is
very little concern for preventive medicine.—
WS., Student Coordinator, Brooklyn.

Newark

What is this community that we were to
reach? They did not respond to radio appeals,
personal appeals, or flyers. The “leaders” we
attempted to integrate within our local organi-
zation did not “produce.” A person suggested
as a leader by our community worker promised
to reach “different folks with different
strokes,” but when we failed to move our or-
_ ganization into his domain he evaporated. To
* the outsider, the Newark “community” is apa-
thetic and hardened against any type of appeal
to join and march. They generally fear and
dislike the treatment that they have received
from the city at Martland Hospital, but they
will not rally with the white liberals to upset
the status quo. What is the community? They
are a disparate group of leaders jockeying for
power and, perhaps, money, within a cross-sec-
tion of distorted values (by white middle-class
standards). To “them” we are richer, different
outsiders who in many cases don’t belong.

These are things I feel very strongly about:
apathy and what is the community here, who
represents the community, who are the com-
munity leaders? I don’t think anybody knows.
We ran into problems with the administration
of the hospital and the administration of the
medical school because they thought we were
upsetting the community, but I think they
were entirely wrong. I don’t think they know
who the community is (though they think they
do) and I don’t think we know. The adminis-
tration doesn’t feel that these people are repre-
sentative, these mothers who have been wait-
ing four hours in a clinic or the factory
workers who have to be dragged to a meeting.

Another thing is the tremendous disappoint-
ment you get when you think you’ve got com-
munity involvement and no one shows up at
the meeting, which was pretty normal for us.
The question is, how do you reach this com-

14

NEW YORK

munity which has a defensive shield around
it? P.D., Medical Student, Newark.

The people are on the verge of a major re-
volt. Right now, they are awaiting the election
year, but if Newark does not have a black
mayor and a black majority council in 1970,
Newark will burn. Newark’s blacks are not
only tired of poor health care but also of the
whole political system.—D.B., Community
Worker, Newark.

Newark-born, I never realized how badly in
need my people are. I never knew how disinter-
ested they are in their surroundings, that they
don’t care to come out and help themselves or
to take part in building a better place in which
they could get a better outlook on life.

I never knew that a community of people
could stand to be content where there are so
many disadvantages, not only with housing,
clinics, welfare, and schools, but with many
other everyday things.

As a community worker in Newark, I hope,
during the next 10 years, that the people will
come out and be willing to take part in trying
to build a better community in which they can
live, It will take time to give the black people
back their confidence in any new organization,
health or otherwise. The needs are far too deep
for a mere 10 weeks of SHP to help them help
themselves. They don’t know who to listen to:
for too many years black people have been lied
to by all kinds of so-called do-gooders. I pray
that the services that SHP has offered the peo-
ple of the ghetto area in Newark have not been
a total loss, but only a start for better under-
standing between the hospital and the black
community.—K.C. Community Worker, New-
ark.

Newark

* * * The newest and most popular weapon
in the war on poverty’s arsenal is an attempt
to change a common feeling in the ghetto of
despair and powerlessness into one of hope and
a sense of power over one’s life by giving the
community control of decentralized local pro-
grams and institutions. This approach may have
some validity as a line of communication and a
peaceable channel for protest which forestalls
SUMMER 1968

or helps to prevent ghetto insurrections. How-
‘ever, the experience I have had in observing
the United Community Corporation Area
Boards in Newark suggests that the commun-
ity approach is not very effective in alleviating
hard-core poverty. These Area Boards are fail-
ures because they do not reach significant num-
bers of the real poor. In large part, the real
poor include those without the time, energy,
knowledge, or hope to go to the meetings of the
Area Boards, to speak up to and not be intimi-
dated by the clique who run the meetings. The
United Community Corporation spends vast
sums on rent and office equipment, and very lit-
tle, if any, money or material goods gets to
those who need them the most.

Much better than this approach would be an
individual approach to the universal problem
of poverty, for example, low income. This
would involve an overhaul of the welfare sys-
tem to provide something like a guaranteed
minimum income and other features designed
to make it possible for persons to get off wel-
fare, for example, enough babysitting stations
so that a mother of dependent children (70
percent of all welfare cases) can leave her
children and work. If a welfare recipient does
start making money or inherits some, he
should not have to give it all back to the Gov-
ernment and thus have to remain on welfare.
There must be an incentive to welfare recipi-
ents to get off welfare; it should be made possi-
ble to earn more by working than by being on
welfare by providing that money earned is not
deducted from the welfare check. The present
welfare system provides no such incentive. In
fact, the existing welfare system is producing
second and third generations of welfare recipi-
ents by such features as requiring children re-
ceiving aid to dependent children to give what-
ever money they earn to the family who then
have that amount deducted from the welfare
check. Neither the mother or the child have
any incentive to get a job because it is almost a
foregone conclusion that neither can get a job
which pays much more than the welfare check.
—N.W., Law Student, Newark.

Harlem
The biggest problem I felt in working in the

Harlem community was, “who is the commun-
ity?” Here I was really stumped. Out in the
Midwest where I grew up, communities were
pretty homogeneous. But in an area such as
central Harlem, community is almost indefin-
able. The community of Lenox Terrace (high-
income housing) is infinitely different from the
community of the middle and low income hous-
ing project across the street, and both differ
greatly from the community of brownstone
tenements they face. The community of well-
kept brownstones in the block of West 187th
Street out of which we were working was very
different from the run-down brownstones on
the same street across Seventh Avenue. Not to
mention the multiplicity of self-anointed com-
munity leaders and ad hoc community groups
working independently toward the same objec-
tives.—W.S., Medical Student, Harlem.

Harlem Hospital was presented to me as a
place where people go to die. Columbia Univer-
sity and its students were portrayed as an in-
stitution that had in some way or another
created the woes and hardships of the people
in Harlem. The city fathers have been neglect-
ing Harlem, I was told, and a most impressive
illustration of this is the beautiful, ultramod-
ern but too long unfinished Harlem Hospital—
a structure which seems to tantalize the peo-
ple. I was told that community control was the
only way out and to get this it was necessary to
demonstrate. It seems, however, that many a
demonstration had gone for nought in the past.
As I passed our neighbors day after day, I
could sense their confusion, frustration, and .
contempt. They were vexed.—E.M., Law Stu-
dent, Harlem.

Harlem

The attitudes that people have about facili-
ties, without even using them, are subtle and
difficult to document. Nevertheless, there were
some things that came up over and over again
which had little to do with the actual health
care delivery facilities, but which kept people
away.

Health is not a high priority issue for many
people who live in Harlem; health care often
means the alleviation of a medical emergency,

15
GREATER NEW YORK

not preventive care or the treatment of prob-
lems that aren’t causing immediate, severe
pain. We ran across numerous cases of people
who had not taken their children to treatment,
even after referral, simply because they didn’t
think it was important enough.

Lack of knowledge about health and health
facilities is one of the reasons for the low
priority; people may not know that a hernia
can strangulate and become a serious problem
very quickly, or they may not know that there
are specialty clinics for problems such as obe-
sity. People seem to think that if a problem
isn’t causing immediate discomfort then it
probably isn’t very serious, If someone does
impress on them the seriousness of the prob-
lem, or if a mother is scared because she
thinks the problem might be serious but isn’t
sure, we found that she would usually take the
child to a treatment facility. The lack of knowl-
edge about facilities available was noted but
was sometimes an excuse rather than a serious
hindrance. ,

Perhaps the major reason why health does
not have a very high priority in Harlem is that
there are so many other problems facing peo-
ple who live there that have more to do with
simply keeping food on the table and keeping a
decent apartment. Rather than try to describe
the galaxy of social problems that afflict people
living in Harlem, I will outline a few: Health

care is expensive; not only does treatment at a.

clinic or a doctor’s office cost a lot, but it may
mean the loss of half a day’s salary to go to
an appointment. Added to this may be the cost
of a babysitter to take care of a mother’s other
children, and transportation costs to get to the
relatively centralized health facilities in Har-
lem. As a result, checkups or non-emergency
problems are often prohibitively expensive.

Moreover, people who live in Harlem may be |

more interested in getting a job with a steady
salary than in attending to health problems.
Housing conditions or keeping up with pay-
ments on merchandise may come before health.
Preventive medicine may be impossible in a sit-
uation where there is a general lack of a fu-
ture orientation.—_R.C., Student Coordination,
Harlem.

16

Going in and among the people, through
some dirty hallways to—almost always—the
topmost floor, seeing the undelivered garbage
on the landings and around the buildings made
me wonder why it is that the city does not do
something about it all. This left me with an
impotent feeling when I realized that we have
come and will be going and leaving these peo-
ple in the same conditions and knowing full
well that what we have done hardly began to
seratch the surface.

It seems to me that SHP, and through no
fault of our own, is really powerless to effect
any meaningful change in the lives of these
people, except that we can bring the needs of
the whole community to the attention of the
powers-that-be with the hope that some social
change will be effected which will lessen some
medical problems encountered in the commun-
ity.

Let’s face it. The incidence of poor eye sight,
TB, and rheumatic heart disease bears a direct
relationship to the socioeconomic conditions of
the environment in which they are found.—J.H.
Medical Student, Harlem.

In terms of health-care delivery, the most
important differences I discerned in Harlem
are matters of priorities. Residents of Har-
lem’s Lenox Terrace, and the middle-class ori-
ented mothers with whom we worked, can af-
ford to be concerned about preventive medi-
cine, dental care, and the like, because their
physical and psychological environments are
more in order than those of the slum tenement
families across the street.

Some of the mothers whom I visited had an
entirely different hierachy of priorities, and
preventive medicine was far down on their
lists, below housing, food, and crisis medical
care, their major concerns were matters of
day-to-day survival in a hostile, uncaring, un-
responsive world.

I found it very difficult to convince myself,
much less a tired, distraught mother of several
children, that one of her kids needed a general
checkup “just because” when they were sleep-
ing three to a bed in a dark, smelly, roach-in-
fested two-room hovel for which she paid $90 a
month.
SUMMER 1968

I felt that I was in no position (strange out-
sider, inexperienced student) to address myself
to her real problems and that even if I turned

her case over to one of our law students, there -

was little he could do for her either. Should we
have come more prepared to direct ourselves to
those needs that the people in the community
consider more pressing than non-crisis health
care? If so, what can we really offer at all ex-
cept a body willing to do legwork or babysit?
(Actually, we don’t have that much more to
offer!)—_W.S., Medical Student, Harlem.

Bronx

The mothers’ classes in the Bronx were not
attended because the mothers did not see at-
tending classes as a priority need. When a
mother has unsolved problems with welfare
and housing, she really is not too concerned
about what happens to her body during preg-

nancy. I am not suggesting that there is not a.

need for such classes, but more immediate
needs should be taken care of first. A better ap-
proach to providing health classes may be to
work through welfare rights or housing
groups. There is a need for individual health
counseling for people facing specific health
problems, but hoping to form a group for the
sole purpose of health classes is unrealistic.—
V.V., Nursing Student, Bronx.

I felt out of place forcing the issue of health
care when the tenants had many other things
they wanted first, especially housing repairs,
full welfare benefits, and better police protec-
tion. The health care I heard about sounded
like all the cliches—poor quality, fragmented,
inaccessible, without regard for the dignity of
the patient, in the control of external institu-
tions. On the whole, I think the real lack was
in preventive measures. The housing code on
hazardous and unhealthful conditions is not
enforced, garbage is not collected, walls and
ceilings let rats and roaches through, diets are
often skimpy.—K.B., Medical Student, Bronx.

When SHP comes back, please do not ask the
community how you can help them because you
will hear everything but health problems.
They will tell you welfare, housing, play
streets. Just let them know you are willing to

help them if they have health problems.—M.G.,
Community Worker, Bronex. :

Bronx

There is mixed opinion in the community
about the health care they are receiving. It is
obvious, however, as you go from home to
home, which family does its best for its chil-
dren and which do not even try to secure the
care available to them. Mothers are often ne-
glectful except when it comes to themselves.
Children are dirty and unclothed and receive
no medical attention. Other mothers of equal-
sized families in the same area do not live ela-
borately, but the home and children are clean
and they do their best. They are the ones who
do not complain too much if asked about medi-

eal care, although everyone has some gripes

about hospitals such as Morrisania. The ne-
glectful mothers are more dissatisfied, but
again are primarily uninterested or despairing.
—P.B., Nursing Student, Bronz.

I really couldn’t state in words the feeling of
disgust and the “I don’t give a—” attitude that
the people in the South Bronx have toward the
hospitals and clinies.—

H.H., Nursing Student, Bronx.

Lower East Side

Much of our information concerning the
Lower East Side community’s view of the
health care in the area was collected by means
of random canvassing throughout the commun-
ity. As with most methods of canvassing, there
are no real instruments to measure the validity
of expressed opinion and experience. There-
fore, after sifting through generalities, in-
dividual misfortunes, etc., we focused upon a
number of problems that appeared to be repre-
sentative of the community as a whole. The two
problematic areas to which our group initially
directed most of our time and energy were: (1)
The recently instituted medicaid and medicare
sliding-scale classifications for clinic fees; and
(2) the transportation problem wherein people
found it an inconvenience to travel to and from
the Bellevue outpatient clinics—E.C., Medical
Student, Lower Hast Side.

If we in the Lower East Side SHP regard

17
GREATER NEW YORK

ourselves as healers of a chronically ill system
of health care delivery, then our treatment of
it this summer can best be described as symp-
tomatic. I do not believe that the health care
problems of the Lower East Side are related to
the methods of health care delivery per se. It is
unfortunate, for example, that a patient may
have to wait a long time at an allergy clinic for
his turn to see a doctor; but if we find that the
patient’s allergy responds remarkably well to
moving him from his dirty, roach-infested ten-
ement to a clean and airy apartment house,
mustn’t we admit to ourselves that the prob-
lem, really, is in the housing? I believe that
future Student Health Projects will make more
enduring and important changes in the health
of the communities they work in if they con-
cern themselves more with social, economic,
and political activism, and less with estab-
lished medical facilities or health-oriented com-
munity organizations which are, afterall, dedi-
cated to the maintenance of the status quo. Im-
proved health care in the Lower East Side area
in the future depends more on providing more
and better jobs, better housing, and improved
education in the community than in cleaning
up the wards at Bellevue or making doctors be-
come nice people. Not that these latter factors
are unimportant but they are luxuries that we
can deal. with after the basic problems have
been solved.—J.A., Medical Student, Lower
East Side.

HEALTH CARE DELIVERY

Lower East Side

It is: difficult to generalize about Bellevue
Hospital. The enormity of the physical plant,
the complexity of its organizational structure,
and the heterogeneity of the hospital’s staff
defy simple categorization. However, a general
impression of the hospital has been imprinted
in my mind through certain experiences that
tended to recur and through attitudes that
seemed to be ever-present.

The physical structure is not well-suited for
the delivery of good medical care to the resi-
dents of Manhattan’s Lower Hast Side. ‘The
hospital is inconveniently located and is diffi-
cult to get to by public transportation. The
problem of transportation to the hospital is

18

made worse by the scarcity of taxicabs cruis-
ing the Lower East Side and the absence of
subway facilities in the area.

Bellevue is a huge, impersonal institution; a
very easy place to get lost in. The structure is
too large, the passageways too cavernous, and
the directional signs are abysmally inadequate.
These features are especially formidable obsta-
cles to patients lacking a firm command of the
English language.

* * * We regarded our group as a commun-
ity-located action organization working with
Bellevue to effect changes that would improve
the delivery of health services to the Lower
East Side. Early in the summer we developed a
productive liaison with the department of pedi-
atrics, whose director served as advisor to our
group throughout the summer. We had in-
tended to focus our efforts on the pediatrics
clinic, but discovered that this department of
Bellevue was very sensitive to the problems of
the community it was treating and was already
attempting to solve problems that other clinics
didn’t even realize existed. In comparison to
other Bellevue clinics, Pediatrics is a paragon.
Therefore, we decided to involve ourselves
with problems of the institution as a whole,
and not with the particular problems of the de-
partment of pediatrics.

To define the existing problems, we first met
with doctors at Bellevue and viewed the work-
ings of the clinics. We went to the community
to. speak to organizations and residents. We
followed up patients who were known to use
the services at Bellevue. We knocked on doors,
spoke to people on the street, and met with |
community organizations. Our relationships
with these people were informal and unstruc-
tured, and our conversations were very sponta-
neous. Certain problems were consistently ex-
pressed by the people, and we chose those that
we thought we could work with.

An illustrative example of our experiences is
our work with the fee system at Bellevue. The
predominant myth at Bellevue is that there is
no problem paying hospital bills: “Medicaid
and welfare pay all their bills”; “They never
pay their bills anyway”; “They fool us by giv-
ing us a wrong address”; “If they don’t pay
"SUMMER 1968

nothing happens to them” etc. Quite a different
perspective on this situation can be gained by
anyone talking to residents of the Lower East
Side about this: “I’m afraid to go to Bellevue
because I have no money”; ‘Eleven dollars is
too much to pay, I can’t afford it”; “Medicaid
used to pay for my medical care, but doesn’t
since the Government took the Medicaid money
away”; and “If I don’t pay my bill the clerk
will embarrass me in front of everyone the
next time I go to the hospital.”

As of July 1, 1968, a new sliding scale of
fees went into effect for all city hospitals. De-
pending on income and the size of the family,
people were to be billed from $3 to $11 for
visits to Bellevue’s clinics. Most patients from
the Lower East Side were in the $3 to $5 cate-
gory, but they did not know this. The signs at
Bellevue still described the old $11 fee for
weeks after the system had been abandoned,
and little effort was made to notify the com-
munity of the reduction in fees. (I was told the
newspapers carried this information as a
public service. I missed the story, and I sup-
pose many others did, too.) As a result of our
prodding of the administration of the hospital
and the office of the commissioner of hospitals,
new signs in English and Spanish were posted
throughout the hospital explaining the new fee
system. In addition, we obtained a pamphlet,
also in English and Spanish, that described the
new fee system and distributed it to everyone
on the streets of the Lower East Side. We also
placed signs in local storefronts.

We developed the transportation problem
with the advice of various community organi-
zations, particularly the North East Neighbor-
hood Association, the United Neighbors Asso-
ciation, the Fifth Street Mothers, and Movi-
mientos Puertoriquefios Unidos. We concluded
that patients in acute crisis were adequately
transported to the hospital via the ambulance
emergency service. However, we thought that
adequate facilities for transportation were
lacking for clinic patients, for patients want-
ing to use the emergency room services during
the night but who did not consider themselves
sick enough to call the ambulance, and for pa-
tients brought to the hospital by ambulance

but who were not admitted and had to return
to the Lower East Side during the night. We
did not think that improving the bus service
would eliminate these problems because we did
not think it sound medical procedure for ill
adults and children to walk several blocks to a
bus stop and then wait a long time for a bus to
arrive, particularly in bad weather or late at
night. We thought that either a hospital or
community-based car service would contribute
to solving these problems. We hope that our ef-
forts in the study of this problem will lead to a
greater utilization of a Medicaid-financed pri-
vate car service by patients unable to reach
Bellevue by conventional modes of transporta-
tion.—J.A., Medical Student, Lower East Side.

Another area we worked in points up the
problem of poor communication between hospi-
tal administration and staff even more. After
talking with the administrator of Gouverneur
Hospital, which runs its own transportation
service for those who can’t use public transpor-
tation, we decided to propose that such a ser-
vice be instituted by Bellevue. Gouverneur pays
for private cars but it also uses the services of
cars paid for by Medicaid for the use of eligible
Medicaid recipients. The patient’s eligibility
for such a service is determined by the pa-
tient’s doctor who fills out a request for it; so-
cial service handles the rest. Naturally, the
funding of the cars and the drivers’ salaries
was the main issue. As far as the administra-
tion at.Bellevue knew, that hospital had never
used and didn’t know that such a service was
available under Medicaid.

A trip to the central Medicaid office at 34th
Street revealed that Bellevue did indeed avail
themselves of these services—at least, the re-
habilitation and orthopedic clinics ‘did. When
informed of this, the administrator was, of
course, greatly surprised that. his initial inves-
tigation hadn’t indicated that Bellevue used
such a service; he said he would make further
inquiries. A few days later he reported to us
that a supervisor at the same medicaid office
insisted that medicaid provided no such ser-
vice! Thus, we have a case of a phantom car
service which neither Bellevue or medicaid

knows about, which Bellevue uses and medi-

19
GREATER NEW YORK

caid provides!—J.M., Nursing Student, Lower
East Side.

We found Bellevue’s administration to be
very receptive and helpful to us. However, it
matters little what one supervisor or one indi-
vidual says, since the hospital’s rules and
chains of command are so extensive and com-
munication is so poor.

In the beginning of the summer we had seri-
ous misgivings about being connected with
Bellevue, especially since the Lower East Side
community is trying to cut the cord with Belle-
vue by establishing its own comprehensive
health center. An end of the dependence that
Lower East Side residents have long had on
Bellevue, and which, to a certain extent, has
allowed poor hospital conditions to continue,
will probably be the best thing that could be
done both for the community and for Bellevue.
People who have a choice will go to the health
facility that offers them the best care.

Bellevue should not make the mistake of
supposing that Lower East Side residents are
too unsophisticated, too irresponsible, or even
too stupid to know the difference between good
and bad health care. For what, after all, is
good health care? Does it matter if a doctor
has won a Nobel Prize if his patient’s bed is
roach-infested? Or,
“doesn’t happen to be Spanish,” yet Spanish is
all the majority of people in this area can
speak? These people are extremely capable of
judging the quality of health care they receive.
This is obvious because many of them, though
complaining about Bellevue’s clinics, have
nothing but praise for the pediatric clinic. In
this clinic there are Spanish-speaking com-
munity workers who help with translation, ap-
pointments are made for further visits (and
they are kept), and, if a patient has a problem
at home, the community health workers,
nurses (and occasionally doctors) will make
home visits to see if further help can be pro-
vided. Bellevue personnel must stop thinking
that a person’s sensitivity to true human con-

cern is dulled because his income is low. If

anything, it is heightened.

* * * In our contact with the community,
the opinions we heard were many and diver-

20

if a doctor’s language ~

gent. I would say that the people seek care in
equal numbers at Bellevue, Beth Israel, and
Gouverneur. Many had no complaints about
Bellevue. Many hated it. The reasons they ex-
pressed most often for using facilities other
than Bellevue were: Spanish-speaking staff;
more courteous treatment; not as long a wait,
therefore a day’s wages didn’t have to be lost.

For those people who missed appointments
at Bellevue whom we followed up and visited,
it appeared the reasons were usually an inabil-
ity to find a place to keep their kids or an in-
ability to travel to Bellevue. For many of the
patients, the problem is what I believe is the
first problem in health-care delivery—they
can’t afford it. They know the hospital will
send a bill and they don’t like not paying bills
so they don’t come for help. In one case in
which the woman neglected going to the hospi-
tal because she couldn’t afford the fee, I as-
sured her the hospital would never refuse her
service, money or no. She finally came to the
hospital and it was found that she needed sur-
gery, which she has now had.—J.M., Nursing
Student, Lower East Side.

The idea for the NENA health center arose
because of the mistreatment of community res-
idents at other institutions and the lack of suf-
ficient health facilities on the Lower East Side.
From my own experience, doing clinical prac-
tice in a municipal hospital, I find many of
their criticisms are valid.

One complaint that I can support, having

worked in a city hospital, is the one of deper-

sonalization that takes place in these large in-
stitutions. People are not treated as individu-
als. They are forced, for example, to see differ-
ent doctors all the time even when a familiar
face would make the situation less embarrass-
ing and perhaps less painful. The doctors that
see these patients in a clinic do not have time
to study the background of each patient, such
as the number of people in a family and the
conditions they live under and if they do get
this information it is not always passed on to
the next doctor.—J.L., Nursing Student, —
Lower East Side.

I do not believe that the residents of the
Lower East Side community feel that they are
SUMMER 1968

not getting good medical care. Most people do
not think about medical care at all until they
are acutely ill, and it has been my impression
that the residents of this community have
found places to be treated that they regard as
adequate. The pediatric clinic at Beth Israel
Hospital and the pediatric clinic at Bellevue
are widely regarded as excellent medical facili-
ties.

Some patients prefer private or union doc-
tors, others prefer Columbus Hospital because
of the large number of Spanish-speaking per-
sonnel there. Some prefer Beth Israel] because
it is near, clean, and they don’t have to wait
long, and some prefer Bellevue because they
like the medical care they get there. Certainly
there are complaints, especially about Belle-
vue: the long-waiting hours in the clinics, rude
and impersonal hospital staff, dirty and de-
pressing surrounding, etc. I believe, however,
that the people have accepted these faults as
inherent and inevitable aspects of the system
of delivery of health care, and are not espe-
cially concerned. with complaining or changing
the present situation —J.A., Medical Student,
Lower East Side.

Newark

Martland, formerly City Hospital, is better
known in Newark’s Central Ward as “Butcher
Shop on the Hill.” This hospital is under-
staffed, underspaced and underfunded, 90 per-
cent of its patients are on welfare. The Board
of Health in Newark is inactive, ineffective,
and unconcerned.

City Hospital was run on a minimum budget
for years. Jobs were political plums and, be-
fore the New Jersey College of Medicine took
over recently, only a portion of the staff ac-
tually worked, others just collected checks. De-
partments, clinics, and emergency room ran in-
dependently with no communication between
administration and medicine, nursing, dietary,
etc. Even good staff became bogged down and
bitter in the medical morass. Result: patients
suffer from bitter, tense staff, uncoordinated
medical care, failure to be directed to existing
facilities. I have seen patients wake up in the
hospital, realize where they were, and run out
of the door dripping blood fron stab wounds.

Newark is ranked at least second in infant
mortality, drug addiction, and TB deaths. Peo-
ple fired on this hospital during the 1967 rebel-
lion. They hate it. They hate the 3-hour waits
in clinics; being turned away from clinics
without treatment; being misscheduled for
clinics; the lack of human concern and the
abuse received from all levels of staff; the lack
of anaesthesia for delivery; inadequate social
services; families being notified 2 to 8 days
after a patient has died, or finding out when
visiting; filthy and uncomfortable waiting fa-
cilities; lack of followup, etc., etc—A.H., Med-
ical Student, Newark.

I particularly don’t like Martland Hospital. I
was sick once when I was pregnant with my
litle boy. Used to have nerve tantrums, and had
to get a shot. When my mother took me to the
hospital, those people put me on the 10th floor,
the psychiatric ward, and I was not allowed to
leave until I was examined. My mother told.
those people I just had to have a shot, and they
kept me there and made me go through all this
red tape. I just wouldn’t take my dog there. I
take my children to Beth Israel in Newark. At
Beth Israel, people act like they are concerned.
You don’t hear smart remarks. The hospital is
clean, you don’t even know it’s a hospital,
doesn’t have that funny smell, and the food is
not food for animals. It’s nice, it’s so much dif-
ferent, the people there are so nice and when
you leave they give you a questionnaire to
write what you like about the hospital.

Not many people from this area go to Beth
Israel because it is a private hospital. When I
was pregnant I had to pay $6 for every visit
for an examination, and I had to pay for my
pills, and it was $300 or something like that to
have my baby and I had to have the cash first.
But a lot of people around here don’t have that
money. I didn’t have it either, but I just had to
get that money because I wasn’t going to the
City Hospital—G.J., NYC, Newark

The delivery of health care to the commun-
ity was ineffective and insufficient. Many of the
hospital departments are undermanned. The
majority of their present staff is grossly un-
productive. This stems from many causes: the

21
GREATER NEW YORK

jobs were under city civil service, many of the
political appointees are unqualified for their
positions; many of the staff believe that good
health care is a privilege and not a right. Con-
sequently, the people administering health care
have corruptive attitudes about the Newark
black community. One of the hospital adminis-
trative staff was quoted as saying: “These peo-
ple are all the same, you have to treat them
like animals.”

Hospital records were out of order; cases
and files were misplaced and lost, record rooms
were open only six hours a day and four days a
week, and doctors had no way of getting any
histories or X-rays during off-hours or off-
days.

Clinic patients were forced to wait anywhere
from 2 to 7 hours before they could be seen;
many were even turned away without being
rescheduled. The people were forced to wait in
filthy, hot rooms, with no restrooms or water
facilities. Many of the clinics are located near
food service garbage rooms, which present
problems with flies and the smell of decaying
waste.—D.B., Community Worker, N ewark.

In the prenatal clinic at Martland I found
many positive things but mostly negative
things. The nursing care the patients receive in
the clinic is very good. The clinic is staffed by
public health nurses who want to give each pa-
tient individualized care as much as possible.
Most of the nurses’ attitudes seemed good and
they appeared to be interested in the patient’s
problems. However, there are only seven
P.H.N.s and approximately 125 patients per
day. Most of the time the nurses got tied
down with paperwork and assisting doctors,
and were unable to do as much health teaching
as they wanted to do. The nurses do make
home visits to try to do some of the health
teaching the patients often miss in the clinic.

The physical setting in the clinic is awful.
The patients are packed into a very small area.
They sit on hard, wooden church pews. For a
while there were no fans in the clinics and pa-
tients would frequently faint from waiting so
long in that hot stuffy room. However, after
enough patients had fainted, someone was able
to procure fans for the clinic. The clinic is very

22

dirty; the floors look as if they’ve never been
mopped, and there was a lot of useless junk
lying around which was finally removed about
24 hours after I called and made the request.
The patients have to wait to see the doctor
in these surroundings from 2 to 4 hours, de-

. pending on how early they arrive at the clinic.

Everyone is given an 8:30 a.m. appointment.
The doctors arrive around 9:00 a.m. to begin
seeing new patients, but do not see returning
patients until 10:00 a.m. Some of this waiting
time is needed by the P.H.N.s to take weights,
blood pressures, etc., but not 3 hours. However,
since there are so many patients and so few
nurses, the nurses seem to be very busy all
morning. The patients are served on a “first
come, first served” basis, so many arrive very
early. If a returning patient arrives at 7:00
a.m., then she will be one of the lucky “firsts”
to see the doctor at 10:00 a.m.

All the patients seem to be treated equally,
except sometimes I have seen certain nurses
giving the Puerto Rican patients a bad time be-
cause they cannot speak English.—L.D., Nurs-
ing Student, Newark.

The lack of facilities for good health care
are not isolated to Martland Hospital and its
clinics. Most of the programs offered by the
Board of Health and its drug dispensary are
plagued by similar problems. The problems
range from improper followup of cases (which
eventually become chronic ailments) to useless
and cursory initial treatment. Medical people
use “lack of supplies” as their excuse. But the
fact is that they don’t make proper use of the
little they do have. As with other services
found in the context of our society, the health
delivery system in Newark are corrupted by an
inherent disrespect for and unconcern for the
poor, nonwhite peoples.

There are many members of the Newark
community who would rather die than subject
themselves to the health care offered by the
city. Those who can afford health care pri-.
vately would much rather do so. For the ma-
jority of the people, however, there are no op-
tions available. Community people are not as
ignorant as many suppose them to be. They
judge the value of their health care only after
SUMMER 1968

years of experience. Newark SHP has numer-
ous accounts of conversations with community
people in which they usually expressed dissat-
isfaction with their health care. Their most
useful parameter is a measure of discomfort.
They will usually tell you that a visit to one of
Newark’s health centers results in an aggrava-
tion of discomfort rather than an easing of it.
In general, the Newark population is repulsed
by its health care—repulsed to the point of
hostility —-R.P., Community Coordinator, Ne-
wark.

While working in the Martland Clinic, I ob-
served that the people who came to the clinic
received good care, but I might add that the
community people were very reluctant to come.
They often would come to the hospital days,
weeks, or even years after they developed med-
ical problems. An example was a boy about 11
years old who came into the emergency room 3
days after he had cut his head on a piece of
glass. The doctor told me he could not adminis-
ter the proper medical care to the patient be-
cause a wound of this type must be closed
within 8 hours of the occurrence. There were
many similar cases where people neglected to
come to the hospital promptly.

I found out by administering a questionnaire
to the women in the maternity ward at Mart-
land that in many instances they had neglected
their health. They did not know about birth
control methods; they had dental problems but
never went to the dentist; and the same was
true of many other medical problems they had.
Some women complained of long waiting pe-
riods in the prenatal clinic, and other patients
said they had received rough treatment in the
maternity ward and delivery room. The main
answer I got from these women when I asked
them why they did not go for medical care
when they needed it were, “they didn’t know
why they didn’t go.” or, “they were afraid to
come to the hospital.”—Anonymous, Newark.

There are many problems of health care de-
livery in the central ward of Newark. One
problem is neighborhood health examinations.
Lasgisted at one such checkup organized by the
city health department. The turnout was not
small, but it wasn’t near a majority of the pop-

ulation of the area. It seems that more imagi-
native means of communicating the checkup,
such as a sound truck, would have brought a
great many more persons. Another problem of
the checkups and the free clinics is that the
older males almost never come. Women of all
ages and children, yes, but hardly ever any
males over high school age. This comment re-
fers to city-run checkups lasting until 7 or
8:00 p.m., and free clinics run by Queen of An-
gels Church between 5 and 9:00 p.m.

Another problem I was told about was that
it is almost impossible to get a doctor to make
a house call in Newark. For this reason, people
who are not in an actual emergency state but
do need the services of a doctor call the city
ambulance to take them to Martland Hospital.
Those who have had a very bad experience
with the hospital and do not wish to return
have nowhere else to go if they are on welfare.
The no-house-call problem undoubtedly — will
continue, but since the college took over Mart-
land Hospital it is possible that maybe 5 or
even 10 percent of the people who have sworn
never to return to Martland may give it an-
other chance after learning it has changed
hands, and, hopefully, they won't be disap-
pointed again.

I did note two other major problem areas in
which improvements should be made. One was
the abominable state of dental care of almost
all the persons in Newark’s Central Ward. I am
unaware of what, if any, dental clinics. are
available. A second more general problem is
finding and helping the real poor—the igno-
rant, despairing, almost helpless person who is
hardly being touched by the health and wel-
fare programs. Some referrals to these people
may come through the emergency room. A far
better source is through. people who know
them in the community. One such case was a
71-year-old guardian of five great-nieces and
nephews and the two children of the oldest
niece whose welfare check was going to be
cut. This woman’s only contact with the: so-
cial services and agencies set up to aid people
was an unsympathetic welfare ‘worker. We
were referred to her by a neighbor who was
one of our NYCs.—N.W., Law Student, Ne-
wark,

23
GREATER NEW YORK

Brooklyn

The population of the Crown Heights area
of Brooklyn is estimated at 225,000 people,
most of whom are either black or Puerto
Rican. These are the patients that use St.
Mary’s Hospital.

St. Mary’s can be seen as a white fortress in
a black forest. It is a voluntary hospital with a
capacity of 237 beds, administered by the Cath-
olic Medical Center of the Diocese of Brooklyn.
In my opinion, it is a 4th-rate hospital in an
area where there is tremendous need. Until
several years ago, the hospital refused to prov-
ide outpatient services for the residents of
Crown Heights. During the last few years, the
forest has crept in. There is still a good deal of
resentment by staff and employees of the hos-
pital who represent the “old guard,” having
such attitudes as: people who receive free med-
ical treatment (the Medicaid fiasco has
changed this) should not care whether it is ad-
ministered with dignity or not.—W.B., Medical
Student, Brooklyn.

Those of us who have observed the workings
of the pediatric clinic at St. Mary’s Hospital
have noted the cursory care given the patients.
We identified this not simply as a function of
disinterest or lack of thoroughness on the part
of the doctors, or as simply a crush of patients
in a short time, but rather that the patient
does not enjoy what we are accustomed to
seeing as the proper doctor-patient relation-
ship. The patient is not seen by the same doc-
tor at each visit, although an attempt is made
to some extent to do this. There is no appoint-
ment system at the present time and the pa-
tients and parents must wait an hour or more.
Most important, however, the doctor sees an
incomplete chart on each patient. He is ex-
pected to treat the symptoms of the episode
rather than the patient as an individual. Often
the value of knowing past facts about the med-
ical history of the patient proves essential to
adequate patient care—-M.H., Sociology Stu-
dent, Brooklyn.

The most common community complaints
were about the service in the emergency room
and the attitudes of doctors toward patients:

24

Hours of waiting in the emergency room, half-
hearted treatment given to welfare patients as
opposed to those who could pay, that children
aren’t cared for unless their parents are there
(try to explain the “law” to people who have
seen a child refused service when he needed
it), that white children get dental care at
Brookdale Hospital a few weeks after they
apply whereas black children must wait for
months—all this has been told to us again and
again. Many people claim they wouldn’t go to
Brookdale if their lives depended on it. The
community resident have been asking for bet-
ter services—a better emergency room, a nar-
cotics program— and Brookdale has been deaf.
—E.B., Medical Student, Brooklyn.

Health care delivery services in the Browns-
ville section of Brooklyn are far from ade-
quate.

Brookdale Hospital has two new programs
—comprehensive child care, and multiphasic
screening—both of which in format appear ex-
cellent. From contact with the programs, it
seems evident that the staff is attempting to
deliver total health-care services to the com-
munity. The programs have not been success-
ful and the services are under-utilized because,
(a) the community did not participate in plan-
ning the program, and (b) Brookdale has had
a reputation for many years of giving second-
class treatment to Brownsville residents.—
L.K., Medical Student, Brooklyn.

Through activities in the clinic, I found out
how many people felt about the health care af-
forded the community at Kings County Hospital
in Brooklyn. Most people readily admitted that
the doctors were quite competent and that they
felt their children were in the best of hands.
One common complaint had to do with the lack
of understanding that the doctors showed con-.
cerning the day-to-day problems of the ghetto
mother. First of all, most doctors did not fully
comprehend the conditions that these people
live under. This was one of the reasons why
the role of the patient advocate was instituted.
We attempted to show the doctors how serious
the problem of peeling plaster and lead poison-
ing was. In most cases the doctors never in-
quired about the living conditions of the family
SUMMER 1968

being treated. They didn’t think to ask
whether there was any loose plaster in the
house or whether any of the children ingested
the stuff.—D.Y., Medical Student, Brooklyn.

I was pleasantly surprised at the excellent
quality of medical care the people receive at
the Kings County Hospital pediatric outpatient
department. Before beginning the job there
this summer, everyone was telling me what a
“hell hole” it was. I found it quite the opposite.
The only major problem that I noticed was the
very long wait encountered by the patients in
the afternoon hours, whereas those patients
arriving around nine in the morning usually
had little or no wait at all. What most people
fail to realize is that with many private physi-
cians, an hour’s wait is not uncommon, and
with the tremendous volume of patients seen
daily at Kings County Hospital, an hour and
one-half wait should not be unexpected. Many
of the people I have spoken to had very little
complaint about. Kings County Hospital. Their
main complaints were usually against the
smaller neighborhood hospitals and private
physicians. Invariably many patients first went
to. these two before coming to Kings County
Hospital.—S.P., Dental Student Brooklyn.

I found the poor delivery of health care in
New York City to be well-documented, and the
people painfully aware of it. The question was,
what could be done about it. I believe I found a
partial solution, legally. _

I found a newspaper clipping which related
that some months earlier the Commissioner of
Hospital had testified before the State Investi-
gation Commission that none of the city’s 21
municipal hospitals met the requirements of the
Federal Medicaid law or the State Hospital
Code, with respect to physical facilities. I went
to the Investigation Commission office in Man-
hattan, read the 200-page manuscript, and we
decided we had a case under article 78 of the
New York civil practice law and rules, which
provides for the issuance of a court order
against any public official to compel him to per-
form a duty to see that the city hospitals meet

- the requirements of the law.

I described the case to a 21 year-old black

man who had come to the SHO office at Down-

state complaining of poor treatment at King’s
County Hospital, and he undertook to bring
the suit. The suit, Moore v. Terenzio, et al.,
Index no. 12459/68, was filed with the Manhat-
tan Supreme Court on August 6, 1968, by Mr.
Hanft, an extraordinary lawyer on the Lower
East Side. There will probably be a hearing on
the order to show cause sometime in the Fall.
—R.H., Law Student, Brooklyn.

Bronx

A young boy in that neighborhood had been
treated at Morrisania Hospital in the Bronx
for-a puncture wound of the knee, caused by a
rusted iron bar. His treatment had consisted of
X-ray and a damp bandage; no antibiotics or
tetanus shots had. been given. He came back
to our storefront complaining of pain. His knee
was red and swollen and he could bend it or
bear weight on it. I took him back to Morri-
sania and spoke to the head doctor. It took 15
minutes of arguing and debate about who I
was and whether or not I had any medical au-
thority before the doctor consented to treat the
boy.—M.J., Nursing Student, Bronx.

Many feel that though health care may not
be perfect, it is good enough to be a major rea-
son for staying in New York rather than re-
turning to rural areas.. Everyone mentions the
long waiting periods before the doctor gets to
see them. I found no agreement in the
Bronx about the quality of health care. The
most common accusations were against the ob-
stetrics ward of Morrisania; no one who had
been there once wanted to return. Bronx-Leba-
non Hospital was felt to treat patients conde-
scendingly; there was a fair amount of bad
feeling towards it from Medicaid patients.—
N.A., Medical Students, Bronx.

The health care which the residents of the
Bronx receive does not seem as bad as some
would believe. Fordham Hospital, while not
the most luxurious spot in the city, seems to.
give effective service. The hospital is, of course,
plagued by the problem of all the city hospitals
—over-crowding, too much red-tape, and not
enough personnel. But stories that it was a
butcher shop seemed from my point of view to
be unfounded. The people in the community will

25
GREATER NEW YORK

all say that the care is horrible and degrading,
but many have had actually no specific reasons
for feeling this way. Either they have heard sto-
ries which may or may not have been exagger-
ated, or they feel they will get the bad side of
things wherever they go. Upon taking a survey
of 60 Head Start mothers and talking to them
more and more, many conceded that their
health care, while not ideal, is adequate.—
J.W., Nursing Student, Bronx.

Health care attitudes were determined from
a questionnaire administered to 60 Head Start
mothers and from a sampling of community at-
titudes. Since Fordham Hospital was serving
our area of the Bronx, most of our responses
dealt with this hospital.

A majority felt that Fordham was not a de-
sirable place to seek care. Long waits, poor
care, disinterested doctors, etc., were given as
reasons. Sentiment ran the gamut from mild
endorsement (usually from those who had had
the least involvement), to outright anger.
Women expressed feelings that they’d sooner
have babies at home than suffer the indignities
at Fordham. Several complained of miscar-
riages due to. poor obstetrical care. Many
avoided health care for all but emergencies be-
cause of such unfortunate experiences.—V.S.,
Dental Student, Bronx.

The people in the Bronx community in
which I worked receive health care that is un-
pelievably bad. Some of them said that they
would rather die than go to Morrisania Hospi-
tal or to Bronx-Lebanon because, once they go
there, the substandard care, the abuse from
staff, and the interminable waiting would
probably kill them anyway. Besides these two
hospitals, Montefiore Hospital’s Neighborhood
Medical Care Demonstration Health Center
also offers service to the area. This facility is
highly regarded by community residents put
unfortunately it can accommodate only a lim-
ited number of patients and it has definite geo-
graphical boundaries which exclude many of
the residents in the area I serviced.

I feel that the community residents who go
to Morrisania and Bronx-Lebanon Hospitals
should document each case of poor health-care

‘26

delivery and insults received from the medical
personnel, especially the initial contact at the
main desk, in order to press for reform. Stu-
dents can do nothing in one summer because
these institutions put up a front of cooperation
for the 10-week duration of the SHP. Educat-
ing the residents is necessary.—B.B., Student
Coordinator, Bronx.

The people would rather go to private doc-
tors in the area, any place but Morrisania, Lin-
coln, and Bronx Hospitals. The people describe
these hospitals as the “dog pounds.” Three
women I know delivered their own children be-
cause Morrisania and Bronx Hospitals don’t
have enough clean sheets for the patients
* * * so the people feel they can keep them-
selves cleaner at home.—M.G., Community
Worker, Brona.

The delivery of health care to the commun-
ity residents of the South Bronx ranges from
excellent to poor. I feel if people really want to
get good health care, it can be found with a lit-
tle effort on their part, but unfortunately many
people are not motivated to try. If they hear
rumors that this city hospital or that clinic is
not doing the job, they fail to complain or
search out better medical care. Laziness is
much of the problem. It is easy to blame it on
discrimination or lack of money, but if some of
the population can get good care and they have
the same problems, why can’t others? The pro-
jects I worked on showed that there are many
service being offered to the slum areas if peo-
ple are willing to ask for it instead of shrug-
ging their shoulders and saying nobody cares.
—E.F., Community Worker, Bronx.

Harlem

After working for 9 weeks on school health
referral problems, we can draw some conclu-
sions about why people don’t use the health fa-
cilities available in Harlem.

The most obvious and most frequently cited
reason for not using outpatient facilities at
Harlem Hospital and other clinics in the area
is that the time spent waiting in line is often
prohibitively long. Most of the clinics are open
only during the daytime and appointments can-
not be made: the waiting time varies but can
SUMMER 1968

be as long as 4 hours. People simply cannot
afford to take time off from work or leave other
children and their homes unattended for that
long. Also, sitting and waiting in noisy, un-
comfortable waiting rooms is not a very
pleasant way to prepare oneself or one’s child
to see a doctor.

Compounded with the long waits, the clinic
procedures and personnel are often insensitive
to the needs of the people who use the facili-
ties. We found that the procedure for register-
ing at a clinic and for Medicaid was often con-
fusing and exasperating, particularly when
questions were asked in front of a long line of
other people waiting to register. We found one
clinic for eye and ear problems where the staff
was downright rude and hostile to the patients
_ waiting. Another frequent complaint was that
doctors did not take time to explain to the pa-
tient or the mother what actually was wrong
and what prescribed medicine was supposed to
do. It seems that the feeling that health care is
a right that people are entitled to is just not op-

erative. Health personnel seem to consider .

their work a nine-to-five job, and patients,
especially, lots of patients, are a hindrance to
the many bureaucratic duties they may have
rather than people to be dealt with in an
efficient, gracious way.

A problem that was a result of the Medicaid
legislation last spring was the institution of
the $11 clinic fee for any visit. This was a
hardship. until a sliding scale was set up for
non-Medicaid patients, but it still represents
another obstacle: the patient must again tell
how much he earns. Needless to say, the people
who were covered by Medicaid before the cut-
backs are now getting less adequate health care
than they were getting when they were covered.

- We found that most Medicaid patients pre-
ferred going to a private doctor to waiting in
the clinics; many non-Medicaid patients would
rather risk paying a higher fee to a private
doctor for a non-emergency problem than hav-
ing to go through the inconveniences of a clinic
visit.

A significant problem is the lack of adequate
psychiatric facilities for the people of Harlem.
In a survey of child psychiatric facilities, we

found gross inadequacies in coverage. All the
facilities in-and-out of the Harlem area had
long delays before diagnosis and even longer
delays before treatment could be started.

* * * An jmportant reason why people
don’t avail themselves of facilities bears di-
rectly on Harlem Hospital; the reputation of
the hospital in the community is abysmal. Peo-
ple say that they have heard nothing but bad
things about the treatment people get there
and refuse to put anyone in their family
through it.

Part of this reputation comes from a time

‘when Harlem Hospital was one of the two or

three worst in the city. Many doctors appear to
have cared very little for the people who use
the hospital and left it to others to improve
services. The house staff had been largely for-
eign-trained and this led to problems of com-
munication with the patients. The list of griev-
ances is long and familiar for large urban hos-
pitals with poor facilities. The significant
changes and improvements that have taken
place recently have not been communicated to
the people who might use the hospital. The im-
provement in quality of the house staff since
the Columbia University affiliation (the fact
that all the interns are now American trained,
for example) has not filtered down to the peo-
ple and the reputation continues to be just as
bad as it ever was. The efforts of all the dedi-
cated doctors (not just the results of the
affiliation) in recent years should be made
known in the community. Demonstrations of
community frustration and dissatisfaction like
the one that took place this summer following
the death of a child who was misdiagnosed
need not occur.

Whether or not these community attitudes
are fair or even rational is not the issue; the
fact is that they are real. The challenge to the
doctor, black or white, is'to understand the
mentality and life styles of his patients and to
deal with them as they are, not as he wishes
them to be.

I will list our recommendations for improv-
ing health facilities in the Harlem area which
we think would lead to more frequent and
more satisfactory use by patients:

27
GREATER NEW YORK

(1) Clinics in the Harlem area should be
made more convenient for the people
who use them; there should be appoint-
ments made, waiting rooms should be
made more comfortable, and babysitting
should be provided. Clinic hours day
and evening should be scheduled for the
convenience of the patients, not the
staff.

(2) There should be health workers hired
from the community who can do ¢ase-
finding and home visits, and who can
act as patient advocates in the hospitals
or large clinics.

(8) Attitudes of doctors and staff should be
screened and standards of courtesy and
cooperativeness should be maintained.
Patient complaints should be solicited
and acted upon.

(4) The New York State Medicaid program
should be reinstated in full.

(5) There should be an attempt to establish
more psychiatric and counseling facili-
ties immediately; the need is especially
critical in the area of child psychiatry.

(6) Health education through all the com-
munication media and with community
groups should be continued actively and
new bases should be sought.

(7) Harlem Hospital should establish a
community relations department on a
formal basis which would concern itself
with more than just the writing of
press releases; it should actively try to
reach the people in the community and
involve them in the hospital.

(8) Community participation in the setting
of priorities for health and the running
of health facilities should be institution-
alized. Responsiveness of health facili-
ties to the needs of the community can
and should be guaranteed in this way.

These recommendations may not solve all of

the health problems in Harlem, but unless
these eight points are addressed, we see no
chance for an improvement in the health care
delivery situation.—R.C., Student Coordinator,
Harlem.

There is an acute shortage of health profes-

28

sionals in Harlem. One school nurse must serve
up to five schools or more; some schools have a
doctor only 1 day a month; school children are
commonly not examined between first grade
and high school; there would appear to be vir-
tually no specialists in private practice in Har-
lem. Parents are concerned. When informed
their children need care they endure long
waits, dreary waiting rooms, rude clerks, and
frequent double standards for paying custom-
ers versus Medicaid and welfare patients.

What seems to be lacking is proper preven-
tive medicine. Harlemites tend to wait until
they are noticeably ill before seeking medical
care. This is due, to a great extent, to the peo-
ple’s mistrust of the medical institutions.

Harlem Hospital has a terrible reputation in
the community. The building is old and over-
crowded, while a new building stands next
door, unfinished, overdue many years, and
many months short of completion. One won-
ders whether the city is giving the new build-
ing the priority it deserves. I suspect a similar
project in the East Sixties would have been
completed on time. The people of Harlem
agree.

The people of Harlem are not blind. They re-
alize that decent housing, proper nutrition and
adequate jobs are necessary for health. Is the
American system as presently constituted able
to deliver these? Doubts are multiplying.

It is to belabor the obvious to say that to im-
prove health care more doctors are needed—
young people from Harlem who will return
there must be trained as doctors, nurses, etc.
Pediatric screening programs in the schools
could be expanded; hospitals can be made more
relevant to the community by placing them
under community control. It is stupid to speak
of anything short of billions of dollars spent in
all areas of human life when considering
health care—L.B., Medical Student, Harlem.

At present, the most important way to im-
prove care in the Harlem area is to lobby for
the speedy opening of the new Harlem Hos-
pital. Also, I would try to get more board-
certified group practices involved in the area.
At present there are only two.—J.H., Medical
Student, Harlem.
SUMMER 1968

There is need for a followup service as an
extension of health facilities in Harlem. People
often do not return for appointments or seek
yeferred treatment. By having individuals go
out into the community to follow up school
health referrals, we have managed, temporar-
ily, to deal with part of this problem. In order
to secure a more permanent solution, on a
small scale, we are in the process of funding
permanent jobs for our five community
workers. In these positions they will function
ag extensions of the school nurses and will fol-
low up the school health referrals year-round.
—S.G., Medical Student, Harlem.

ATTITUDES
Brooklyn

The doctors must know the community. that
they serve. They must be acquainted with the
customs and beliefs of the patients. They must
know their patients and respect them as fellow
human beings. In order to treat someone with
compassion, one must understand this person
and look on this person as a comrade in pain,
not as a stranger who cannot be understood.

There are a variety of problems about com-
munication between the patient and the physi-
cian. The patient or the mother of the patient
often viewed the doctor as competent but un-

concerned. They often felt that the doctor

didn’t care about them. On the other hand, the
doctors viewed the patients as being hostile
and unreceptive to the care they were deliver-
ing.

There is a definite lack of communication be-
tween the members of the community and the
hospital as an institution and as a representa-
tive of the white man’s world.

What is needed is more community involve-
ment in the running of the city hospitals. and
more effort on the part of the hospitals to
make their services known to and accepted
graciously by the community.—D.Y., Medical
Student, Brooklyn.

Bronx

The following two experiences illustrate the
problem’ of routine medical care delivered
without concern for the patient and his specific
needs.

Gladys is an 18-year-old girl who has a little
boy and is expecting her second child. Gladys
made an appointment to visit the Morrisania
prenatal clinic and I decided to accompany her.
She misunderstood, or was not told, that she
would not see a doctor at this time. The pur-
pose of this visit was to obtain a clinic card
and to have the preliminaries before seeing an
obstetrican. During her interview with the
clerk, Gladys said that she had been going to
the N.M.C.D. and that they had referred her to
Morrisania. She said that she was told that she
no longer lived in the N.M.C.D. district. The
patient had never been seen prenatally. An ap-
pointment had been made for Gladys, but she
did not keep the appointment. With this bit of
information the clerk asked Gladys why she
had not seen a doctor sooner. Gladys appeared
very hurt by this question because she said
she had seen a doctor. The clerk told Gladys
that she was old enough to be her grandmother
so she shouldn’t try to tell her that she had
seen a doctor when she hadn’t. I was irritated
with the clerk for making a judgment without
trying to clarify with Gladys as to how she
saw the situation. It is possible that Gladys
saw a medical doctor and thought that she had
seen an obstetrican. Gladys did say she. didn’t
keep an appointment to have some blood
drawn. This one encounter left Gladys with an
unfavorable first impression.

Gladys was told, or rather I was told, to take
her to have blood drawn, her teeth checked, a
chest X-ray, and, finally, to see a social worker.

The lab technician did not say anything to
Gladys when she ‘went to have her blood
drawn. The technician was very hurried and a
bit gruff. Gladys was frightened and did not re-
ceive any psychological support or instruction,
such as to look away or to grasp something to
make the experience easier for her.

Our next visit was to the dental clinic. At
the registration desk I had tried to tell the
clerk that she had seen a dentist within the
last 6 months, and that maybe it wasn’t neces-
sary to see a dentist again since it was so close
to the time of her delivery. At the dental sta-
tion I was told that the X-ray machine was
broken and that she would have to make an ap-

29
GREATER NEW YORK

pointment for another day. At this point I said
that it was hard for this woman to get to the
clinic and unless it was absolutely necessary
that she see a dentist at this time, that I pre-
ferred a new appointment not be made. The
clerk, somewhat confused, called the nurse.
The nurse checked the records and found that
Gladys had seen the dentist at the end of
March. She arranged for Gladys to see the den-
tist without coming back to the clinic.

Next we went to the X-ray department.
After waiting about half an hour Gladys was
geen. The technician did not smile and ap-
peared very tired and bored with what she was
doing. She made no effort even to acknowledge
the patient’s presence.

Our last visit that afternoon was to the
social service department. She was the only per-
son we met that day who appeared interested,
and we felt she had the time to speak with us.

We came back that evening for the prenatal
clinic. The doctor started asking questions, and
Gladys became confused and appeared fright-
ened. He got irritated because she was not re-
sponding to his questions. The nurse then in-
formed me that I was not supposed to be with
the patient while she was with the doctor be-
cause I was violating her privacy. I did not
leave go she sent in another nurse to inquire if
I was translating for this woman. Even though
the head nurse did not object the other nurses
did not want me there speaking with the doc-
tor. It was not their routine.

The doctor also followed his routine. He did
not interject any personal comments at. all. In
the examining room I could hear him bawling
her out for using salt because of her high
blood pressure. I’m not sure any doctor had
told her this before. He then told her she was
to have a Pap smear. I could hear Gladys say-
ing that she had just had a Pap smear, and I

know she had because I had read the letter she .

received stating that the results were negative.
Maybe the doctor did have reason to doubt
Gladys, but he didn’t take much time to listen to
her.

Our last visit was with the nurse. The nurse
was very pleasant, and did not appear to be
rushed. Gladys did speak up to ask about the

-30

problems she was having with her leg. Th
nurse explained that elevating her legs woul:
help. She suggested that Gladys elevate he
legs while reading a good book. I had to chuckl
at this because Gladys only has a 9th grad
education and has difficulty reading and writ
ing. The nurse did some diet counseling whic!
was very inadequate for this patient. Sh
handed the patient a diet sheet and said t:
avoid salt and greasy foods. No inquiry wa:
made into Glady’s eating habits.

Rebecca is a 64-year-old Negro lady who wa:
referred to me by a dental student because hi
felt that she needed more comprehensive car:
than just seeing that she get some dentures.

I decided to take Rebecca to Morrisania t
have a checkup. This was to be my first ex
perience with registering a new patient. J firs
asked a clerk processing new patients what th:
procedure was for bringing an elderly patien’
to the clinic who hadn’t seen a doctor in some
time. She said to bring the lady to the emer
gency room. I replied that there was nothing
acutely wrong with this lady and asked if there
wasn’t some other procedure. “No, you mus
take her to the emergency room”. I didn’t ac-
cept this as being the solution so I asked at the
information desk on leaving the hospital. She
suggested that I speak with the nurse at the
screening clinic. The nurse said that the screen-
ing clinic was perhaps the best solution.

We returned to the clinic the next day. We
arrived at 8:15 and were seen by the clerk by
about 9:00. Shortly thereafter we were seen by
the doctor at the screening clinic.

The first question he asked was, “What's the
matter, why did you come.” After a pause with
no answer he said, “Well, what’s wrong with
you, you know that this is a hospital.” At this
point I answered by saying, “Nothing is the
matter with this woman in particular. She just
hasn’t seen a doctor for some time, and I think
it is advisable, She had poor vision, she is hard
of hearing, she needs dentures, and has had
problems with her heart in the past.” By this
time I was disturbed by the lack of dignity and
respect the doctor showed this patient. After a
very brief examination, he discovered high
blood pressure and decided she needed a car-
SUMMER 1968

diac series. He was very impatient with Re-
becca. He would get irritated when she did not
understand his questions. He even tried to tell
‘her how to talk. Rebecca answered some of his
questions with a “ya.” He told her to say yes,
not “ya.” What particularly irritated me was
his being more interested in my being a student
nurse than in Rebecca. I think it would have
been much more beneficial for the patient if his
interest had been directed toward her. The doc-
tor said to make an appointment for the medi-
cal clinic for Rebecca. I asked him about the
eye clinic. He did not mention the E.N.T., den-
tal or G.Y.N. clinics. This would seem to indi-
cate that this doctor is not providing compre-
hensive care, or is even considering preventive
medicine —V.V., Nursing Student, Bronz.

Lower East Side

The biggest obstacle to the delivery of good
medical care at Bellevue Hospital is the perva-
sive atmosphere of what I have heard referred
to as “Bellevue Paranoia.” It is an attitude
composed of varying degrees of lassitude, ob-
stinacy, and covert hostility. It is personified
by the elevator operator who will not tell you
what floor a certain clinic is on because it is
not his job to give information; by the clerk
who will not admit you for a clinic appoint-
ment because it is 10:10 a.m. and registration
for the clinic stops at 10:00; by the perverse
administrator whose decision it was to man the
information desks with personnel who do not
speak any Spanish; and by the physician who
can just walk away from patients waiting to
see him in a specialty clinic because he thinks
it’s time to go. These attitudes are accounted
for in many ways: overworked doctors who
must see too many patients in too little time,
frustrated clerks frozen in positions with little
upward mobility, etc. Regardless of the excuse,
it is an attitude which exists throughout the
hospital and which the hospital has failed to
deal with.

; Bellevue has, for too long, enjoyed the posi-
tion of being the only center in the area offer-
ing extensive facilities. That it has also been
one of the most notorious is often not consid-
ered. It was interesting to observe, in the pro-
cess of speaking with community people, the

repetition of a few common complaints about
Bellevue’s services. It would be a conservative

‘estimate to say that 90 percent of those per-

sons we asked cited the lack of courtesy to be
their main complaint about Bellevue. Medical
eare, they say, is fine, but “the clerks are rude
and we’re treated like dirt.”

Bellevue must refocus its attention from
medical education to that of service to the com-
munity. This is, of course, difficult to do. I was
told by a resident in pediatrics at Bellevue that
he cares about his patients and their continu-
ing welfare, yet if Bellevue’s census continued
dropping as it had in recent years, and the “in-
teresting cases” no longer were seen there in
such quantity, he would promptly leave and so
also would most of his colleagues. “Let’s face
it,” he said, “what I’m most concerned with at
Bellevue is my education. Sure I care about my
patients, but that’s not what I’m here for; pri-
marily I’m here to learn.” As long as the pa-
tient remains in this secondary position in the
physician’s list of priorities, no amount of new
buildings, equipment, or famous names will
lure patients to Bellevue Hospital.

Bellevue’s pediatric clinic has serious “com-
petition” from Beth Israel Hospital’s “I Spy”
clinic, which also handles children. There, the
doctors speak Spanish, as do all the health-aid
workers on the floor. These health workers
make regular home visits and followup care on
their own patients. The “I Spy” clinic does ac-
tual soliciting and canvassing in its area, ac-
tively trying to get people to come.

This active community action on behalf of
the health care facility is the essential feature.
It is what’s lacking at Bellevue and seems to be
what Bellevue still refuses to do. More than
one doctor has said to me, “I don’t know what
our job is in respect to the community any
more; should we go out and get them, or
should we let them come to us? I don’t know.”
For a hospital whose census has dropped in re-
cent years and which faces an estimated 75
percent loss of its outpatient department pa-
tients to the new NENA health center, is there
much of a choice? They must reach out ac-
tively to the community if they expect to see an
increase in their patient load. A new building

31
GREATER

alone isn’t the answer.—J.M., Nursing Stu-
dent, Lower East Side.

Newark

Generally, postpartum patients felt their
prenatal care was satisfactory; their one com-
mon complaint was the long waiting time.
* * * Tt ig not unusual to see 150-200 preg-
nant women come to prenatal clinic at Mart-
land Hospital in one morning, nor to see them
wait 3 or 4 hours to see a doctor who gives
them only 5 minutes. There is little personal-
ized attention because there is no time to give
it with such inadequate staffing. Little wonder
that mothers wait until their delivery date or
near before coming to the hospital.

Many of them were dissatisfied with the
treatment they got from the nurses in the de-
livery room; they felt that the nurses were
giving them very little emotional support; that
the nurses conveyed an “I don’t care” attitude.
I quote a young mother: “I delivered the baby
all by myself; they (the nurses) only stood
there watching.” The general complaint about
the postpartum floor was the attitude of the
staff; many patients felt they were rude.—
J.Q., Nursing Student, Newark.

* * * Besides the decrepit, dirty, and dingy
conditions of community health facilities in
Newark and the poor quality of health care ad-
ministered, the ultimate crime is the complete
insensitivity of most health care personnel to
the patients whom they have supposedly dedi-
cated their lives to serving. The patients are
treated like cattle, herded in, thrown out if
they dare to speak or question, and herded out,
usually with a few harsh words of condescen-
sion. The obvious reasons for the conditions
are lack of funds, lack of staff, and ultimately
lack of concern.. Hopefully SHP fostered con-
cern if nothing else. ,

The people of the community are completely
disgusted with the deplorable health care of-
fered them. However, only an exceptional few
will speak up to the hospital staff. The major-
ity of the community people I’ve had contact
with feel like puppets on a string—if they
don’t jump when the hospital personnel says
jump, they get no health care. Obviously

32

NEW YORK

changes are necessary fast, but I didn’t ac-
complish them and SHP didn’t accomplish
them.—K.S., Nursing Student, N ewark.

People do not like being treated. like dogs at
city hospitals; they do not like to be kept wait-
ing for hours at a clinic; drug addicts do not
like to be considered criminals when they seek
medical attention. In short, the people of Ne-
wark’s Central Ward are just like people every-
where—they want to be treated with respect
and dignity. This does not seem to be an unrea-
sonable request, but in Newark it is far from a
reality.—B.W., Medical Student, Newark.

The hospital is contracting a psychology in-
stitute to begin sensitizing staff to needs of the
patient, and to coordinate and improve com-
munications between various levels of supervi-
sion, This idea for a sensitization program was
sold to the administration by speaking with en-
lightened members of the administration on all
levels. It is hoped that staff will begin to func-
tion as a whole towards patient care.

An in-service sensitivity training program
now running in the nursing department will
continue weekly until I leave in October. I am
using tape recordings of community people
talking about the hospital and working with
staff reactions to this stimulus material. This
program is serving in the interim preparatory
to the more general program.—A.H., Medical
Student, Newark.

Harlem

We received many complaints about the
“nasty attitudes” of the personnel in the clinics
at Knickerbocker Hospital, poor treatment,
long waiting periods and frequently a lack of
communication between the patient and doctor
due to a language barrier. The Harlem com-
munity feels that the comprehensive pediatric
health center that Knickerbocker is trying to
establish is fine but that it will be some time
before the center is completed. They would like
to use Knickerbocker’s facilities since it is in
their vicinity, but generally refuse, except in
the case of dire emergency, to tolerate the
treatment they presently receive from person-
nel at this hospital—P.J., Nursing Student,
Harlem.
SUMMER 1968

MEDICAID, MEDICARE

_#* * * The pharmacies are another bone of
contention in the Harlem community. The peo-
ple on Medicaid feel that they are not being
given the same kind of service that non-Medi-
caid people are getting, especially if their
cards are not “filled out properly.” Also there
ig no drugstore in Harlem which is open 24
hours, or even late in the evening.—J.H., Med-
ical Student, Harlem.

We've run a couple of experiments on a Har-
lem drugstore: we got prescriptions for the
same drug for Mrs. X. who has a Medicaid
card and Mrs. Y. who doesn’t have a card. The
store gave about the same service to each cus-
tomer in terms of time. The drugs sold were
different, the Medicaid drug being generic, and
Mrs. Y. had to ask for a bag to carry it in.
Also, when Mrs, X. asked how much the drug
was going to cost Medicaid she was told, in ef-
fect, that it was none of her business.—R.C.,
Student, Coordinator, Harlem.

It takes longer for a Medicaid patient to get
his prescription filled. There seem to be legiti-
mate reasons, or are they legitimate? Many
are clerical in nature and could be avoided. One
wonders if these professionals are excessively
jealous of their independence and excessively,
almost cruelly, preoccupied with resisting a
“government takeover.” And who finally suf-
fers if the prescription is left unfilled ?-—L.B.,
Medical Student, Harlem.

These past 2 weeks revealed a problem
which was not entirely surprising. We found
that most holders of Medicaid cards regarded
themselves as recipients of a gratuitous act
from any agency, doctor, or pharmacist that
delivered services to them. They felt as if they
were obligated to put up with any indignity.
However, this does not derive from the fact of
Medicaid, but from a general feeling on the
part of many of the community of being sec-
ond-class citizens. The situation is compounded
when the person slighted does not know how to
have redresses made, or does not have any
place to appeal. I see the role of SHP as mid-
dlemen between the community and the deliv-
erers of health care, acting both as advisors to

and trouble-shooters for the people of this
community.—JH, Medical Student Harlem.

DENTAL HEALTH

Nowhere was poor health care brought home
to me more than in the dental clinic at the
health station. Being a dental student, I was
able to observe and question the dentists as
they treated the Head Start youngsters I
brought from St. Joseph’s. From the equip-
ment which was antiquated, to the techniques
used which were criminal, to the attitudes
which were racist, to the ability which was
low, to the knowledge which was minimal, the
entire service epitomized the worst in health
care, I will not proceed further into a detailed
analysis of the care here but IT can summarize
what I saw by saying that, by comparison,
Fordham Hospital was a model of health care,
and that the city has no justification for allow-
ing outright malpractice to exist within its ser-
vice. At the conclusion of the program, I rec-
ommended that this health station be boycotted
by the Bronx community.—V.8., Dental Stu-
dent, Bronz.

A particular deficiency of health care deliv-
ery on the Lower East Side can be seen in den-
tal health services. There is no dental clinic in
the neighborhood and the people are oblivious
to the effects of poor dental hygiene on overall
health of body.—B.G., Nursing Student, Lower
East Side.

Since one child out of eight gets dental ser-
vice in the community, the need for dental edu-
cation for the parents and children, and _ also
the need for more and better dental services, is
absolutely imperative in the Lower East Side
community.

The parents frequently said that they can’t
find good dental services in the community (no
dentist or clinic was apparently satisfactory),
and others told me they could not afford it.
Morally, I feel this is one of the most terrible
things that could happen in the wealthiest
country in the world. Everyone J talked to was
disgusted with the lack of dental services and
financial aid for the underprivileged. Some-
thing must be done in these two respects and I
will certainly try to do what I can in the fu-

33
GREATER NEW YORK

ture to alleviate such a situation —G.L., Dental
Student, Lower East Side.

LEAD POISONING

In the course of our survey of lead poisoning
incidence in the South Bronx (and, to a limited
extent, in Harlem), we came in contact with a
wide range of community institutions, most of
which were of an Establishment-type nature.
First reactions to our requests were guarded
until we had explained our purpose and our
procedures, at which point we found people
most willing to aid us. We found, for the most
part, that dealings on a personal level were
more profitable than when we were forced into
a head-on encounter with a bureaucracy.

In terms of concrete results, our group came
in contact with 1,200 households and informed
them of lead poisoning dangers. We collected
and analyzed 500 urine samples from small
children, and our results will soon be made
available to the general public.

We found that a good many asymptomatic
lead poisoning cases had not been to a hospital
recently, nor received medical care, nor sought
it out.—I.B., Medical Student, Bronz.

Two suits were filed this summer having to
do with lead poisoning. Acting on a suggestion
from Paul DuBrul, Mr. Hanft asked for the
court, under article 78, to order the New York
City Health Department to compel the remo-
val, pursuant to section 173.18 of the health
code, of lead-based paint from the walls of two
apartments in which children have suffered
lead poisoning from eating chipped paint and
plaster. In one of these families, three children
have been treated for lead poisoning, one seven
times. One suit asks that the court order the
removal of lead-based paint from all apart-
ments in New York City.—R.H., Law Student,
Brooklyn.

The Central Brooklyn Coordinating Council
and our group are working on the problem of
_Jead poisoning. The hope is that we can get a
group of people from all over Brooklyn—par-
ents, doctors, and people in other fields—inter-
ested in the problem to meet after SHP is gone,
and maybe take some action or at least make
demands. ,

.B4

Brooklyn has the highest incidence of lead
poisoning, and it is increasing. A lot of people
don’t know that children can die or get perma-
nent brain damage from it. Say there are 600
cases of lead poisoning a year found in the
city: well, if these 600 cases were diphtheria
or polio, everyone would worry about it be-
cause it would spread. But lead poisoning is
just in the poverty areas, and does not
“spread,” so no one is concerned about it.

Our purpose is to get the community inter-
ested, to get them to realize that no one is lis-
tening to their problems.—W.S., Student Coor-
dinator, Brooklyn.

The Brooklyn Community Council SHP
workers coordinated the Brownsville and East
New York activities of a campaign throughout
Brooklyn against lead poisoning. This involved
contacting parents whose children had had
lead poisoning in the past 214 years, distribut-
ing flyers and posters, and speaking to com-
munity organizers and workers, in order to en-
courage attendance at a mass meeting we were
holding. A door-to-door canvas was conducted
explaining the effects of lead poisoning and
how it was related to poor housing conditions.
A bus was arranged to take area people to the
meeting.

The meeting was attended by approximately
80 people, 10 of them from Brownsville. In the
estimations of most people involved, the meet-
ing was successful. However, the effectiveness
of communication techniques, which involved
so many man-hours and netted such a small at-
tendance, can be questioned—L.K., Medical
Student, Brooklyn.

DRUG ADDICTION

In taking steps to establish a narcotics cen-
ter in the Brownsville section of Brooklyn, we
met with people from the Governor’s Office,
Ramirez, Narcotics Addiction Community Cen-
ter and C.C.V.N. This meeting was quite en-
lightening: the State people couldn’t account
for the placement of funds and had no idea
where the appropriated money went; the
money that was appropriated to private ad-
diction rehabilitation centers was never given
to the centers. Moreover, the State programs |
SUMMER 1968

weren’t servicing the real addict population:
75 percent of the addicts in the city are black,
put only 15 percent of the addicts in the
Ramirez program are black.

We found that Model Cities had money for
health facilities and that the Multi-Service
Committee, which was supposed to make the
funding decisions, was not functioning. We
acquired the directions on how to write a pro-
posal, and spent several days at the Addiction
Rehabilitation Center in Harlem with our
NYCs, speaking with ex-addicts and addicts.
They helped us in writing the proposal for a
Brownsville narcotics center. We presented the
proposal to model cities and the leaders of
Brownsville. The response has been very fa-
vorable.—E.B., Medical Student, Brooklyn.

The narcotics problem is a big one with no
good answers at present. Everyone in the
Brownsville community knows people that are
“shooting” and that kids at nine years of age
or younger are turning on by glue sniffing,
reefers, and goof balls. In talks with two of the
NYCs working with us, it became evident that
they were interested in working perhaps in a
preventive sense with youngsters and drugs. In
order that we would not duplicate other pro-
grams, and to avoid some of the previous mis-
takes, we contacted and spoke with all groups
working with drug abuse in Brownsville, in-
cluding:

(1) Addiction Services Agency (ASA), part

_ of the Phoenix Program of New York
City. They have a storefront which is
an induction center and meeting place
for A.W.A.R.E .and R.A.R.E.

(2) Narcotics Addiction Community Center
(NACC). They have a fairly formal
and traditional approach as part of the
New York State program. Their preven-
tive measures consist primarily of
films which can be loaned to any group,
and staff members occasionally will an-
swer questions with film showings, or
go to the schools. Unfortunately, none
of the films are directed towards the
“ghetto” children or towards children
around the age of nine years. The
NACC takes a limited number of ad-

dicts into detoxification and rehabilita-
tion programs run by the State.
(3) Interfaith Hospital, owned by

hospital maintains a twenty-one day de-
toxification program. Most addicts come
in from referral from other organiza-_
tions, but any addict can walk into the
center. Some minimal rehabilitation
work is done.

(4) Brookdale Hospital, whose psychiatric
service has a newly formed narcotics
program. They are doing some metha-
done treatment; they have no preven-
tive program. ~

(5) Brownsville Community Council Nar-
cotics Committee, a group of interested
community people who want better
treatment and preventive facilities in
Brownsville. They have attempted to
improve the effectiveness of police con-
trol and arrests of addicts, and they are
presently undergoing some training
with the addiction services agency.

None of these groups really reaches the
youngsters or does anything with the glue sniff-
ing problem, so we decided to canvas all stores
which would possibly sell glue, carbona, or
other toxic substances. We visited 80-100
stores, informed the owners of the law and dis-
cussed the problem with them. We presented
them with a copy of the law against the sale of
glue for the purpose of sniffing, and attempted
to get them to attend a meeting we had
planned. (We were surprised that so many of
the storeowners were: Puerto Rican, and re-
gretted not having copies in Spanish.) The
meeting was conceived as a way to make a
small attempt to change attitudes, rather than
just forcing people to comply with demands or
rules. At the most, we had expected five sto-
reowners to come, that would have been a suc-
cess—but none showed.

Shortly after this meeting, we had a discus-
sion with three NYCs, who were requested to
do some protesting at stores selling glue. They
discussed the drug problem and fairly freely
described various encounters they had had with
drugs. One in particular, who is a gang mem-
ber, had very strong feelings about drugs since

85
GREATER NEW YORK

he had seen two of his uncles and a cousin
hooked. The NYCs noted that most of the drug
usage is in the evening: the kids either work
or hustle all day and then get high at night. It
is more or less the thing to do. From the discus-
sion emerged the idea of organizing some even-
ing activities, an idea which will be further
developed.—L.K., Medical Student, Brooklyn.

As a part of the Brownsville project, we can-
vassed the area to inform storeowners of the
dangers inherent in glue sniffing. We handed
them literature concerning a meeting at which
storeowners would confront members of the
community and discuss this topic. It is of inter-
est to note what transpired in one hardware
store in the area, where a man behind the
counter claimed: “I hope kids continue to sniff
glue; they will get sick and die and stay off the
streets.
these kids don’t know it’s dangerous. * * * I
will continue to sell it to them,”

The next week, in conjunction with the
Brownsville Community Council, a plainclothes
narcotics officer waited outside the store as two
young children entered to ask for glue and
bags. After the man sold them, the policeman
came in and issued him a summons, which he
refused to accept. The policeman called a squad
car and he was arrested.

Perhaps if this incident were made public,
through news media, a greater public aware-
ness of the problem would follow, and the peo-
ple of the area would pressure storeowners not
to sell glue and the police to make more ar-
rests. The problem at present is so great that
you cannot walk down the streets without
seeing young kids sniffing glue.

The meeting on glue sniffing was a failure
because not one of the 100 storeowners in-
formed about it showed up. At the meeting the
topic digressed from glue sniffing to gun-con-
trol legislation, etc., and members of the com-
munity claimed that glue sniffing was not such
an important problem that such priority
should be given it. Our activities were, in es-
sence, called useless.—D.K., Medical Student,
Brooklyn.

We spent 2 days driving our NYCs around
Brownsville from store-to-store, attempting to

36

* * * You are stupid to think that .

buy glue. Happily, our earlier campaign seems
to have had some effects: only one store that
we visited was still willing to sell glue. We re-
turned to this store 2 days later with 20 not-
so-eager pickets, and left about a half-hour
later with the druggist’s total supply of Duco
Cement. Picketing is apparently a very effec-
tive prod.—J.T., Medical Student, Brooklyn.

My feelings and views about the problems of
the ghetto have changed since the summer
began; I am less optimistic and more depressed
over it all.

Tuesday afternoon an addict walked into Ac-
tion Center 3 in Brooklyn; he had two friends
with him who had agreed to drive him to In-
terfaith Hospital. He has been an addict for 8
years. A girl friend who was maybe willing to
marry him, and a growing fear that the next
rock he tossed through a shop window would
be the last, had convinced him to call Inter-
faith on his own and make an appointment to
be admitted on Wednesday morning. From. us
he wanted pajamas, soap, and cigaretes, since
he had no possessions of his own. We took him
to Action Center 5 since I’d heard that they
had a good program there. The lady there
called the welfare center, then informed him
that he could not get pajamas and soap and
cigarettes until the following afternoon. She
asked him why he had waited until the after-
noon to come in, since he must know that “in
offices things have to be done in the morning.”
He walked out. I followed and begged him to
go the Interfaith anyway with his friends, and
promised to get pajamas and soap and ciga-
rettes to him the next day if he couldn’t get
them through the hospital. He wasn’t so sure
he wanted to go anymore, and after 2 hours of
waiting around for nothing was quite angry
and confused. So was I. I begged him some
more, shook his hand and wished him luck. On
Wednesday afternoon, Interfaith Hospital had
no record of his arrival.—J.T., Medical Stu-
dent, Brooklyn.

The official Newark City narcotics bureau is
a division of the Police Department. Lt. Ken-
ney of Newark’s Narcotics Squad was friendly
and informative but I was horrified at his atti-
tude toward drug addiction. He and his staff
GREATER

under her circumstances has stamped on her
record, “18P”, which means out-of-wedlock
pregnancy. The stigma follows her throughout
her life. The final decision to accept a girl back
into school is left up to the individual school
principal; for reasons cited previously, the
principal is usually not anxious to have such a
girl in the school, and permission to return
to the girl’s original school is often denied.

If the girl tries to remove the social stigma
of her out-of-wedlock pregnancy by marriage,
she is denied an education because she is now
considered a married woman.

There are only seven centers in all of New
York City that offer educational facilities for
teenage mothers; three in Brooklyn, three in
Manhattan and one in the Bronx. These cen-
ters offer both educational and health facilities
while the young mother is out of school and
living at home. However, they can only accom-
odate 40 to 70 girls at one time, which means
that 85 percent of the unwed mother popula-
tion is not being reached and is therefore not
being educated.

Other resources offering educational and
medical facilities are “shelters for unwed
mothers.” These shelters only accept girls who
are planning to give their babies up for adop-
tion, or girls who have no home or cannot cope
with their home situation. These shelters range
from $40 a week, up. Ninety percent of the
Negro and Puerto Rican girls do not go to the
shelters because, either, they live at home,
are unwilling to give up their babies for adop-
tion, unable to afford the shelter, or lack infor-
mation about such shelters.

I found that in certain instances these cen-
ters and shelters were not able to fulfill the ed-
ucational needs of the girls either: most of the
educational facilities already set up do not
have full-time teachers; and subjects such as
advanced math, languages, and commercial
subjects are not taught because they require
special teachers and equipment. This means
that it is only token education; and the girl
may also require classes in child care and nu-
trition, personal hygiene, social services, fam-
ily counseling, and psychiatric counseling.

These girls usually Jack parental support

38

NEW YORK

and personal motivation. If total rehabilitation
is to take place, their families must become in-
volved. Society has spent thousands of dollars
to help rehabilitate the drug addict, high
school dropouts, and people coming out of our
penal institutions. Why hasn’t something been
done for the unwed teenage mother? Perhaps
it’s because she is not seen as a threat to soci-
ety like the drug addict and ex-criminal 1
M.J., V.V., Nursing Students, Bronx.

Mornings weren’t too busy in the emergency
room any more so I began to give a question-
naire (concerning prenatal care) to patients on
Martland’s postpartum floor. The actual ques-
tion and answer session was slow, but in talk-
ing with these women I was appalled to learn
that: (1) Most of the women had very little
prenatal care, partly because they dislike the
long waits in the prenatal clinics and partly
because they didn’t think that prenatal care
was very important; (2) too many were un-
married and under 16, and very few (young or
old) knew much about birth control—they re-
ceived pamphlets for family planning, but most
had not bothered to read them; (3) most of
these women accepted their poverty, ignorance,
and degrading surroundings (24-bed wards
with paint falling from the ceilings) because
they knew of no other existence or did not
know to whom to protest; (4) most impor-
tantly, many of these women could not read or
speak above a grammar-school level, even
those who had graduated from high. school,
and some could not even construct complete
sentences or understand words like abortion.
That lack of ability to communicate was not
just a problem of the black mothers; it also ap-
plied to many of the white mothers I inter-
viewed.—K.0., Nursing Student, Newark.

HOUSING

Article 7—-A is a “rent strike: law passed in
1965. It is the most effective means of getting
slum dwellings repaired ever passed in New

' York. It provides that if specified conditions

dangerous to life, health or safety exist for
more than five days in an apartment building,
then one-third of the tenants can sue to get an
administrator appointed to collect the rents
 

SUMMER 1968

and make the needed repairs from the rent
money. The law is not a flawless piece of legis-
Jation. Among other things, it requires an ar-
chitect’s estimate of the cost of repairs be
made at the expense of the tenants bringing
the suit.

In connection with various community or-
ganizations, an extraordinary lawyer on the
Lower East Side, Mr. Hanft, has brought
about 75 article 7-A suits in the last year or
two, and has had adverse decisions in only two,
and in those two cases the repairs had been
made by the time the decisions were made.
The law has received little publicity, and
Mr. Hanft believes it has been downright cen-
sored in the press. For instance, on May 27,
1968, the New York Times wrote a long article
on slum problems including tenant legal rem-
edies, without mentioning article 7-A; the
New York Post wrote a feature on a slum
building in which Mr. Hanft had an article
7-A suit pending, and failed to mention that
fact; when picket lines were organized to
picket large department stores which advertise
in these papers, the television stations refused
to cover the story.—R.H., Law Student, Brook-

lyn.

We found that the Crown Heights Neighbor-
hood Improvement Council was very quick to
respond to our report of dangerous housing
conditions. In one instance, they sent out an
inspector the same night that the complaint
was called in to them.

One of our complaints was at 1018 Park
Place in the Crown Heights section of Brook-
lyn, where there was loose plaster falling from
the walls and garbage and dead vermin in the
alleyway between their building and the next.
The pressure that was put on the landlord by
our organization and the Crown Heights Im-
provement Council resulted in a new plaster
and paint job for three apartments in the
building, and a thorough cleaning of the alley-
way.

We found the RESCU agency to be the most
cooperative and productive of any of the or-
ganizations dealing with housing conditions.
The role of this agency is to make emergency

o ‘repairs in cases in which the conditions are so

detrimental to the welfare of the occupants
that these conditions cannot be allowed to con-
tinue for one more day. One of the flaws of the
program is that certain conditions that could
be disastrous to the health of the children are
not deemed emergency repair. Despite the
threat of lead poisoning, the presence of fall-
ing or loose plaster is not now considered a
reason for emergency repair. Our studies on
the incidence of lead poisoning from ingestion
of loose plaster and paint have shown us that
this condition leads to a sick and often criti-
cally ill child in too many cases.

Even though Project RESCU is a city
agency that is part of the superagency, the
Housing and Development Agency, it has man-
aged to cut out a lot of the red tape that was
formerly involved in getting needed housing
repairs. It has shown many people that repairs
can be done without having to go through the
entire “mishmosh” of housing agencies and ad-
ministrators, and it has gained the confidence
of the community. This was clearly shown in
the demonstration for RESCU in the fall of
1967, when the agency was threatened with a
funding cutback: 1,500 people attended a rally
on behalf of the agency.—D.Y., Medical Stu-
dent, Brooklyn.

The “channels” we had expected to set up
for the follow up on housing complaints discov-
ered through our hospital social history are be-
coming bogged down in red tape. By trial and
error, we have nearly reached the end of all
the agencies who have passed the buck. The
latest system for housing and health violations
is to type up a resume of each case separately
on a memo. One copy is sent to the Department
of Buildings for the Borough of Brooklyn. A
carbon is sent to the health commissioner. The
third is kept for our files. A cover letter with
the seven memo cases was sent out today to
each agency. The question is now what to do if
no answer to received.—M.H., Sociology Stu-
dent, Brooklyn.

The real problem is housing. The community
knows that housing is not only an urgent prob-
lem, but is also a central one; many other
problems, particularly health, are dependent
on it.

39
GREATER NEW YORK

My first approach in handling housing prob-
lems in the Bronx was to work with each per-
gon individually; call the landlord about the
tenants’ complaints; help a tenant look for a
new place, and so on. It’s the wrong technique,
but the right problem. One-to-one work is
probably the only way of doing good patient
advocacy, but it’s not a productive technique
for improving housing. Housing is much more
directly a community problem than health is:
all the tenants in a building are inherently a
group with common problems.—K.B., Medical
Student, Bronx.

I worked as a community organizer in a di-
lapidated apartment building on Monterey Av-
enue in the Bronx. After working as a patient
advocate for four of the families in the build-
ing, I had decided that an effort should be
made to confront the landlord and to make him
pay for his negligence. We held two meetings,
at which the tenants chose a captain and trea-
surer, and during which tenants’ rights and vi-
olations were itemized. A lawyer was recom-
mended to us by a representative of “Little
City Hall,” and the tenants decided to hire
him. The treasurer was able to collect a $5 fee
from nine of the 13 tenant families. During the
last week of the project, an architect who
works with the lawyer in a group called the
7_A Associates made a systematic inspection of
eight of the worst apartments. Article 7—A
specifies the following sequence of action:

(1) Landlord summoned to court for apart-
ment violations. Specific repairs or-
dered. -

(2) Landlord obtains one week adjourn-
ment, during which he must indicate
specific progress on repairs orders.

(3) If these repairs are not initiated during
a prescribed period, the building owner-
ship is transferred to a court adminis-
trator and rent is payable only to this
administrator.

(4) The landlord does not receive ownership
back until major repairs requested are
on the way to completion.

I intend to be present during the first court

action in September. Arrangements have been
made with a community organization for simi-

40

lar court actions to be taken against landlords
in all the buildings on the same block of Mon-
terey Avenue. These efforts may contribute
more to the good health of the community than
all of the screening, physicals, and referrals
that could be made for this same neighbor-
hood.—J.G., Medical Student, Bronx.

LEGAL SERVICES

Legal services are about as adequate as med-
ical services. The Legal Aid Society is an es-
tablishment organization that will really fight
like - - - - to get you a divorce but if you want
to sue a landlord, look elsewhere. They do an
excellent job on family problems. I don’t want
to downgrade the importance of this, but they
by no means offer a full range of capable legal
services. As far as the criminal division goes,
they are a fine outfit if you are guilty. The
criticism has been leveled that they plead
everyone guilty. From my summer contacts
with them, I believe this to be true. This prob-
lem is compounded by the fact that The Legal
Aid Society is the only organization offering
legal counsel on a wide base to persons in-
volved in crimes.

The legal services provided by the NAACP
are mostly (if not exclusively) for what they
consider landmark cases. If you can’t get into a
trade union, they might take your case, but if
you are a petty thief they won't. Most of the

_other organizations are interested in rendering

aid in those cases that will bring publicity to
the organization. If there are other legal ser-
vices available, I am unaware of them. (which
doesn’t mean that they don’t exist or that they
haven’t had much impact on the community).

As far as community attitudes about the
quality of the legal care that they receive £0,
they are resigned. They have come not to ex-
pect it, so they don’t miss it. They are unaware
of the role of the lawyer and exactly what he
can do for them. (In this respect, I don’t think
Harlem’s attitudes differ from those of the
lower economic groups across the country.)

The concrete legal services that the project
rendered were limited by several factors: only
two law students; lack of experience on the
part of the law students; the very nature of
law insofar as it takes a long period of time to
SUMMER 1968

andle a case. In terms of people reached and
ises handled, I would say that they come to
bout a dozen. That, as far as J am concerned,
; disgraceful. It was so because the project
ras entirely unstructured for law students. I
hink that it was an error to hire us without
ny real idea of what we were going to be
oing or of whether there was any real need
or us in a project like this. The other big mis-
ake was the assumption that law students
vould, on their own, know what to do. Law
chool has almost no relation to social prob-
ems. They don’t teach us about these things.
‘We knew that we didn’t know, but the project
lirectors didn’t know that we didn’t know.)

If it is within the goals of the SHP (and ’'m
aot saying it should be), law students should
be assigned to work with a lawyer in the com-
munity itself. Most of the good work is being
done by private, non-funded lawyers. These
guys are really doing some exciting things, but
they are shorthanded. It would be to the bene-
fit of the community to assign a law student
with a lawyer like this. I don’t know whether
this would fit into the conception of SHP that
its leaders have, but it would be more effective.
—_F.V., Law Student, Harlem.

AGENCIES

Harlem

It seems as though someone has finally
begun to understand what is meant by com-
munity participation. The phrase used to mean
that you’d have a black Ph.D. from Scarsdale
on your planning board to approve of ideas
from the “community” point of view. Well, yes,
he was black.

But the Riverside Health Clinic in Manhat-
tan is something different. The Department of
Health, backed by St. Luke’s Hospital, has set
up this comprehensive health facility, working
closely with a Community Health Council
which actually is made up of people living in
the neighborhood, people who will be the con-
sumers of the health care.

Since the Clinic was to be funded by O.E.O.,
some sort of community participation was .re-

« quired in the planning of the facility. Often,
though, community people involved in such

programs are not truly representative, and
therefore do not speak directly for the needs of
the people. In setting up the Riverside Com-
rounity Health Council, existing community ac-
tion groups were contacted and each was asked
ty send a representative. This group then be-
came the Health Council.

While this system of selection may not be
perfect in that only those people already in-
yolved in community programs were eligible
fur the Council, use was being made of the peo-
ple who would be using the facility. According
ty O.E.O. policy, the Community Council is not
galaried. This is to insure against the position
pecoming one of status rather than of concern.
(Funds were provided, however, for transpor-
tation, babysitting, or for time lost from the
job while Couricil meetings were taking place.)

The Council meets on a biweekly basis. Its
functions are concerned with the hiring of peo-
ple to staff the health facility—-making sure
that people hired are from the community and
representative of it. The Council also deter-
mines that people hired have the proper atti-
tudes needed to work with the community.—
J.A., Medical Student, Harlem.

Brooklyn

One of the main accomplishments of Project
RESCU (a program get up by the City Hous-
ing and Development Agency to facilitate
speedy repairs following complaints) has been
to prove to the white power structure that the
placks can do much for themselves.

For example, the head of Bedford-Stuyves-
ant’s RESCU is a black man who was raised in
the area. He has much knowledge about the
needs of his fellow placks and can communi-
cate with them. He is very responsive to the
complaints that are filed with the agency. He is
hindered by a lack of funds and by the lack of
good investigators, especially black ones. There
are, according to this man, not enough black
inspectors. The connotation of the housing
inspector is still one of disgust and mistrust in
the community. When the people see a black

“man coming to inspect their homes and help

them, they are more responsive and also filled
with a sense of pride —D.Y., Medical Student,
Brooklyn. pote

4

EE
GREATER NEW YORK

I came to the conclusion that the basic prob-
lem with Youth In Action was lack of money.
It seems that the Government has managed to
give just enough for the middle-class Negroes
to set up a bureaucracy; these funds, however,
have not been sufficient to permit the bureauc-
racy to function.

The funding is on a year-to-year basis, thus
causing a great deal of insecurity and a high
turnover rate in the administration; and since
the administration is constantly changing,
good relationships with the regular staff never
have a chance to materialize. Furthermore, a
great number of the administrators and super-
visors are members of the middle class, profes-
sionals who, for the most part, are more inter-
ested in using the programs to further their
own personal careers than to eliminate pov-
erty.

If the Federal Government would supply
sufficient funds on a long-term basis, many of
YIA’s problems would cease to exist. It would
seem that the Federal Government really isn’t
serious about eliminating poverty but is perpe-
trating an immense fraud.—R.J., Medical Stu-
dent, Brooklyn.

I was struck by the immense bureaucracy
that is Youth In Action, and by the apparently
large gap between administrators and working
staff. The workers, who are community people,
make up for a lack of formal education with a
great deal of understanding and ingenuity, and
are on the whole impressive.—J.T., Medical
Student, Brooklyn.

Some of the problems with the community
antipoverty agencies is that they are in a sense
competitive with each other for Federal funds.
Year to year funding, common in many Fed-
eral programs, is a hindrance to good rapport
between different local agencies. Agencies don’t
communicate to each other about programs
they are conducting or applying for since they
don’t want to chance losing anything to the
other agencies. An example of this in Brooklyn
was seen when the Brownsville Community
Council was, with our help, writing up a pro-
posal for a narcotics center in Brownsville
through the Model Cities Program. They

42

wouldn’t let a copy of the proposal out of sight
for fear that Bedford-Stuyvesant might steal
the idea.

Some degree of protective self-interest is
reasonable, but it would seem that if each area
had a certain amount of funds allocated for re-
newal, health care, new construction, etc., each
year (or 5 years), there would be less competi-
tion, more sharing of ideas and perhaps even
less Federal and local red tape. Each commun-
ity would be assigned funds depending on their
needs and local conditions. On the Federal
level, fewer agencies with overlapping func-
tions would be needed. Perhaps the existing
Model Cities areas could be used as a start.
Each local Model Cities office would know how
much money was available to its area. The ex-
penditure of these funds could be decided by a
joint action of Model Cities and other existing
community agencies in the particular area.

The Model Cities program has so far ignored
existing community agencies in the area, and
therefore any planning proposals drawn up
were probably staff-oriented and not communi-
ty-oriented, as decreed by the philosophy of the
program. This could probably be remedied by
hiring community people to staff the commit-
tees, thus eliminating meetings which end with
“we'll have to find out more about that”; and it
would give the community a real, not just ap-
parent, say in the planning.

Much resentment exists because local anti-
poverty agencies feel that their funds will be
cut due to the creation of this superagency,
Model Cities. They also feel, and rightfully so,
that all their work and planning is being ig-
nored since this new agency’s committees du-
plicate and have preference over their own
committees (which seem to have more com-
munity experience). It seems that for any ac-
tion to be taken these days much preliminary
planning, studying and investigation is neces-
sary. Many of the local agencies have been
doing this for the last few years and now a
new agency comes to do more planning, ignor-
ing any previous studies of the area. It appears
to many people that this is a way to make pov-
erty programs ineffective: keep them financed
as long as they are just studying the situation,
SUMMER 1968

but once they start to do something about the
status quo, give the funds to someone else so
they can plan some more.—W.S., Student Coor-
dinator, Brooklyn.

Newark

Our office was located in Area Board No. 2 of
the United Community Corporation in Ne-
wark. Our relationship with the UCC proved
‘to be detrimental to our services—patient ad-
vocacy and community organization and partic-
ipation. Many community residents were skep-
tical, even bitter, about any organization that
dealt with UCC, as it is known throughout the
community that UCC is part of the degenerate
political power structure that has a strangle-
hold on the Newark community. Any attempt
of theirs to service the people would be viewed

as a move to subjugate the community into the |

power structure. UCC has also been involved
in a few scandals. When Newark had its riots
and fires, UCC was designated as a distribution
point for food, clothes, and furniture. Before
anything was distributed, the staff of each area
board took what they wanted. Working in
Area Board No. 2 handicapped SHP because
community people were reluctant to come to
our office for services or organizational meet-
ings.—D.B., Community Worker, Newark.

Bronx

During the summer, I worked with two com-
munity organizations in the Bronx: the Tre-
mont Community Council and the St. Joseph’s
School Head Start program. The former or-
ganization is a summer, O.E.0.-funded group;
the latter, a parochial school affiliated with the
large and powerful Roman Catholic parish of
St. Joseph’s on Bathgate Avenue.

After attending one meeting of the Tremont
Community Council early in the summer, and

- having become acquainted with several of its

permanent members, I could only conclude that
it was thoroughly infiltrated by nuns, priests,
and policemen, and that its lay members were
neither representatives of, nor interested in,
basic efforts to confront and combat the causes
of poverty, sickness, and crime in the neigh-
porhood. The major preoccupations of the Tre-
mont Community Council during this past
summer appeared to center around the mainte-
nance of a good self-image in the neighbor-
hood. Attempts to achieve this included numer-
ous block parties, parades, recreational out-
ings, cleanup campaigns, visits by political and
church leaders (including the Archbishop),
and organization buttons.

The summer recreation program was run by
a Vietnam war veteran who was biding his
time until he could apply for a job in a Man-
hattan business. After some fruitless attempts
to question the basic goals and motives of the
Tremont Community Council, I decided to
adopt a position of peaceful coexistence. The
Council did, after all, provide four students,
two community workers and three NYCs with
office space, phone, and clerical facilities. The
Tremont Community Council had been bought
out by O.E.O. and the church; SHP members,
in turn, were bought out by the Tremont Com-
munity Council. It was a cozy arrangement: a
priest offering his buddy the cop a salami sand-
wich, while a Vietnam veteran shooed the
pesty natives out of the storefront. SHP |
workers maintained, in true style, a conspiracy
of silence.—J.G., Medical Student, Bronsx.

43
Part 3: ROLES IN CONFLICT

INTRODUCTION

For a multitude of reasons, highlighted in
the categories comprising this section of the
report, the summer experience for most of the
SHP participants was memorable more for its
frustrating role conflicts (both real and imag-
ined) rather than for any specific task accom-
plishment that may have occurred. There was
little disagreement as to what needed to be
done during the summer (“improve health care
delivery”) but agreement as to how best to
achieve this highly desirable objective was
never reached on any level of the project or-
ganization. Furthermore, approaches to a
given problem suitable for one area or area
subproject often turned out, because of basic
differences in the communities and health care
delivery systems involved, to be inappropriate
or ineffective for other areas or area subpro-
jects. Particularly where strong project leader-
ship and firm preceptor arrangements did not
exist, the necessity for modification of many. of
the original task proposals and the develop-
ment of new subprojects throughout the sum-
mer required that SHP workers constantly
re-evaluate and redefine their roles in the pro-
ject.

The diversity of views in the excerpts that
follow illustrate the resulting confusion and
frustration experienced by project participants
as they faced the realization of their limita-
tions, lack of power, or failure to deal with the
summer’s various problems most effectively,
ranging from broad questions of SHP/SHO
philosophy versus SHP/SHO practices, to deal-
ings with community groups, institutions, and
agencies, to relations within the SHP “family”
itself.

STUDENTS AS A FORCE FOR CHANGE

Why do many in SHO feel frustrated after
summer projects? Why does our bickering

seem endless and unproductive? We have not
decided whom we should support, the medical
schools or the community; we have tried to be
all things to all men.

We have failed to respond to the real prob-
lems in health—the need for change in schools
and health institutions. This summer, we did
much that was stop-gap. We helped, as advo-
cates and organizers, but these roles provided
few innovations; they merely reformed bad sit-
uations in a hospital system which the com-
munity detests. We should have devoted our
entire efforts to helping the community gain
control of its hospitals and to helping commun-
ity organizers challenge the inequities of the
existing health establishment. But we were’
still trying to protect the health establishment,
project our middle-class values, and preserve
our image as a “liberal” organization.

We have chosen to “sensitize” ourselves, to
educate health students. But we are still acting
as “good” whites in the poor community. The
problem, however, is not being educated at the
expense of the community. This SHP was
doomed from the beginning since it chose to be
educational. It chose to cooperate with the
health establishment, but failed to listen to the
needs of the community. The community
wanted people who would help it help itself to
organize area health councils and who would
give the community organizers ways they could
challenge the long waits and poor care of the
second-class hospitals. They wanted picket
lines of sincere white students and the black
community around these hospitals, if that
would help the struggle. Eventually, SHO
would have to realize that it must work for
first-class health for all, not just for the rich.
To do this, health students would have to take
a position favoring community control. In fail-
ing to do this, we only served to further erode
the pride and self-esteem of the poor.

45 |
GREATER NEW YORK

What is SHP? SHP itself does not know.
Our project lacked participatory democracy ;
we never met as a whole to decide upon any-
thing. Prior to the project, we failed to build
proper ties to the community, especially in the
Bronx. Thus, in many instances, we did not
have well-planned projects; they just fell to-
gether. I think SHO’s leadership let a sinking
boat flounder by not constantly re-evaluating
the project and by not providing for direct
participation, or even revolt in the ranks. In
essence, we did not learn from the failures of
previous SHPs and we were doomed to repeat
them.

The thing which haunted me most during
the summer was an expression from the
French student revolt this May: “The walls
have ears and your ears have walls.” I wanted
to help the Bronx community I worked in, but
I also wanted to listen to them. But people
wanted action and results. They were tired of
more white faces. In the inquisitorial darkness
of their eyes, I could sense the deep resentment
my skin had aroused. The community was not
a wall. It did respond to sincerity, but it
wanted its own leaders. Advocacy, or doing
things for the community, would solve noth-
ing; helping the community’s leadership
would. I laid some groundwork for a commun-
ity health council, but much of my work organ-
izing tenants to protest a garbage pile in their
courtyard, and poor housing conditions, did lit-
tle for the whole community.

I think the experience did much for me. I
have a clearer idea of what the blacks want
and what I need to do to help re-educate
whites; white students must become more mili-
tant in their own communities.

Student power is desperately needed in the
health schools. We must begin to build a base
within our own society to attack what it has
been doing to the black and white communities,
in hospitals and in teaching institutions. Stu-
dents should begin to fight for: (1) A student
veto in all areas of student life and studies;
(2) student-faculty control of school decisions ;
(3) more social orientation of courses; (4)
more responsibility of schools and hospitals to
the community; and (5) a militant SHO, dedi-

46

eated to community control, which would bring
needed information about health institutions
and their politics to community groups inter-
ested in health care, and which would actively
fight for sweeping changes in health schools.
Health professionals of the future must begin
to face the realities of our society now, and
should begin to force changes by militant reso-
lute actions. —R.C., Medical Student, Brone.

Before one can relate to a “task” it is neces-
sary to develop an idea of what the “task” is.
The SHP leadership has not clearly defined the
SHP “task.” At the beginning of the summer
there was talk about sensitization, and in the
outline for the final report they ask “how the
people in your community feel’ or “evaluate
the concrete service you provided.” It is too
bad they were not able to develop their leader-
ship beyond scurrying about trying to get
people to do their individual tasks. It is even a
greater pity that they were not able to think
beyond a “task” to be performed or a contract
to fulfill to the point where they quickly lost the
moral leadership of SHP and never gained the
conceptual leadership which they had the
potential to attain.

What are the conceptual goals which should
guide one’s efforts? Perhaps they should be to
educate doctors and students to the medical, so-
cial and political aspects of health problems—
why they exist and what can be done to correct
them on a long term, fundamental basis. The
question is not, how many will return, but,
how can the health system from the national] to
the city level be changed for all people so that
communities are not dependent on a few white
doctors who are kind enough to return to work
in patchwork, pilot project clinics.

The orientation to the type of education is
key—it should be intensely political. Change in
health system, and the people who rule them,
will only be achieved through political action.
The A.M.A. has effectively known this for
years, Task-oriented service projects or paying
the salary of NYCs to “sensitize”? white medi-
eal students to black people gives a minimal
political orientation. The overall tone of the
New York SHP has been intensely a political.

It is difficult to decide what makes medical
SUMMER 1968

people political. The present approach of gov-
ernment funds for service projects and sensiti-
zation is not the answer. That a national SHO
convention is afraid to come out strongly (or
at all) against the war in Vietnam or that the
SHP is organized around fulfilling Government
contracts retards meaningful political activity.
Students must obtain a degree of autonomy
from their medical school faculties before they
can even begin. One approach which the Col-
umbia SHO is planning to take is to build a
hard core of politically active students and doc-
tors to start with, and to attempt to slowly
build from this. We hope to extend our base to
other medical professions and perhaps to form
some communication with the hospital unions
eventually. This will be attempted through the
continuation of the Liberation School “Politics
of Health” classes at Columbia's College of
Physicians and Surgeons, meetings of the coa-
lition of community doctors, house staff, and
medical students at Harlem Hospital, and
through the involvement of these people in po-
litical actions’ on health issues at all levels.
This blend of education and political action is
something which can be pursued on a year-
round basis without costing money.

If medical people are asked to work on a vol-
unteer basis, they will begin to develop ways of
handling the medical responsibilities of being
politically active doctors; once they are profes-
sionals, they can then fall back on these ap-
proaches with confidence. Because this ap-
proach does not involve money, instead of
wasting nine months of effort gaining grant
money and then three months of “activity”,
leaders could spend the whole year actively
working politically.—K.C., ‘Medical Student,
Harlem.

A question with which we all have to wres-
tle: do I serve each suffering individual on a
person-to-person basis and reach only a few of
the many needing assistance, or do I direct my
energies at solving broader problems which
could benefit the greatest number of persons?
To my view, where medical politics are con-
cerned, there just isn’t time to split one’s atten-
tion and energies between medical practice
(for example, service projects) and medical

politics, and still be effective in both areas, at
least, not this early in the game when our com-
petence in either of these areas is so limited.
‘We can no longer afford to keep winning the
small skirmishes (for example, patient advo-
cacy) while losing the war (for example, little
or no change in the health care delivery insti-
tutions with which we worked this summer).
—_W.S. Medical Student, Harlem.

Because I have not succeeded in making
many grievances known to the people who con-
trol the health care delivery system, I feel the
project should be organized to put pressure
where it is needed. Perhaps SHP should not be
funded if it is not going to provide a systematic
means of working within the system to exert
pressure. Stop-gap measures will not suffice to
appease the frustrations of the patients at-
tended to by the student, and SHP will lose all
meaning to the community if it accepts in prac-

tice the wrongs of the present health delivery

system.—R.F., Medical Student, Bronz.

The lack of sophistication of some of the
leadership and most of the fellows—I include
myself—in the SHP is a principal issue. I sus-
pect all of us learned this summer, but I ques-
tion whether, other than sensitizing ourselves
to community health needs so we might be
more effective in the distant future, we accom-
plished very much. For that I do not think the
structure of people of SHP, or the communities
with which we worked, are at fault. We are
not capable of implementing vast changes in
health care in poverty areas. People suffer
from poor health not only because the city hos-
pital system does not meet their needs; not
only because the average physician is self-seek-
ing; not only because the average medical
school is more concerned about research than
people; they suffer because their children eat
lead paint off the walls; because their apart-
ments are inadequately heated in winter and
too warm in the summer, and overcrowded in
winter and summer. SHP might cause a
landlord to repair an apartment, but in one
summer SHP is not going to begin to attack
the causes of poor health in poverty areas. We
are unsophisticated and we are not revolution-
aries; we work within an establishment. We

47
GREATER NEW YORK

may serve to improve that establishment with
what we have learned this summer. With the
structure of SHP as it now is, we probably will
not contribute to revolution, but only to evolu-
tion.

How can we become revolutionary in our ac-
tions as well as in our words? We would have
to begin accepting more sophisticated people
into SHPs. People who were not idealistic the
way we were. People not afraid to offend the
health establishment. People unwilling to fit
into existing community organizations, if those
organizations. might have goals with which we
disagree. People willing to accept a subsistence
wage for the summer, to live in the community
with the people, to work with them day and
night. Most people accepted into the SHP were
not like this. For the most part, they were so-
cially concious but not dedicated, concerned but
not committed.—J.W., Medical Student, Lower
East Side.

There was little threat to the Establishment
made this summer. This, of course, brings up
the question that SHO has been struggling
with for as long as I’ve been associated with it,
and from what I can tell from the literature,
from its inception. It is the same question that
caused two New York SHO leaders to resign
before the summer began. Is the SHP to. con-
cern itself with political issues, or is it a
service and educationally-oriented organiza-
tion? I believe that any local SHP is doomed to
failure unless the students and community peo-
ple are in agreement on this question. One of
our major problems was that even the students
could not agree among themselves as to pur-
pose. Those of us who had been working and
preparing for the project during the year had
difficulty understanding and were angered by
the lack of commitment displayed by some of
the people who came in June. They, in turn,
were angered by our attitude, which at times
must have seemed more dogmatic than ra-
tional. It was never really stated, either in the
application or at orientation, that the SHP
wasn’t “just a job,” and that people who wer-
en’t really willing to commit themselves were
not wanted. For that reason, it was wrong of
some of us to expect (and often to demand)

48 |

commitment. I never understood the rationale
that gave lowest priority in the selection of
students for this year to people who had pre-
vious SHP experience. If students are willing
to come back after one summer’s experience,
they must be committed.—J.P., Medical Stu-
dent, Lower East Side.

I was confused about the role of SHP in gen-
eral. It was not clear to me whether it was sup-
posed to be a service project or a political pro-
ject for better health care. As a result, I did
not know which way to go. There was 2 lack of
communication in the local Newark project as
to which direction everyone was headed; every-
one seemed to be doing his own thing. So it
turned out that I acted mainly in the service
role because it is too difficult to make any at-
tack on organization without cooperative sup-
port. When any movements on the administra-
tion of the hospital were planned, I think med-
ical students became fearful of being thrown
out of medical school.—L.D., Nursing Student,

Newark.

Turning to the cold, hard facts, how do we
assist in providing good medical care for the
most people? This, I feel, is almost an impossi-
bility for students. We do not have the knowl-
edge or power to provoke the radical changes
that are drastically needed. The whole philoso-
phy of doctors and nurses, must be analyzed
and evaluated, and this is a task that must be
accomplished individually by every person who
enters these professions and is responsible for
the quality of care they give. In one’s mind,
there must be no distinction between race,
creed; or nationality, but each must be treated
as an important person, “my patient,” and I
must do my best to assist “my patient” with
his every need—physical, psychological, socio-
economic, etc. Our job is not finished when we
have handled the priorities, such as medica-
tions, yet patients are damn lucky if they get
even their immediate utmost needs attended to.
I think we can talk and talk about how an in-
dividual may assist in providing better care,
but we had better ask just what everyone else
is doing—including the people in influential
positions—to change health care delivery
systems.—P.B., Nursing Student, Bronx.
SUMMER 1968

I see the role for next summer’s SHP
as * * * working directly to change institu-
tions. The latter, I know from last summer’s
experience, is extremely difficult to do. I think
it is a necessary step for SHO to take if it
wants to provide any other service than ban-
daging a festering wound. Changing an institu-
tion ig a slow process, and student fellows
should realize this, but not let this realization
discourage them. To illustrate how difficult
change is one just has to ask the chiefs of each
service, If the chief has been on a service for
any length of time, and if he has just a little
sensitivity, he will tell you exactly what is
wrong with his service. Ignorance isn’t the
reason. This doesn’t mean that fresh eyes and
uncluttered minds will not bring about new
ideas for change.

Changing the institution is directly involved
with what the community asks of us. The com-
munity feels that if we have no power to
change, then why are we offering to help. This
statement was made during Orientation. Alone
it is hard for the community to change a sys-
tem, but united with the forces of people who
will someday be a part of the system, it should
be possible to start changes.

I think the project should strongly emphas-
ize being of service to the community. Unfor-
tunately, medical schools have a bad reputation
of taking from the community without giving
anything in return. Medical and nursing stu-
dents study the ghetto so they can better treat
poor people. What do they do to change the
conditions that cause ghettos? What good is it
to know that poor housing adversely influences
health if no effort is going to be made to
change these conditions? The same applies to
the realization that city hospitals give poor
care. This has been known for a long time, but
the situation still remains. I believe that with
education comes the responsibility to make use
of new ideas and information. If the responsi-
bility was taken there would be no conflict on
the issue of who was benefiting from SHP, be-
cause both the student and the community
would benefit.

I think that, as health professionals to-be,
we should be concerned with prevention.
Cleansing a cut and bandaging it promotes

healing, but it doesn’t remove the glass from
the streets to prevent further cuts.—V.V.,
Nursing Student, Bronx.

I don’t know anything about heart, stroke,
or cancer, and I don’t know anything about the
enabling legislation behind regional medical
planning, but if we're interested in future
funding we might look at SHO under two
lights ; first, enviormental health; second, com-
munity participation.

If the people in the Division of Regional
Medical Programs are serious about good
health, they’ve also got to be serious about
environmental health. They’ve got to care
about good housing, safe streets, good trans-
portation, and decent incomes. At this stage,
they’re probably not committed enough to
stake anything on those goals; but they may
be willing to keep us tootling along for a few
summers. At the very least, we can keep re-
minding them that they can’t set up routines
for testing and treating people without know-
ing how their patients live. We could feed
them ideas on how to make their programs
accessible, acceptable; we could point out
things they should study, such as the par-
ticular stresses of poverty and their relation
to heart disease. Somebody has got to re-
mind them that good ambulance service and
good telephone service is as important to the
proper care of patients as a good surgical suite.
I think SHO can act as a source of new ideas in
environmental health; and act as a small force
fighting for good housing and decent living
standards. .

Community participation can tie RMP to
SHO. Project fellows—students and particu- .
larly community people—are better able to
identify the people and groups that RMP
should be in contact with to set up local com-
mittees.

As far as I can tell, RMP has no access to
the community. SHO can’t honestly function as
that entree, but it can steer RMP towards the
right people. And SHO can keep lines of com-
munication going both ways by telling RMP
who to contact and by telling the community
that RMP is moving in.—K.B., Medical Stu-

dent, Brona.

49
GREATER NEW YORK

Outside of the community, SHP can play a
very important role. One of their major tasks
should be to work within the medical and other
professional schools to change the curriculum
and to get more ghetto youth admitted to these
schools. Since the students are part of these
schools, they can have a strong voice and exert
pressure for change.—K.D., Medical Student,
Lower East Side.

The white medical student must go back to
his own area and make vital changes come
about. He must work to get more blacks in-
volved in the health sciences and in community
health. One way to do this would be to get
medical schools to admit more black students
and to start programs to get black students in-
terested in going to medical school. Medical
schools are going to have to make a special ef-
fort to seek out qualified blacks and encourage
them to enter the health sciences.—D.Y., Medi-
cal Student, Brooklyn.

INTERVIEW

Q: What direction do you think SHP
should take. Should it continue to try to edu-
cate the medical student to the needs of the
community or try to help the community? Or
should students focus on working through
their schools?

A: It was a good sensitization experience
for me, but there’s a limit on how much you
need. You could supplement this experience by
having medical students work through the
medical schools trying to get them to change
their orientation. We’re going to continue SHO
into the year, working through our Community
Medicine department. We tried this summer to
revolutionize from the inside, and really didn’t
do it. This is the question to consider : whether
we can do more from within the white middle-
class structure as concerned medical students. I
think continuing SHPs would be good here, but
they would have to be restructured; there have
to be different guidelines. Something has to
keep going during the summer, whether
through SHPs or the medical school. It’s going
to be the same people anyway. But if it does
come through the medical school, right now is
the wrong time because medical schools are too
reactionary to be objective. * * *

50

REPORT

J proposed an elaborate freshmen orienta-
tion scheme with a flyer, talks at orientation
about the SHO project and community medi-
cine, a siminar program with many of the
parties involved during the summer, and a con-
tinued advocacy program. Through a variety
of intimidating tactics, my efforts (and those
of a number of others) were squashed. Our
first flyer, dangerously honest and filled with
what the administration considered half-
truths, was not approved. We revamped the
flyer and sent it to the incoming frosh, along
with a bibliography of books about the com-
munity they will enter. The administration
has refused to give us time at orientation be-
cause they doubt our credibility and demand a
sponsor and acceptance by the medical school’s
student council. This is hardly feasible because
the council won’t be meeting for another
month or so, and the administration thinks we
have been “put off.” Hardly! The community
medicine department likes our ideas and will
integrate a tour of Newark for entering fresh-
men into the biostatistics curriculum. It now
depends on our organizing the means for this
program. The seminars must be planned and
the structure for an advocacy program devel-
oped. What we have proposed is student-family
advocacy, some emergency room advocacy, and
community doctor-student interaction. Much of
this will depend on the support of incoming
freshmen.—P.D., M edical Student, Newark.

To go out and try to be a revolutionary
group. cannot be done through an organization
like SHP. These people who are going to try to
take over the Health Department, who are
going to go down there and force change,
that’s okay, but that’s a different group of peo-
ple, not us. If we did that we’d antagonize peo-
ple and it would be detrimental to our using
certain facilities.

Tf someone were to tell me that we shouldn’t
have an office on Springfield Avenue in Ne-
wark, and maybe we should work in the hospi-
tal, I’d really want to know why. I understand
in a basic way the concept of black power,
where a group of people has to get to a certain
level of power to meet the white money estab-
SUMMER 1968

lishment on equal economic and psychological
grounds, I don’t think the SHPs are keeping
anyone down; I think we are helping the
NYCs and some of the little kids around here,
talking to them, also assisting the people
through the advocacy program. Anyone who
says that we shouldn’t come in is hung up in
his own thing which doesn’t seem to be rele-
vant to what we’re doing. We’re not putting
ourselves in a position of. power, we're putting
ourselves in a position of asking the commun-
ity, “What do you want us to do?”—D.T, Stu-
dent Coordinator, Newark.

The community-oriented projects were more
successful in educating student fellows, but
they weren’t as successful in getting things
done. A lot of the time we got wrapped up in
the bureaucracy of these different agencies,
and that shortens your summer greatly. * * *

If the students were more radical * * * you
would get a lot less done. You would make a lot
more noise and you would get a lot more of the
hospitals and medical schools angry with you.
* * *T think in our situation the best thing is
to get something done by. working with these
people. In a place like Newark where they get
nowhere with the administration, you can’t
work within the existing structure because
they won’t hear you, so maybe there you have
to become more radical. It probably depends on
each situation.

I think the health system as it is today has
to be changed, but when people talk about re-
volution, about scrapping the system and mak-
ing a new system, I don’t know. There has to
be a radical change and maybe a revolutionary
change, but it has to come through what exists.
—W.S., Student Coordinator, Brooklyn.

I perfectly agree with attempting to reor-
ganize the entrenched, oppressing superstruc-
tures in America that are the source of so
much agony. However, I think it is a mistake
to ignore the immediate stopgap measures,
especially if one is involved in the delivery of

_ health services, I think that the above two are
not mutually exclusive and it would be wrong
to focus on one to the exclusion of the other.—
B.F., Medical Student, Brooklyn.

After the initial phase of orientation to
Martland Medical Center, I limited myself to
working with individuals of the Newark com-
munity who had some specific health problem,
attempting to procure good medical care for
them and, through this, to effect some changes
for better health care in general.. This led to
constructive criticism of and suggestions for
the facilities I came in contact with such as
clinics, social service and welfare. I found my
suggestions usually received with much hostil-
ity and also a sense of hopelessness. But I
found most health and social service profes-
sionals agreed that the city of Newark must
improve existing health and social services, as
well as create better facilities. Unfortunately,
by the time this relationship of trust and mu-
tual concern for the community was developed,
it was time for me to write this report and
leave. In actuality, nothing was accomplished.
—K.8., Nursing Student, Newark.

* * * T go to Columbia Liberation School to
the seminar on hospitals to hear the “radicals”
hold forth. I describe the suit (against the city
hospitals) and ask for assistance on a future
suit against Harlem Hospital to obtain better
health care for the community. I am stunned
by the apparent indifference and even hostility
of the group, and come away very troubled.—
R.H., Law Student, Brooklyn.

Too many times during the course of this
summer I have seen highly idealistic and well-
motivated SHP workers try to attack too large
a problem (example, the poor health care given
by City Hospital). Frustrated in their attempts
to accomplish anything tangible, their energy
becomes channeled into hypercriticism. Even-
tually, this criticism leads to antagonism and
ill will, and the SHP worker gets discouraged,
throws up his hands and quits.—B.W., Medi-
cal Student, Newark.

Unfortunately, I.and many other student fel-
lows came to the project with the psychologi-
cal orientation that something could be done
about the political problems through our ser-
vice activities. As the summer progressed, it
became obvious that a different focus is re-
quired. Getting out of my psychological “set”

51
GREATER NEW YORK

and into another bag proved to be difficult and
frustrating, since little can really be accom-
plished by individuals in the area of political
activism, especially twenty or so students,
without any power base, attempting political
activism directed at intransigent health estab-
lishment professionals.—W-S., Medical Stu-
dent, Harlem.

THE STUDENT HEALTH PROJECT
AND THE COMMUNITY

INTERVIEW

In terms of basic directions for SHP in the
future, and one of the limitations of this sum-
mer’s project, it seemed to some of us residents
in the community who're struggling with the
basic problems of inadequate care, could be

giving more attention to developing substan-

tive positions on how better care could be de-
veloped. We feel that even while students are
involved with problems of personal practices
and intergroup relations * * * for example
how they can relate to other groups such as
the Neighborhood Youth Corps—they still
have a basic responsibility to think about the
problems of institutional change, taking reso-
lutions and. making their positions known,
thinking through these things.

« * * Different communities are at different
stages of evolution. On the Lower East Side,
where there’s already some substantial com-
munity control, you have a different situation
than in a_ totally unorganized community,
where the basic leadership which is there has
to be discovered and put together in a coalition.
I was surprised to find that (some of the com-
munity people at the final conference) did not
know anything about hospital affiliations pro-
grams and who’s controlling the development
of care in their own areas, because all summer
long there has been no discussion of this. I
think that if the students, who really do have
substantive knowledge or can get it in a hurry,
don’t make this knowledge available to com-
munity residents, they’re losing a very great
opportunity to do the very things they say they
believe in.

One of the problems in an organized com-
munity is the danger of subverting the com-
munity leaders who are already in operation.

52

We had one subcommittee which perhaps
would have functioned better if there wasn’t
such a temptation to let the students do the
work. They were very helpful, but I think that
the community resident who was the chairman
of the committee would have felt more of a res-
ponsibility to draw together Puerto Rican and
Negro neighbors on that committee, if those
four students hadn’t been there functioning as
a good substitute. In a less organized commun-
ity, if there’s a vacuum, then you can put to-
gether your leadership—whether it’s chairmen
of social clubs or ministers of churchs; put to-
gether a coalition and talk to them. This argu-
ment that “we don’t know who the community
is, so we can’t talk to anybody,” doesn’t go, be-
cause you could put together a coalition of who
it is.

* * * The basic maturity level of students
varies. Some of them are very happy to play a
neighborly role, to help someone do something.
There are others whose need for a role is so
great that they have to go in and do it for
them. It might be that communities ought to
develop screening processes and use certain
kinds of students in certain projects. Some stu-
dents might be more ready than others for a
highly confidential or difficult community stra-
tegic problem. You wouldn’t want to talk about
those things to students who are toddling when
it comes to being able to relate in a comforta-
ble way to community people. Maybe we could .
develop programs for students which are basi-
cally immersement programs. In other words,
maybe there could be a subcommittee of some
community organization concerned with just
taking students around, showing them what
misery is, and how people are struggling. That
way they could get a first-hand understanding
of why things need to be changed.

I think there’s a line between commitment
and accomplishment; it’s something we haven’t
given enough thought to. Just because a stu-
dent is committed and deeply concerned about
giving better health care doesn’t mean he’s
going to be able to use his time in a way that’s
going to accomplish that. Then there’s the
question of how to hook that concern up to an
awareness of the constrictions of the medical
systems: the medical power structure, the
SUMMER 1968

questions of State policy and city policy, and
the planning mechanisms, and how these
things to which we had very little access as a
community were impinging upon us. In what
way were the students addressing themselves
to this? In order to understand that, the stu-
dents, perhaps, would have to go from an im-
mersement experience in the community into a
seminar, the kind that Robb Burlage runs.
Frankly, the students have a lot of power,
within the medical institutions and on a policy
level, if they want to put their energy in that
direction.

* * * Perhaps if their contributions in com-
munities were judged programmatically neces-
sary, then let those students be funded, but
let’s not just pay them to come in and sit down
and decide what they want to do. I think if
you’re really trying to develop deep contact be-
tween community people and middle-class peo-
ple, you don’t do it by putting a glob of people
down in a storefront and letting them be there
from nine-to-five. You do it by placing individ-
uals carefully into situations where they get
involved in family life and become aware, in a
visceral way, of what life is, as in the Peace
Corps and American Friends Service pro-
grams, * * *

We have to be humble about trying new
models. We ought to experiment and if one
thing doesn’t work let’s try another. I think
you have a beautiful element here among these
students who are dedicated, and they ought to
have an opportunity to do something ‘basic,
whether or not they can bring the rest of their
structure along with them. Two or three are
going to live in the community now. Of course,
the Lower East Side is a neat place to live, and
I think a lot of people come because of that,
but as they become community residents they
may play a completely different role.—S.D.,
Community Worker, Lower East Side.

I believe that there is no place for an SHP
on the Lower East Side next summer unless
the students maintain a continuing relation-

ship with the community. This means that the .

projects started must not be dropped during
the rest of the year. The community is justifia-
bly cynical about “outsiders” who come in and

experiment on them and then leave when their
interest flags. I don’t even think it is our deci-
sion as to whether we have succeeded or failed.
If we leave while they are still willing to ac-
cept, or tolerate, our presence we are being de-
structive by once again reinforcing their cyni-
cism about outsiders. From what I’ve seen, the
community people are honest rather than po-
lite, and will tell us to get the hell out when
they want us to go.—J.P., Medical Student,
Lower East Side.

Though we did accomplish some things in
the Harlem area, I hope that there is a more
efficient way to spend the fifteen to twenty
thousand dollars that went into just the sala-
ries for the project personnel. I am not at all
sure that we were justified in, first, going into
their community as we did, without an invita-
tion, and then in leaving after doing our 10-
week thing. True, we have left some perma-
nent accomplishments, but they are really the
results of the work of a very few people who
had been working independently of SHP be-
fore the summer and who will continue to do
so after the summer. There were just too many
people getting too much money to accomplish
what, for the most part, amounted to little
more than a temporary and insignificant ser-
vice for the community and a sensitizing expe-
rience for themselves._S.G., Medical Student,
Harlem.

We are surprised to find kindness and con-
cern for us among these people in Harlem who
seemingly do not care about anything. On the
other hand, there is no way for the members of
the project to become acquainted with the com-
munity as a whole, and so the work that can be
accomplished is small. We remain outsiders
who come and go, like the summer.—aA.G.,
Nursing Student, Harlem.

One main complaint I have is that our pro-
ject should have been more involved with com-
munity groups or institutions. In that way, our
presence would have become known to the peo-
ple of Harlem and there would have been less
of an aura of “here’s a bunch of college kids
coming in for the summer.” I don’t know if the
community was aware enough of our existence

58
GREATER

to have felt this way, but individuals in the
group were self-conscious lest this be the ap-
pearance we present.—M.1,, Psychology Stu-
dent, Harlem.

When I began work in this project, I knew
nothing about SHP. I knew that I was sup-
posed to be a liaison between the project stu-
dents and the community. I became more. I did
everything from house-calling on unwed
mothers to cleaning and removing garbage at
the project office in the South Bronx.

In the beginning, I merely performed my du-
ties—-appointed and volunteered—without much
thought to the reasons for being of this project.
Then I began to think. I questioned; I was
answered; I was disgusted.

According to the project fellows and SHO
literature, the main goal was “sensitization” of
white, middle-class, medical students. A per-
fectly rational idea—from the white medical
student’s viewpoint, But from the moral point
of view, this is an horrendous injustice to the
community! How can SHP invade a ghetto (to
“help,” of course) with an army of white medi-
cal students, and for ten weeks perform acts of
charity and fellowship, but simultaneously
have the anguish of the ghetto as a secondary
reason for justifying the existence of SHP?

The makeup and foundation of SHP must be
changed. In fact, it had better be changed, or it
will get kicked from one ghetto to another
until there are no ghettos left. (And then its
only alternative will be Scarsdale and similar
communities. )

SHO must have total commitment to the
community, but not a paternal commitment. It
must help train black, Puetro Rican and all mi-
nority groups to help their brothers and sisters
in a meaningful manner. By meaningful, I
mean meaningful from the community point of
view, not the interpretation of the community
point of view by the white medical students.—
C.R., Community Worker, Bronx.

The health care in my community is very
poor. It’s the worst possible care anyone could
get. This is why people stay away from the
hospital until the last minute. Having students
come in the summer is not helping. The num-
ber of people reached by SHPs this summer

54

NEW YORK

does not cover a third of the people who are in
need of help. It’s a waste of time for everyone.
You have students who think they have done a
great job, but it’s because they filled their own
need to “help poor people.”——M.H., Community
Worker, Bronx.

The main goal of the Student Health Project
is to help the people of the community. At first,
people were reluctant to accept any outside as-
sistance, but gradually they began to realize
that sooner or later they would need someone
to help them, and they began to assimilate
with the so-called “foreigners.” Now, at the
end of the summer, when things are really
getting on their feet, everyone is packing his
bag and saying “goodbye.” Once again, the
community is hit with the hard truth—no one
really cares.—C.B., NYC, Bronz.

Ideally, I think a project such as this one
should strive to make itself obsolete; the goal
should be to help the people become more in-
terested and show them how to gain more
power to solve those problems which continu-
ally afflict their daily lives —LB., Medical Stu-
dent, Bronz.

It is just that you have to decide what SHO
is out to do. If it is to educate students, then
the community is a good place, but if it is to
help the community then maybe there are bet-
ter places than out with community groups.—
W.S., Student Coordinator, Brooklyn.

WHITE STUDENTS IN BLACK
COMMUNITIES

SHAWANGA WORKSHOP: THE ROLE
OF THE WHITE STUDENT IN THE
BLACK COMMUNITY.

Position Papers Presented By Willard Finderson,
Leslie Clarke, Mrs. Altanese Maxwell, and. Peter
Dorsen (Moderator).

I believe that there is a place for white stu-
dents in a non-white community to a certain
extent, but just because you’re in the medical
profession does not mean that you don’t need
NYCs to serve as your contact to the commun-
ity. If you were to go out into the community
and try to run your program by yourselves,
you'd be rejected. Someone was saying yester-
SUMMER 1968

day that he would like to run the show him-
self, but for too long we’ve been dependent on
the whites to tell us about ourselves. For in-
_ stance, whites run the school system for us, and
this means that our children learn about them-
selves through whites, and that shouldn’t be.
We should have our own school systems, our
own television and radio stations, things like
that. This way we can express ourselves, we
can tell our children about themselves without
the help of whites who distort history.

As far as having a lot of white students
come into nonwhite communities, they do no
help. They should go to their own communities
and express to their own people how we feel.
It’s easier for you to talk to your own people.
Of course, you have to come here to find out
what it’s like for yourself, but it’s very difficult
for you to tell me how I should live. The non-
white community needs help from just about
everybody. I’m just trying to say you can’t
come into this community and say you’re going
to do it on your own, because you can’t. If you
want to help, you can go back to your own
community and express how we feel and what
we need. We should let you know what we
need, and this way you can try to open the eyes
of your brothers and sisters, and maybe we can
get along together in this world-——W.F., NYC,
Brooklyn. ~

At the beginning of the summer, I raised a
big stink about why a white student would
want to come into a black community. I said if
they want to help the black cause so much they
ought to give their own communities the word.
Now it is the end of the summer, and I’m going
to reverse my previous position.

This has come about by much experience,
much thought, and a little bit of ink on paper.
The place of the white student, if he is sincere,
is in the black community doing what he
knows best. There is no way of knowing if a
student is sincere, that is up to him. In my ex-
perience this summer, the black man did noth-

ing but b.s. Once they got a title and $20,000 a .

year, the black bourgeoise in all the top posi-
tions forgot their roots. Give a black man that
title and his money and you don’t see him any-
more. The white students I worked with

seemed a bit more dedicated to what they were
doing. I don’t care if you call me Uncle Tom or
traitor or any other such names, my first con-
cern is with the welfare of my people. What I
want is black sincerity, and whether you be
black or white you can have that. I saw dedi-
cated black students this summer and I also
saw the other ones. I’m not saying there are
not white students who b.s. I just didn’t come
across any this summer, For this reason I don’t
care who comes into the community, any color,
as long as he is sincere—black sincere. I noticed
that all some of the militants did was call for
“Black Power;” they didn’t do anything.—
L.C., Nursing Student, Brooklyn.

The bias of this report is.that of a white,
middle class medical student. Perhaps as a rep-
resentative of this group, I derived a lot more
from Newark’s Central Ward than I could con-
tribute. My skills were certainly limited, and

-my credibility often questioned. I definitely

could be of better service as a physician, as a
lawyer, as a nurse, for example, once my train-
ing was completed, if I were assigned to a spe-
cific task. And particularly, I think, if the pe-
riod of time in which I was involved in the
community was longer. But again, I think this
period of sensitization, and perhaps even the
small amount I did accomplish, was impor-
tant for what I might be able to give later to
medicine and to the community. Perhaps also
our impatience, because we were only working
for ten weeks, was quite important because we
were more demanding of change and cutting
red tape.

On the one hand, the student already has el-
ementary knowledge of his profession and his
skills, so that he can be a liaison for those
less informed about what quality of health
care they should be getting—what is adequate,
and what their rights are in terms of health
care. I think the white medical student could
get the ball rolling, as we did in many cases
this summer. But I think it’s up to community
health councils staffed with community person-
nel to replace him. This suggests, I think, a
definitely political approach.

I also think it’s awfully important that the
“volunteers” continue into the winter if they

55
SUMMER 1968

only time my kids will get a chance to get
something better is if a group of white people
get together and say, okay, we’re going to do
this for you.

Are you suggesting that we do not have a
place, that we’re making a mistake by coming
in?

Right, you do not have a place! Besides, and
this has been getting me angry all summer
you’ve been getting involved in personal, deep
problems, and all you can really do is go to
Welfare with them, or take them to the hospi-
tal, and then you’ve got a file of everybody’s
personal sex life and everything like that, and
then you leave. I don’t believe that your mind
is so together that you’re not going to discuss
these things that you’re not going to have an
idea of “this is how they live” kind of thing. I
really believe that this plays in your mind
after you leave. There were very few white
students this summer who didn’t have that
typical attitude—maybe they can’t help it. But
you don’t understand how the system has made
us this way—you just say, well, this follows up
with things I have been taught all my life, and
this makes you feel superior. * * *

Can I put it to you and ask, why are you
here with us now if you don’t believe in
it. * & &

I’m angry at myself the whole summer, be-
cause someone told me, I think you'll like this
job because you’re outgoing and you sincerely
have a feeling for people, and you might really
enjoy doing this kind of work. When I went to
orientation I got an impression that a lot of
things were going to be done for my people, I
resented the idea that white people would have
to be there to keep doing it, damn it; but all
right, I thought there was still going to be
something done. And then all of the things you
said you weren’t going to do, such as, you wer-
en’t coming in with microscopes, and you wer-
en’t going to write books, and stuff like that.
You came in and started doing the same damn
things you said you weren’t going to do. And
that made me disgusted * * * that made mea
part of your sneaky, underhanded way of get-
ting what you want. I think the only ones who
got anything out of this were the students who
maybe will get a credit in school, or the “edu-

cation” of working in the community. I’m very
ashamed of myself, and very disgusted with
myself, and I would never, ever get into any-
thing like this again * * * ‘

Whenever anybody from SHP took some-
body to the hospital, they got better care that
day, but the day that you couldn’t be there to

' take them, they got the run-around, they got

the same old thing. SHP isn’t going to be here
all the time, I don’t think. What’s going to
happen after SHP is gone?

If SHP was able to get a few people in, was
able to get services for them, I think that when
SHP moves out, these people will get so angry,
they will get together and try to organize in
the way in which SHP tried to get them ser-
vice. So SHP, I feel, did something, even
if * * * only to get them angry. They’re
going to be angry if they can’t get it any more,
so I think we did something.

I think it’s ridiculous to assume that every —
white man that comes into the black commun- -
ity is there just to take advantage of the peo-
ple, is there not to give anthing, just to be do-
gooders. I think many students that went into
the black communities this summer really were
interested and wanted to change the situation
of the people. We have our hangups in the
white community, but I think the blacks have
too—the fact that some black people distrust
all white people, this is something that’s
wrong with our society. We’re heading towards
an all-black and an all-white society. This is
terrible. If we’re going to stay out of the black
community, all you’re going to head for is two
separate communities. The fact that white peo-
ple give a damn about what’s going on in the
black community is a very good thing, and IT do
think we have something to offer; I think some
people really care about what goes on and can
go into a black community and ask people,
“how would you like us to help?” and then do
for these people exactly what they want us to
do, I think this is performing a service, and I
think the white person does have such a place
in the black community. And you say it would
be better if we had black students going into
the community, but we don’t have them now.
What are we going to do, wait around for 10 to
20 years until they come?

57
GREATER NEW YORK

are accepted in the community. I’m thinking in
terms of the structure of the welfare rights
program where there are outsiders present, but
community people must administer and pursue
claims themselves.

I think it really should depend on the local
climate of the particular area, as to just how
much a student does become involved. On the
one hand, he can live, work, and sleep in the
area as VISTA workers do, or he can merely
work out of a storefront and return to his
white middle-class neighborhood for reasons of
safety or convenience. He can also choose to
work in an emergency room or agency and
never enter certain parts of the community.

Certainly, the community is cynical about
10-week do-gooders. It is cynical about ques-
tionnaire makers and posters. It is cynical
about photographers and bookwriters who
many times catch the people’s misery on their
films or in their books, which only supports
the distortion whites already may have. I
think the question is: Is this worth the time,
effort, and money involved?—-P.D., Medical
Student, Newark.

The students working with the community
during the summer in the Harlem project were
very helpful and they really worked very hard
in our community to help our children and to
serve their health needs. They seemed so dedi-
cated. If there was any question we workers
wanted answered, or whatever systems and
medical terms needed explaining they did it. I
think their being here was great as long as
they provide a service to help the community
to do what was needed. And if they didn’t
reach but ten children and did a very good
thing for those children, then they belong. And
that goes for all white students. I think more
of this work should be done, but not on the
basis of color, or what the community is, or
whether you belong. You belong wherever
there is a need for dedicated people.—A.M.,
Community Worker, Harlem.

Open Discussion

I was just wondering if WF’s argument
could be a counterattack, because you feel the
NYCs have been attacked so far. I worked in
Harlem, and I worked for a few weeks with

56

another white student. We didn’t have any
NYC’s with us and we were accepted in Har-
lem. We got a few wisecracks, sure, but that
was minor. We had health services to give to
these people and we went out and gave it to
them. Just because we were white they didn’t
refuse help; they wanted it.

Do you think if there had been just black
students, do you think they’d have been more
effective?

I don’t know, it just worked out in Harlem. I
don’t know the situation in Brooklyn.

I think as a community person, you can iden-
tify more with a black student than a white
student. Of course, if you have some services to
offer, the people would be stupid if they didn’t
take advantage of it. I’m just saying they’re
more inclined to accept a black person than a
white. They'll still accept the services, but in
different degrees.

I worked in the South Bronx area, and I got
a chance to talk to a lot of the people. In my
community, you always see white people pick-
ing up our kids; you see white people taking
our kids to camp; you see white people teach-
ing them during the winter months. Why can’t
we have black people being taught to do these
kind of things? .

A person who needs help isn’t going to say,
“P’m not going to accept it because he’s white”;
a person won’t do that, But we get the feeling
that we always have to be led by whites,
whites have to take us to the hospital, etc. I
really reject this thing of patient advocacy. All
right, it’s one thing for me as a black person
(although I feel kind of uncomfortable) taking
a 60-or 70-year-old woman to the hospital just
like she’s a baby but for a white person to do it
makes them feel a continual dependence on
whites. I’ve even met some black people who
would rather a white student would do some-
thing for them than a black student. You know
why? Because white society has taught them,
“don’t trust your own kind of people”; it’s a
sick thing that they would prefer to be taken
by a white student. * * * You're not letting
them grow, you’re keeping them down by con-
stantly coming in and leading them.

I don’t want you coming in to take my kids
to the park, or on hikes. It would seem that the
GREATER NEW YORK

The thing about black self-esteem, and tak-
ing something away from a black person by
being white and having to do something for
them, that’s really beautifully expressed in
Carmichael and Hamilton’s book, Black Power
and the Politics of Liberation. It’s really a very
good document on this. To get to the things
you were talking about, how would you re-
structure SHO, so that it would do what is the
most important thing, to train community peo-
ple to do what medical students think they can
do. I think SHO at Yale in New Haven has
done the best thing along this line, which is,
they have as many community workers as
students. * * * Maybe SHO should just be a
sort of enabling force, so that we can enable
community people to do things for themselves.

I think what we should have been doing was
giving our expertise, what we know about the
hospitals, to community organizations, and this
is the pattern we can take for next summer.
We should go in and work with these commun-
ity groups during the year, so that we would
have some plan of going in next summer. Then
we could say, OK, you know we've learned how
the welfare system works, and we know how a
hospital system works, and now we’re going to
work with a group of five or six people from
your community organization; we’re going to
tell them all we know about health and wel-
fare systems. * * * I think that’s where we
can work, and eventually we’ll work ourselves
out; that’s what we should work for. * * *

I think black people are all trying to reach a
level of pride, esteem in themselves and things
like that, so that, when they reach this level,
they can communicate with the white people,
with the white power structure. So they’re all
going towards this one aim, to communicate.
What you’re doing down on the bottom is irrel-
evant. We need help, in all kinds of forms.

The whole concept of white students going
into a black community to offer what they have
to offer—some mysterious type of expertise
which I have yet to see—is totally bogus, be-
cause what took place in Newark this
summer * * * I could have gotten twenty-five
high school kids to do the exact same thing.

I think you’re being very naive, very conde-
scending, very racist, and everything else

58

that’s sick about our society, in supposing that
community people don’t know what good
health care is, or how to get it, These people
have learned over the course of many years
what bad health care is. And if you go up to
any one of these people in the clinics, they will
tell you why their treatment is bad. They
might say, my discomfort is aggravated by
going to the hospital, rather than being eased.
Rather than having their problems alleviated,
their situation has become chronic through bad
health care.

What you need is outspoken, militant people
who gather people around them and make
themselves more assertive to demand certain
things. If you are a powerless body, and you
demand from a powerful body, you’re not
going to get anything, which is the case in Ne-
wark. The Newark City Hospital is a very
powerful body, very bureaucratic, very much
in the system. They know they’re very power-
ful, and they don’t have to “sit down” to real-
ize their power. But the community people,
often, have only one recourse open to them:
they have to Bogart, they may have to close
down a hospital, they may have to burn it
down. And there are plenty of people in Ne-
wark right now who would rather die in the
streets than use that Newark City
Hospital * *.*

What you need for white students, first of
all, is to get away from this thing of coming in
to learn about us. Whites always want to be
one jump ahead of not only what we’re think-
ing, but of how we're going to go about doing
it. More than that, they want to be able to give
their suggestions and exercise control over
how and what we’re going to do. There are
plenty of black people in Newark, and in other
black communities around the Greater New
York area, who have plenty of ideas about how
they’re going to change things. The whites are
very curious about this; they can’t stand to sit
back and work in their own communities. Some
of the really liberal whites realize how deca-
dent their own society is, so they reject work-
ing in their own society; they want to come
down and leech off the black society. And they
can do it with the Student Health Organiza-
tion, the same way they’ve done it with all
SUMMER 1968

these anti-poverty programs, across the board.

You've got to get away from this thing of
not rehiring even the few whites who perform
well in the project during the course of the
summer, who get beyond this learning experi-
ence, who finally realize what they can offer,
and who can then come in and differ with it.
The second summer, these kids aren’t even
hired by SHO; SHO’s intention is to bring in
more leeches, to suck and learn off the black
community. This is what these kids do, and
when they go back to their own medical
schools, they can’t do a damn thing. They
aren't going to Bogart their way into those
buildings, they aren’t going to do the very

things they’re demanding of black people. I’m ~

not saying we want to make a parallel health
system, I don’t think that.a lot of blacks
today want to see a parallel of the white
society. We don’t want to have black folks
doing to their own folks, what white folks
have been doing to us for so long. What you
have to have is creative people who will
help develop totally new methods in health
delivery systems. If whites are going to
come into a black neighborhood, the black peo-
ple in that neighborhood should determine who
the whites are who will return. The white stu-
dents who worked in the Newark community
should submit themselves to evaluation if they
want to work the next summer. The black peo-
ple they worked with should say which ones of
them should come back.

I think that white students could definitely
serve a role in a black community. Maybe not
make up a black community health council, but
they can certainly educate their own folks as
to what’s going on by working from out here.
We can get more done that way. We have three
or four kids who go to the New J ersey College
of Medicine. They have been more effective by
associating themselves with community people,
with the high school kids, and with the non-
hospital people, rather than doing it the
other way around. If they did it the other
way around, they’d get co-opted, they’d get
softened. A lot of the health science students
have seen how really desperate the situation
is. Two or three of them have been threatened
with being kicked out of school, just because

the administration didn’t want SHO people to
inform freshmen about how there should be
more involvement with community people as
part of their medical school education—some-
thing as simple as that. Some of this experi-
ence is vital if white people expect to practice
in black areas. ,

As far as providing an immediate service for
people in a community like Newark, that is
vital, because these people really don’t want to
be bothered with you if you can’t do something
definite for them. And white kids can do this.
They can come with a clear mind as to exactly
where they stand. A lot of them are just too
mixed up, because in a place like Newark
there’s always talk about violence, and when
such talk hits the fan, where are you going to
be? I remember that at all the meetings, just
before the project got under way, they kept
talking about what are you going to do in case
of violence. And I just sat there and said, man,
you people should know what you're going to
do. If you’ve arrived at a certain point, either
you get the hell out or you know which side of
a gun you’re going to stand on. It seems stupid
that they would worry about it since they
would have been working at the hospital all
summer. The first thing you would do is go
the the hospital, because people are going to be
coming in there, all banged-up and shot-up, or
whatever, so you could be the most help there.
That’s the way they can be the most help now,
when there are no riots, in the city hospital.

Patient advocacy is a beautiful and meaning-
ful thing. We didn’t drop it, we got hustled out
of the hospital. The hospital is scared of the
community, and some of the medical students
are even scared of the community, though I
think quite a few of them got over that. But
the immediate service, the advocacy, is ex-
tremely important. Even if this project was all
black, if they did not offer an immediate ser-
vice to people, it would be useless and stupid;
they wouldn’t be able to help anybody.

There could be a place for SHP next summer
in Newark. Apart from antagonizing people in
Martland Hospital, student fellows only antag-
onized each other this summer. I would drop
the policy that former student fellows not. be.
hired the following year. This should be based

59
SUMMER 1968

mer in the ghetto.—L.C., Nursing Student, Ne-
wark,

There is a certain core of adults in Newark
who have really had it. They don’t believe any-
body, or anybody in a position of power, or the
city government. They are also struggling for
their own living, and because we're college
graduates, they aren’t going to believe us.
We're too clean and too “Establishment.”
We're not living and sharing their experiences
with them. You can be white and share the
-experiences and get accepted by doing the same

thing, by being a day laborer. I really think .

you have to break that economic barrier and do
the same type of work to reach them.

I’ve had one negative experience; it was sort
of funny. One of the student fellows who didn’t
have his name tag on was talking to a guy
from the African place across the street. Then
I came in with my name tag on and broke in on
the conversation; the guy took one look at me
and said, “Are you a medical student from the
medical school?” When I said, “Yes”, he just
got up and walked out. He didn’t say anything,
he just got up and walked out of an elaborate
conversation.—D.T., Student Coordinator, Ne-
wark.

Those non-black people who are selected
shouldbe more carefully screened for attitudes
and grasp of the problem. An upper middle-
class student who honestly sees nothing wrong
with taking photographs of human suffering
with his Nikon-F is a mistake. His presence
and his blundering are too expensive. Let him
learn elsewhere. Asking to be shown through
someone’s home for the purpose of seeing just
how bad it is is too much. Is he going to fix it?
—A.M., Nursing Student, Newark.

I was assigned to be a patient advocate out
of a poverty program storefront, the League of
Autonomous Bronx Organizations for Renewal
(LABOR). The office was located in the middle
of an old tenement area with both black and
Puerto Rican residents. The assignment at first
seemed to be a challenging approach to the ad-
voeacy work because LABOR’s primary con-
cern is organizing tenants around housing code
violations. I was to work with a community

worker on Gouveneour Place, a short block
which offered ample opportunity for being or-
ganized around housing, sanitation, and health
issues.

The first three weeks were spent planning
and executing a block cleanup and block party
—the accepted way of getting the residents
“fired up” for tenant council meetings set up
by the LABOR staff. While discussing code
violations with tenants, I was able to uncover
very few medical problems, but heard a bar-
rage of complaints against the sanitation de-
partment and the police who have failed to
come through with a play street for three
summers. The block swarms with kids, from
toddlers to teenagers, and no one hears the
angry parents’ protests against speeders and
the dirty streets. I decided, therefore, to ex-
plore the possibility of closing off the street
to through traffic. While the cleanup and
block party were successful as stopgap meas-
ures, neither provided the expected induce-
ment to organize tenant councils. Nor were
the petitions signed by all residents or meet-
ings with police successful in getting through
city bureaucracy and around uncooperative
tenants to get the street closed.

I had questioned the merit of such measures
as a means of getting to the people and helping
them work together. It was explained to me
that this mostly black-inhabited block had not
responded to past organization efforts despite
the vast need for the attention from city agen-
cies which group effort initiates. I felt that
this community was apathetic because all out-
side agencies had failed to use the manpower
potential already there. Even LABOR operated
by importing black organizers from other

* areas.

Were the people unresponsive because I ap-
peared to have initiated efforts to get the street
closed off? I think it naive to settle on such a
simple answer, but I did begin to realize how
these people feel about whites coming into
their homes, exposing their dilemma of apathy
and an unresponsive system controlling their
lives. Appearing to know more about the sys-
tem and how to apply pressure, the whites are
expected to do for them what they have been
unable to do. I was told by many of the outspo-

61
GREATER NEW YORK

on performance and compatability with the
non-white community. Community people
should not be “used” to train liberal white
leeches, or even to help them become more well
informed. Only those who know what they can
offer and how they can offer it should be hired.

SHO could possibly split its forces for the
summer project into two forces. Those who
will work in non-white, for example, black
communities, and those who will talk to their
own folks.—R.P., Community Worker, Ne-

wark.

INTERVIEW

Q: Do you think the health students related
to the Newark community well?

A: Yes, they fitted in very nicely, they wer-
en’t too anxious, they were understanding,
very pleasant—they weren’t formal. The peo-
ple around here don’t like people to be formal.
They like down-to-earth people. The students
fitted in all right. If they hadn’t, they wouldn’t
be here this long.

* * * A number of things would have hap-
pened if we’d cut into the hospital the way we
wanted to. There probably would have been a
riot, I know that. SHP really wanted to protest
against the hospital for the people there. The
hospital people don’t treat the patients
right. * * * If we had really pushed com-
plaints as hard as we wanted to, and had had
the people protesting, it would have been 4
huge mess. In a round-about way it was best
to do as much as we could, but not to do it too
strongly. * * *

You see, community people never really stop
to think about how they’re used to being
treated. The people know they’re being treated
mean, they know they’re not being treated fair,
but they never stopped to realize what they
could do about this until the health students
came here. That’s when they stopped to think,
why should we be treated this way? Before
they had said, “Oh well, we’re going to be
treated like dogs, let’s get used to it,” and they
never tried to do anything about it. If the
health students would have come in-and started
protesting, then the people would have remem-
bered how the riots worked; how our people
were killed and their families weren’t even no-

60

tified till a couple of days later; how people
who were in a coma were operated on without
permission from the family. ** * Tt would
have brought back a lot of bad memories and
would have really been a mess.—L.J., NYC,
Newark.

I agree that getting “sensitized” is a good
idea, but I don’t think three months are needed
if it is to be done in the manner we tried. My
philosophy is all-or-nothing; we should move
in completely or we should have a “detached”
attitude, as many of us had. We returned to
our white middle-class suburbs like clockwork.
I think it important for white middle-class stu-
dents to re-evaluate the ghetto. They'll find
that the residents are some of the finest and
most decent of people and that there are rea-
sons why they act in the manner they have or
feel as repressed as they do as denizens of an
involuntary ghetto. But it is curious that
many of us are victims of a white involuntary
ghetto imposed on us by bigots and opportun-
ists in our own families and communities, in
many cases of the worst kind, the silent bigots
who are the hardest to weed out and the most
dangerous to our society. Being sensitized—
which I admit to be of some value—we must
re-enter our own communities and shatter the
fears of integration and the myths of black ig-
norance and irrationality that are perpetuated
in the white communities as they are now. We
must also remember in the future, when we are
doctors and nurses and lawyers, to be nonsub-
scribers to the hypocrisy of our milieu.—P.D.,
Medical Student, Newark.

I think that inducting a lot of white kids to
come and work in a black ghetto for the sum-
mer without some type of screening or inter-
viewing is simply a newer and better means of
legalized exploitation. For years we've been
pushed around and used and now when whites
start feeling guilty, they want to rush right
into the ghetto with their righteous attitudes
and change the world. And when the summer
is over, they can go back to their family and
friends with news of how they’ve redeemed
themselves through the great community ser-
vice they rendered the “poor folks” this sum-
GREATER NEW YORK

ken residents that seeing the white students in
this role only aggravates the wounds they have
suffered. They wondered why more isn’t being
done to train the community people to do my
work. They argued that if I do know the sys-
tem better, I should be demanding reform and
working within to change it. If I as a health
student am committed to helping these people
get the services they deserve, in their eyes my
place is not in their community, but in the clin-
ies and hospitals—R.F., Medical Student,
Bronx.

The subject of health is very touchy. Most
people won’t discuss it openly. I feel that you
must have the quality of being able to talk toa
person in a way that will make him or her feel
at ease. You can’t expect to knock on a person’s
door and have them tell you, in detail, what is
wrong with them physically, especially, if
you’re a white person. .

I am black and I know when a white person
comes to my door I’m a bit skeptical. I know if
a white person comes to a black person’s door
to ask about health, the black person will
think he’s crazy or tell him to get the hell out
of there. Despite the fact that many white stu-
dents have stated that people in the community
didn’t receive them that way, I know for a fact
that nowadays that’s what you'll get.—H.H.,
Nursing Student, Bron.

The question has often been asked, “What
are white medical students doing in a black
and Puerto Rican community?” Naturally,
- this question arouses fear and guilt feelings in
some of the community. As a black person, I
feel that no one black person can safely say
what the community feelings are about this
matter. Luckily, the SHP has not had to face
this problem because when people are in need
or want help they don’t care about the color of
the person who is giving them this help. If one
were to look at the question of black vs. white,
they would realistically see that there are more
white medical students than black. Therefore,
Student Health Projects cannot consist of all
black medical students.—M.J., Nursing Stu-
dent, Bronx. :

From my experiences this summer, I have

62

found that medical students are, on the whole,
inconsiderate and self-centered. With the excep-
tion of three, I found that they are interested
only in what they can gain and how far it can
get them. The attitude of most medical stu-
dents is one of condescension. They act as
though the community should be on its knees
praising them. Most of them seem to be saying, |
“Look, you should be glad that I’m giving up
my precious time to work in your poverty-
stricken ghetto area.” This feeling is. not
voiced, but felt instinctively by the community.
It is often said that a person acts the way he
feels. ,

To being with, it’s bad enough that people
have to live in conditions such as these (rats
and roaches crawling all over the place), but
you don’t have to remind them and make them
feel bad about it. After all, they don’t like it
any more than you do. If someone were to come
to my door with that kind of attitude and tell
me that they wanted to help me, I’d tell them
where to go and how to get there fast —C.B.,
NYC, Brone.

This comment is an attempt to respond to the
position supported by most militant black or-
ganizations (for example, the Black Caucus of
the Chicago SHP) that the “very presence (of
white middle class health students) is destruc-
tive and you cannot make yourself relevant to
us at all.’ Two crucial issues are raised here:
what kind of “presence” is destructive, and
what is “relevant” involvement for SHP mem-
bers? I propose the concept of the “relevant
absence” of white SHP members in the black
community. How is this “relevant absence” to
be implemented. By (a) tutoring and job
advocacy of community teenagers and adults
for entry into the health professions; (0) sup-
port for organizations for control of local
health facilities; and (c) supporting construc-
tive union demands for professional advance-
ment and higher salaries among hospital slave
labor groups.

All of this implies that Whitey must with-
draw from the destructive summer colonial out-
posts called storefronts and confront the injus-
tices of his own mother country (medical
schools, hospitals, clinics). If he does not make
SUMMER 1968

his confrontation peacefully, his black SHP col-
leagues will have to do it violently. As in the
present systematic oppression, the future in-
surrection against inadequate health care will
unfortunately leave its deepest scars on the
poverty-stricken patient.—BJ.G., Medical Stu-
dent, Bronz.

I think that in most cases of a black person
and a white person working together, the white
person doesn’t really expect too much from the
non-white, and the non-white knows this and
therefore doesn’t do any more than is expected
of him.

What I mean is, you only get what you expect
out of most people. If you expect very little,
that is just what you get—very little. So if you
intend to have a project next summer, don’t
fool yourselves, as one student said, that you
are all things to all people, because you cer-
tainly are not fooling the people in the ghettos
or the community people you are working with.

The people that I worked with this summer I
believe were sincere and in most cases hard-
working, honest people. Some of them I liked
and worked well with, but others I felt were
just curious to see what life in a nonwhite com-
munity was like, not because they really eared,
but just because it was an opportunity to sat-
isfy their curiosity and get pretty good pay, too.

Another thing I feel about this project is
that the white students are feeling guilty about
the wrongs that have been done to black people
for so long and are trying to make amends, so
they say to us, “What can we do for you, what
can we give you to makeup and let you know we
are sorry now?” Well, this may be great, but I
don’t want you to give me anything, not as a
gift, not as charity. If white people want to
help black people, don’t give handouts; don’t
treat grown men and women as children that
have to be taken care of. First ask and find out
if your help is wanted, then give the help that
is asked for, don’t try to shove your way of life
down our throats. I really think that the big-
gest help you can give us is in teaching and
showing us how to help ourselves; show our
young people how to get into colleges, what to
do to get grades that are college level. Let us

older people meet and work on equal lev-
els.—N.W., Community Coordinator, Brooklyn.

I believe that being black is becoming daily
more and more of a criterion for working in the
black community. However, it should be noted
that all it does is get one into the community; it
does not make the job in the community any
easier after you are there.

The fact of my having worked in Youth In
Action since February was more of an asset
than was the color of my skin.—E.C., Medical
Student, Brooklyn.

The white student, if he comes in the area
with the right attitude (that of being willing to
work for the wishes of the community, not to
dictate to the community what must be done),
can do much good for his brothers—black and
white. He can give his black brothers the tools
needed to carry on the fight for better health
care. He can help them organize and give them
information about the white power structure
that can be used to change it. He can align him-
self with the members of the black community
in demanding reforms and revolution. He can
show the medical world that whites must work
together with blacks in order to make a better
society for all—D.Y., Medical Student, Brook-
lyn.

The project director and I talked about the
appropriateness of medical and nursing stu-
dents working in these communities this sum-
mer. Just where do we fit into the scheme of
things already going on. I feel very strongly
that our role should be support, not leadership.
Black people should be doing their own orga-
nizing, not only because it is likely to be more
effective, but because of the need for a black
identity and solidarity, We’re really just an-
other group of absentee philanthropists who
come in for ten weeks and do our thing and
then leave. The only things that will have last-
ing significance are projects that speak directly
to the needs of the community and which have
the interest and support of the people for whom
they’re intended. To that end, we can try to en-
list support for a project, but the real leader-
ship must come from the people who are inter-
ested in it, not the health students.

63
GREATER NEW YORK

Also, in the words of Malcolm X, we might
fruitfully spend our energies “organizing our
- own people” and trying to make them cognizant
of and responsive to the expressed needs of the
community. This refers mainly to the hospitals
we'll be dealing with, but also to our medical
schools and some of the city agencies we deal
with. We can perform a unique function in that
we are health science students and can talk to
doctors and nurses in a somewhat knowledge-
able way. I think we should look for ways in
which we can serve as intermediaries between
the community and the health providers and
use our position not to be apologists for the
health providers but as advocates for the unre-
presented. Hopefully, as decentralization and
community control becomes a reality, the need
for this function will wither away also. The
name of the game is participatory democracy
and we should try to facilitate that. These re-
marks apply more to the white health science
students than to the blacks, but it’s unfortun-
ately true that some blacks are only slightly
more effective than whites.—R.C., Student
Coordinator, Harlem.

It’s late Tuesday night, and I’ve had a full 24
hours to go over the black history talk. I had
really looked forward to the Monday night
black history class: first, because I thought it
would be interesting and, second, because T had
heard the speaker praised. I was disappointed
on both counts.

The topic for the class was something about
the transition from African to slave. The
speaker began with a glowing exhaltation of
the “rich” African culture and religion, and
moved on to talk about the life of the plantation
slave. I don’t know much about the African
heritage, but I found this discussion of it
neither enlightening nor pertinent. It was
pitifully one-sided, filled with half-truths,
totally lacking in historical perspective and, at
times, a complete perversion of the past to suit
the speaker’s own present needs. In the course
of my own studies on the Civil War and Ante-
bellum South, I had read the same authors to
which he made reference (and a great many
others as well), and I honestly believe he judi-
ciously edited everything he read and presented

64

only that which he found expedient. He criti-
cized other Negroes (excuse me, J mean black)
historians and branded them “Toms” because
they had the intellectual honesty to tell history
as they saw it, even if a different telling would
be a better demagogic tool. I was really in-
censed. I came to work on this project because
I am tired of white lies and hypocrisy, and I
will not now accept black lies. After rejecting
“Bstablishment” propaganda, I won’t fall prey
to radical black propaganda.

I have spent too long at academic institutions
and will not willingly cast off respect for intel-
lectual honesty and truth, even though it’s cur-
rently in vogue to do so. It has become fashion-
able to class these terms under the column
headed “bourgeois educational system” and re-
ject them, and that is a great pity. At any rate,
as history I found the talk a failure. It was,
however, useful in that much of his approach
to history exemplifies what we’re seeing today
in the new trends the Negro movement is tak-
ing—namely, over-reaction.

When I began working here ten weeks ago,
the words “Black Power” really frightened me.
They conjured up images of burning buildings,
shattered storefronts, and gun-point confronta-
tions of black and white. It wasn’t the immedi-
acy of riots that was frightening, but rather
the future prospects of the black movement—
where is it all leading? The idea of black con-
trol of the schools and hospitals had been men-
tioned at various meetings and discussions, and
I refused to accept it because I inseparably
linked it to a total rejection of the white com-
munity by the black. I could see recurrences of
the Ocean Hill-Brownsville school incident in
all the situations where blacks were suddenly
given control of the local institutions. I could
see the firing of white people, not on the basis
of their competence, but on their whiteness
alone, What was particularly disturbing is
that it appears to be a rather unsatisfying -
culmination of black discontent both for the
white community and the black as well. Whites
control the money and power structure of the
country, and it seemed like the black man was
hurting his own struggle by permanently re-
jecting Whitey. These considerations led me

 
SUMMER 1968

to write off the Black Power movement as
irresponsible and immature.

I interpreted the Afro cult as the natural
complement to the Black Power movement. The
stress upon things Afro is easily seen and felt
around here—all along Lenox and Seventh
Avenues boutiques have sprung up where Afro
clothes are sold and the “natural” hairstyle be-
comes more popular daily. I didn’t like the Afro
rennaissance for a number of reasons. It has all
the earmarkings of a fad, and like other fads it
flourishes on conformity and is steeped in hy-
pocrisy. The artificiality of the whole thing was
particularly disturbing. While the American
Negro obviously does have an African heritage,
the Afro rebirth, as it appears now, seemed to
have little meaning for him in 20th-century
Harlem. It all appeared so inane. I had no diffi-
culty calling it “just a lot of people swept up by
ethnic mongers.” Of course, the black man
should be conscious of his black heritage; it
would be a crime to disavow it—he can no
more deny it than he can deny his blackness.
But the whole thing seemed so unreal—a re-
treat. What I came to realize slowly was that
the need which forces him to seek out this
African cult is very real. There is a void as
to the identity of this black man—just who
is he? The question is not how he appears to
the world but rather how he appears to him-
self.

On my way to and from our office I walk past
the southwest corner of Eighth Avenue and
137th Street—past the crap game in perpetua,
and the old men sitting on the stoops and stand-
ing at the corner; past the tired faces with eyes
still bloodshot from the last night’s cheap whis-
key; past the panhandling junkies, coming
down and looking for their next shot; past pur-
ple pants and old yellow Cadillacs. The side-
walks themselves are speckled with the trodden
remains of chewing gum, tar, spittle, and urine.
On hot afternoons, the south side of 137th
Street is in the shade—and it teems with name-
less black life.

Harlem is a nightmare, and it is against that
background of the all too real ugliness that I
must come to terms with Black Power and the
Afro cult. The question of identity looms up
again, can the black man help but build up a

defense against the wretchedness that sur-
rounds him? Can he help but try to close out
the ugliness? Consider the incidence of hard-
drug addiction in Harlem—the needle offers
relief: escape. The same for the bottle—it too
promises escape. How can the black man an-
swer the question: who am I? Is he the stag-
gering drunkard, the unwed mother, the
bastard son, or the local whore? The reality
of the nightmare is too much to bear—a new
identity must be found. The Negro tried to
adopt white middle-class values and was
doomed to failure, because he can never be
white and is not now middle-class. Afro was
seized upon because at least it is compatible
with being black. Unfortunately, that is the
only relevance I could find for the cult,
and it is for this reason that I saw it too
as a blind alley, a fad, a foster ethos. Yes, the
black man once was African, but 250 years of
slavery followed by another 100 years of mock
freedom and urban poverty living have far re-
moved him from the 16th-century African.
Whatever African he had in him has long since
died and cannot now, in the 20th-century Amer-
ica, be brought pack to life. The Afro cult
seemed to me a backward-looking sham. It ap-
peared that the Negro had taken up the cult for
no other reason than his denial of white
middle-class America—a denial born out of
350 years of frustration and hate.

From the mid-fifties to the early sixties,
Civil Rights looked as if it were going some-
where: Supreme Court decisions and picketing
appeared to be gaining ground. But the proc-
ess was much too slow and after the first
century of “almost-freedom,” every year was
harder to take. The Negro of that period
appears to have fallen into the trap of think-
ing that because he could now ride in the
front of the bus his blackness would pass un-

noticed. But as the slow years rolled on he

soon realized that no matter how close he
gets he’s never going to be white. Out of
the old and new frustrations came the propo-
sition that “Black is Beautiful.” The politi-
cal adjunct to this is that Black can run things
without Whitey, and if we don’t give him the
chance, he’ll seize it for himself. The Negro,

65

a ansenmsscmsmmesmasssaa

 
GREATER NEW YORK

unable to become white middle class, makes the

psychological defense of rejecting it.

I’ve spent a whole summer listening to black
leaders, at times working with them, and each
day walking around Harlem, always trying to
put Black Power and the Afro movement in the
proper perspective. If you listen to black
leaders you get the impression that this is the
end—the final step in the evolution of the Civil
Rights movement. They seem to say now all
that’s left is for the black community to get
fully behind it, and the final assumption of
power is imminent. This is what always threw
me off about Black Power—the proposition that
it is the matured product of black unrest.

It would be unfair to Black Power and the
Afro cult were I to leave the impression that
they are useless socio-psychological defenses,
because, for all their superficiality and imma-
turity, they serve an absolutely vital function:
they make being black something acceptable,
not to the white man, but rather, to the black
man himself. The trouble I have had with
Black Power is that it disguises itself as the
end, when in reality it is the means—the vehi-
cle by which the black man can regain his self-
respect and pride. I seemed to fear Black Power
because of its finality—the black-community is
given control of its schools and responds by
firing all of its white teachers. The crime in
that is that by disregarding competence, the
black community can destroy what institutions
it has. I do believe it should determine policy
and make decisions, but not on the basis of
black and white.

If the black leaders were given control now,
as they demand, white heads would roll, and if
the matter were left at that, Black Power
would be an insidious creation. But I don’t be-
lieve it can be left at that. In the beginning
there will be abuses of power which will arise
for two reasons: (1) The immediate psycholog-
ical need of the black man (the very need
which prompted the birth of Black Power) will
demand that for once black be on top; and (2)
the black community itself will have to learn
the responsibility of power (a lesson it cannot
learn until it is given the exercise of power).
These things will happen—they must happen
—for before the black man can tackle the stag-

66

gering job of revitalizing his institutions, he
must come to terms with himself. When his
personality development is complete he can
then look to his sociological ills, and therein the
Black Power phase will have to end or at least
sufficiently alter itself to allow acceptance of
white support and aid. The white sector has too
much of the broader political power, too much
of the money, and too much of the professional
personnel for the Negro to ignore it—the black
man would be a fool if he did.

I’ve asked myself where the white man fits in
now, and the only answer I can come up with
is that he doesn’t. He can support the move-
ment to give the black communities the power
they demand, but that is all. It is the black man
himself who must struggle with that power.
Until he’s ready to ask for, and accept, the
white man’s help, all Whitey can do is watch
* * *__BG., Medical Student, Harlem.

COMMUNITY EDUCATION AND
TRAINING PROGRAMS

This summer I think the community asked to
be able to do for itself what is now neces-
sary for outsiders to do. The community wants
to know how to obtain the knowledge necessary
to meet its own needs. This was clearly stated
during orientation, but I’ve seen little evidence
of any action. I think it would be extremely ad-
visable for the health science students in the
future to act as tutors. There is no question as
to who would benefit from the service. Part of
our work this summer with the NYCs was to
provide educational programs. I saw very little
evidence of this taking place. A few poorly or-
ganized classes were given but no ongoing pro-
gram seemed to exist.

Our knowledge could be applied by having
community workers and health students teach
the community how to do advocacy. If one
health science student spent his time teaching
patient advocacy to a group of community peo-
ple, he then could work himself out of a job.
Health advocates from the community should
be taught as much as possible about the hospi-
tal and other health facilities. I see the role of
the health science student as that of setting up
relationships making it possible for the com-
munity advocates to function, A thorough in-
SUMMER 1968

troduction to the hospital is necessary. I found
that in my dealings with Morrisania Hospital
very few of the hospital staff had been in-
formed about SHP and patient advocacy. At the
beginning of the summer, we were introduced
to some of the staff, but apparently this was not
effective.

One drawback I can see to having community
advocates is that of status. The reason that stu-
dent patient advocates are effective is because
they represent a group which puts them on a
higher level than the patients. If patient advo-
cates were people who used the clinics them-
selves, the institutions may not feel they have
to pay any attention to them.

Therefore it would be very important for a
thorough saturation of the institution on pa-
tient advocacy.—V.V., Nursing Student, Bronx.

Instead of literally taking people by the hand
to welfare, department of buildings, and hospi-
tals, SHP should direct its goals more toward
showing the people of the community how to
help themselves. By this, I mean forming wel-
fare rights groups, showing people how to put
in complaints which deal with housing, sanita-
tion, and health, directing them toward job
training programs, SEEK (college discovery),
and tutoring junior and senior high school stu-
dents to prepare them for college or health ca-
reers.—M.J. Nursing Student, Bronx.

If there was nothing we could do in the hos-
pital in the existing milieu, there was a more
positive path open: the community might have
been spared the indignities of that facility if
the people’s knowledge of health matters had
been more sophisticated. There should and
could be much more profit from an emphasis on
prevention, This could be accomplished via lec-
tures, demonstrations and discussions about
maternity, first aid, dietary patterns, contracep-
tion, abortions, etc. The personnel for this en-
deavor could come from at least two sources:
SHP members (out of all the education we have
among us it struck me as ironic how little we
were able to utilize) ; and the health profession-
als already in the community. There are local
physicians, nurses, and nursing students who
are possessed of varying amounts and types of
knowledge. They should be contacted and asked

to contribute. Why wait for the disease to hap-
pen and then fret about the cure. Get ahead of
the problem.—A.M., Nursing Student, Newark.

Health care in Newark would be greatly im-
proved if medical people could be sensitized to
respect and have compassion for the people
they are being paid to serve. I feel strongly
that many people are too hardened by now, and
the answer, I think, is to be found in the imme-
diate training of community people in medical
fields so that they can replace bad personnel.
This should occur at all levels. People who re-
fuse to be responsive to the desires of the com-
munity should be removed from their jobs.—
R.P., Community Worker, Newark.

I find that in Newark, at least, a major rea-
son for poor medical care is that people do not
know what they are entitled to, or even what
adequate health care is. Therefore, since New
Jersey College of Medicine and Dentistry is
new in the Newark community, we must first
act in an observational capacity, conjoined
with much communication with the residents
of the community, in order to create a plan for
actions that we can take. We should also act in
an educational capacity, relaying our informa-
tion and suggestions to the community.

I believe that this is our most important
function in the community, for if we stand
only as a small group of students against a
large political organization, we can expect to
make little or no impression. From my experi-
ence this summer, I can see that the large
machines which we are fighting against, like
Martland Hospital, are deathly afraid of the
community and its wrath and would bow to the
demands of a coherent community group much
more readily than they would to us.

The majority of the people in the Newark
community are unaware of their rights and the
injustices imposed on them, and are not orga-
nized into any protest organization. Therefore,
we must educate the community through agen-
cies, schools, PTAs, meetings, advocacy, and
door-to-door soliciting, and whatever other
methods become necessary.—K.0., Nursing
Student, Newark. :

‘It was realized that new and totally differen

67
GREATER NEW YORK

methods of health care delivery were needed in
light of the doctor shortage and population
rise witnessed in America. Functions that
classically have been the sole domain of the
physicians would necessarily be taken away
from him and given to persons lower down on
the health professional scale, thus freeing him
to see more patients. As a result, such func-
tions as history-taking, blood pressures, pulse,
immunizations, and vaccination were consid-
ered possible areas whereby a dent could be
made in the solid but perhaps rusting armor of
the physician, without too much fuss being
made. Included in the role of “nhysician-assist-
ant” were other functions, such as dissemina-
tion of nutritional, health, and safety informa-
tion to visitors to the clinic.

Now, many months after the conception of
the above idea, what we finally have is very
different from the original seed. During this
time, we molded and remolded our concepts so
that a meaningful and realistic position would
be established. No longer are the various func-
tions mentioned above a part of the physician-
assistant’s role. The history-taking is now the
primary function of the physician-assistant.

* * * The questionnaire (history-taking)
was considered a total success by health sci-
ence students, NYCs, and especially by the doc-
tors of the clinic who found the screening his-
tory an invaluable aid. But a question arose as
to what to do with the social pathology that
was detected by the history. The answer to
that, we all agreed, had to be part of the physi-
cian-assistant’s role, for example, it would be
his function, and a major one, to do followup
work on the patients he thought required such
attention. With this in mind, we set out enthu-
siastically to do home visits. After a number of
weeks of a split regimen—clinic hours and home
visits—we groped with the problem of the ex-
tent of followup care to be indulged in by the
physician-assistants, in light of the fact that
95 percent of the patients seen needed fol-
lowup, and it would be impossible, physically
and realistically, to do so. We decided that the
social worker role of the physician-assistant
would be limited to getting in touch with the
proper agencies and notifying the Social Ser-

68

vice Department of the clinic, who would be
responsible for gathering feedback informa-
tion and informing the physician-assistant as
to what has been done and what the physi-
cian-assistant should do next. This worked
with great success.

Patients that we have seen (over 800) ex-
pressed pleasure with the fact that someone at
last was concerned with their total health situ-
ation and not just with the episodic treatment
of whatever condition their children were
brought in for.

Kings County Hospital Pediatric Clinic,
which was already held in high regard by the
patients (for they honestly receive excellent
care there) received an extra boost by this con-
cern on the clinic’s part. Patients, upon revisits
to the clinic, looked for the physician-assistant
and relayed to him any problems that arose
since they last saw each other. The use of phy-
sician-assistants not only gave 100 percent bet-
ter medical care because they concerned them-
selves with the total health problem of the pa-
tient, but also served to minimize the tedium of
the long waiting period.

Now, what about continuation of the pro-
ject? The Pediatrics Clinic is funded by a gov-
ernment grant under rigid stipulations as to
hiring of employees. With this straightjacket I
am in the process of negotiating five new posi-
tions for physician-assistants under the social
service department, beginning next July Ist.
Why next July 1st? After careful considera-
tion, it was concluded that it would be much
wiser, and more realistic and meaningful to
have a 40-week training program that not only

includes on-the-job training, but gives aecred-

ited courses in English, math, science, sociol-
ogy, etc. The benefit of such a program is that
someone with a minimal education (6th grade
and up) can acquire skills that will enable him
to have some upward mobility, rather than to
place him in a position that he has no hope of
ever rising above or moving from.—B.F., Med-
ical Student, Brooklyn.

My experience * * * is proving to be quite
interesting. * * * I learned the art. of taking
case histories, and the task of learning all of
the names of the diseases was easier than I
SUMMER 1968

expected. The doctors working with us proved
to be very patient. * * * The medical students
in our group are very friendly and always try

to help us in any way that is possible. They.

have patience with us and are always around
to assist if we need their help.

The best time is when we are given the op-
portunity to go out in the waiting room and
call our own patients. Even though I was quite
nervous at first, I greeted the people with
friendly smiles and all of the fright went away
from me, The parents are more than willing to
come and talk with us because we not only took
an interest in the patient, but also in the rest
of the family and in the conditions in which
they live. We figure that we are showing the
parents that we too are concerned about the
welfare of their children and also about the
conditions in which they are living. This
makes the parents feel that the health organi-
zation has a strong concern for the welfare of
their child, and for the people living in the
community. Speaking with these people about
their children’s health, and the rest of the
family, gets the feeling of fright out of their

system because they feel that they are talking .

to community people, being us, who are faced
with the same problems.—L.J., NYC, Brook-
lyn.

I don’t think there was that much_resistance
from the doctors to the idea of physician-as-
sistants, because when it got started the doc-
tors’ main complaint was. that the question-
naire didn’t have this in it, or it didn’t have
that, and they wanted more on it, which was a
good sign. * * * The St. Mary’s group has had
one person working for a month or so, and just
recently they’ve got another person that we
hired, and they’re scheduled to have two more
people hired by the time we leave in Septem-
ber. Thus, four community people will be
working in St. Mary’s after we leave—W-S.,
Student Coordinator, Brooklyn.

I saw the SHP workers in Harlem this sum-
mer as a liaison between the community people
and Harlem Hospital and the various other
agencies involved. We served to help people
take the best advantage of services rendered by
the Harlem Hospital clinics, other clinics, and

public school health programs. The atmo-
sphere at the beginning was one of beholdeness.
—people did not know their rights. Many
thought that because they were Medicaid re-
cipients they were obligated to the various
treatment facilities. Others felt that they could
only go to a clinic and not on a private physi-
cian. Our job was to educate the community to
think differently —J.H., M edical Student, Har-
lem.

Halfway through the summer referrals from
Public School 175 were running out and I re-
quested some from Public School 100. Along
with the referrals we acquired the opportunity
to train 10 “parent assistants” from the school.
These community mothers were in training for
6 weeks in various aspects of education, and

‘two of us met with them for 3 weeks to explain

the departments and procedures of health fa-
cilities, and to give them experience in field
work on referrals. We used Public School 100
referrals and covered nearly all of them. Feed-
back from the parent assistants and the school
administration was favorable—C.W., Medical

Student, Harlem.

* * * JT started the project thinking that all
my job would entail would be getting people -
started and somewhat oriented to Harlem and
the goals of our project. After that, I hoped to
be able to get into some projects of my own
and simply be around to give suggestions and
help other people by being a resource. It has
turned out that there was a lot more supervi-
sion involved and I had to dream up things for
people to do simply to keep them from sitting
around the office doing nothing. I needn’t bela-
bor this but I have found it the biggest disap-
pointment in the project for me personally.
The reason I mention this is that the Public
School 100 part of our project is an example of
the way I hoped things could work; the two
guys who went over to Public School 100 to see
about referrals found out about the training
program there for community mothers and
then worked out an arrangement whereby they
could be useful as advisors. This had the dou-
ble advantage of supporting an already exist-
ing program and working in a role as advisor,
not an organizer of a new project. There are

69
GREATER NEW YORK

enough projects going in Harlem, already; we
don’t need to go organize any more, especially
ten-week ones. (Incidentally, lots of people in
Harlem have told us this, too) At any rate, I
think these two workers did exactly what we
should be doing and the point is that they found
the job on their own initiative in the process of
working on referrals.—R.C., Student Coordi-
nator, Harlem.

Another means of attacking the problems of
health care delivery, however, may not involve
working in poverty areas but rather in the
upper levels of American society. Perhaps edu-
cation of middleclass America is more impor-
tant than working in poverty areas in the long
run. This task is much harder to undertake
and, as of yet, the mechanisms of such an oper-
ation are out of sight. The task is to get the
unconcerned, unknowing, and uncommitted
people concerned with the problems the coun-
try faces. This, perhaps, is what SHP’s in the
future should direct their energies to.—W.S.,
Student Coordinator, Brooklyn.

COMMUNITY ORGANIZING

Newark

It’s so difficult to have any kind of political
gathering in a community such as Newark.
The Leroi Jones approach is probably going to
be the most productive, because it is going to
let these people speak for themselves. Just or-
ganizing and bringing a group in to sit in the
hospital is not going to work the way you
might want it to. Ultimately, though, I think
it’s the best thing, because when you surround
an administrator with five or six big black cats
and scare him personally to death, then have
some little guy come in and mediate, talk
calmly to him; and make him see that he
- doesn’t have to be afraid, then something will
be done that both sides will like. The basic ob-
jectives of the administration of all hospitals,
really, is to serve the community: they just
want to do it their own way. |

We got a group of people together and
they’re working on a community health council
on their own. It is going to be black and Puerto
Rican; they’re going to try to advocate, to let
people know what is available. They decided on

70

this themselves. It is going to be year-round,
and they’re going to try and get funded. There
seems to be a consensus that this is the kind of
thing that SHP’s should focus on, but there
can only be so many health councils.—D.T.,
Student Coordinator, N ewark.

When we first arrived at Martland Hospital
in Newark, either the staff was unaware of our
function or they pretended to be. During the
first weeks, we were given a lot of “busy work”
to keep us out of the way. During this time,
however, we compiled a list of criticisms and
recommendations which we offered to help
carry out. Eventually, this list was presented
to the hospital administrators, who did noth-
ing. After repeated attempts to get some sort
of action, followed by repeated failures, we re-
sorted to other means in the form of trying to
develop a community health council. This coun-
cil, if it becomes functional, will be the biggest
achievement of the summer because it should
make the hospital receptive and sensitive to
the requests of the black community. We, as
health science students, can meet with admin-
istrators for the next ten years and get abso-
lutely nothing accomplished, because they feel
that we’ll only be there for a certain length of
time and then they'll be rid of us. However, the
hospital will be forced to listen to organized
community people because they aren’t going
anywhere and mean business. This council,
composed of community and professional peo-
ple, will be able to make demands of the hospi-
tal with no excuses accepted.—A.C., Nursing
Student, Newark.

I believe that if the community health coun-
cil fails, one of the proposed major accomplish-
ments of this summer fails. It must be said
that the grass roots in the Newark community
took no interest whatsoever in our efforts, and
perhaps such a council must evolve some other
way. I honestly feel that community involve-
ment in the medical school development could
help create the type of environment for in-
struction and health care delivery that would
be in the forefront of medical accomplishment.
—P.D., Medical Student, Newark.

Our most important project is to organize
SUMMER 1968

the community, and to get them to work for
themselves and realize that they can do some-
thing if they’re organized.

We tried to do this in the beginning. We ar-
ranged to have a meeting with the community
and sent the health science students around to
different churches. I think about three or four
students were interested enough to go; three-
quarters of them didn’t even bother; this as-
signment wasn’t important enough for them. It
would be naive to suppose that white people
can organize a black community.

There’s much to be said for focusing on one
objective. It makes a lot of sense, but the im-
portant thing is that it’s not a silly objective,
that it’s an objective which is at the basis of a
council made up of community people. I
couldn’t see focusing the manpower on getting
everybody to health examinations: they get a
health examination, so what; they still live in
those shitty houses; so now they know they’re
sick; they still don’t have enough health clinics
to take care of them and when they do go to
the clinics they get treated badly
anyway. * * *—R.P., Community Worker,
Nework.

Bronx

I have begun to help the tenants of one
building with a rent strike; I happened to be
‘the only one in the office when a tenant came in
and asked for help. LABOR is understaffed
and gave me pretty much a free hand to do
what I thought best. I have reservations about
my role for several reasons: (1) Should I, as
an outsider, be organizing? (2) Will my han-
dling this rent strike put a strain on my rela-
tions with LABOR? (3) Can I actually cope
with the problem?

' I’ve worked out some partial answers:

(1) No, I shouldn’t be organizing. Luckily
the tenants organized themselves very
quickly, and I can carry out their spe-
cific wishes—write letters. for them
with their demands to the landlord, get
a lawyer to answer their questions, get
a survey of the building done. And I
have a worthwhile goal in helping
LABOR be a good resource for them,

tapping them for personnel, for exam-
ple.

(2) My personal relations with LABOR do
have strains in them. Mostly I try to
work them out by clearing with them
what I want to do, and talking things
over as much as possible. It’s amazing
how effective just talking is in working
things out.

(3) I’ve made some bad mistakes, especially
missing followups, but luckily the real
strength is in the tenants. The most im-
portant thing I can do is keep an effec-
tive relationship going between the ten-
ants, LABOR, and the rent-strike law-
yer. But if I try to make it my rent
strike, and judge success and failure in
those terms, then inevitably I’m manip-
ulating the tenants and inevitably I’m
doomed to failure since they’re the only
ones who can pull it off.—K.B., Medical
Student, Bronx.

Brooklyn

One of the major goals of this summer was
to help get a narcotics center established in
Brooklyn. Since it is too amorphous to expect

_ that mass community meetings would somehow

end in an actual center, we worked with a few
interested community people who were moti-
vated toward action and interested in getting
results. After these people formed a concrete
plan and structure for their narcotics center,
the community was asked if it wanted such a
center by circulating a petition.

Initially we had hoped to get people in
Brooklyn mad about the problem of drug ad-
diction, to get massive community concern and
action. We soon learned that it is next to im-
possible to get community people to a meeting
or to get them active. This is not too surprising
when you realize that most people work, are
struggling to feed and support their family,
are asked to attend scores of meetings that

never accomplish anything.
* * * How is any progress made within the

community? Usually there are a few commun-
ity leaders who are motivated and are very ef-
fective. It is these people who make most of
the positive changes. Unfortunately, what

71
GREATER NEW YORK

some people call the “community”’—the person
who works, comes home and doesn’t give a —
—is not going to accomplish anything. The few
community people who are effective must re-
present the whole community; they can’t know
what every person in the community wants,
but they are the only people who are taking
the responsibility and must make the decisions.
—E.B., Medical Student, Brooklyn.

STUDENT HEALTH ORGANIZATION
SERVICE PROJECTS

Bronx

The original purpose of the South Bronx
project unwed mothers clinic was to provide
quality comprehensive professional services to
young unmarried mothers in the South Bronx
Bathgate Avenue area. This goal was to be ac-
complished through individual counseling ses-
sions, group and family counseling sessions,
classes in mother and baby care, grooming,
personal hygiene, family planning and family
living. Home visits where indicated were to be

- an integral part.

Our objectives for the Mothers Clinic were:
(1) To improve prenatal care of young
mothers;
(2) To promote quality health of mothers
and their children ;
(3) To reduce fear of the birth process
through education;
(4) To help pregnant teenagers gain an un-
derstanding of themselves ;
(5) To facilitate the appropriate use of com-
munity resources ; ,
(6) To help bring about community aware-
ness of the needs of pregnant teenagers;
(7) To assist in the rehabilitation of preg-
nant teenagers ;
(8) To provide an accredited continued edu-
cation program for pregnant teenagers.
Those persons involved in the mothers clinic
consisted of three student nurses who had com-
pleted a course in the nursing care of mothers
and children, and a physical therapy student
who was to serve as a translator since many of
our clients were expected to be Spanish-speak-
ing. My job was purported to be faculty advi-
sor to this group of students.

72,

To prepare the group for participation in
the mothers clinic, a bibliography of required

‘reading was prepared and group discussions

were held, in order to help the students iden-
tify their feeling about unmarried mothers and
their associated problems.

In addition, group participants located and
visited some of the various agencies, such as
adoption centers, shelters for unmarried
mothers, etc., in order to find out how these
services may be utilized in procuring assistance
for our anticipated clients.

The group was aware that even though as
many as one in three pregnancies in the South
Bronx area is out-of-wedlock, obtaining clients
for our clinic would be a difficult task. In order
to reach these people, we sought assistance
from the various community organizations and
neighborhood groups. Key persons in prenatal
clinics and public health agencies were con-
tacted. As a result, we were permitted to inter-
view patients during clinic visits to encourage
their participation in the mothers clinic.

One of the big problems was that community
groups did not offer much encouragement since
they felt that there were far too many tempo-
rary agencies in their community already. Be-
cause of this attitude, a file of at least 80 candi-
dates for the mothers’ clinic, which we had
been told was available, became unavailable
due to “confidentiality.”

Flyers were distributed, signs posted, letters
written, telephone calls made, schools visited,
and door-to-door canvassing was carried out as
additional ‘efforts for procurement of clients .
for the mothers clinic. (Even so, project direc-
tors said that this was not enough.) These ef-
forts yielded a very few young mothers who
may benefit from the quality counseling and
teaching available at the mothers clinic.

As a result, we became involved in housing
and welfare problems. Because of this involve-
ment, we became acutely aware of the critical
need for educational facilities for pregnant
teenagers, especially in the South Bronx area.
We learned.from the people of the community
that pregnant teenagers are dismissed. from
school as soon as the school officials discover
that they are pregnant. Secondly, if they are
SUMMER 1968

able to return to school following the birth of
the baby, they are rarely permitted to return
to the same school. Thus, a minimum of 18
months may be lost prior to the continuation of
their education.

This problem seemed to take priority and
the group then set out to discover how we
could possibly help the community to meet this
need. We were aware that there was a very
small educational facility for pregnant teen-
agers in the South Bronx. Key persons in this
program, as well as the few other programs of
this sort in New York, were contacted. Visits
were made to each of these agencies. Our pur-
poses for these meetings were manifold,
though mainly we hoped to obtain some help-
ful information about setting up such an edu-
cational facility.

The group was informed that the best way
to proceed was to locate a suitable facility and
obtain a commitment for medical services.
These tasks were accomplished. We were then
faced with two additional problems: first, the
formal writing of a grant proposal, and sec-
ondly, finding a sponsoring agency.

Recognizing that these were problems that
we could not handle alone, the group sought
help from those persons who were supposed to
be able to help us. Yes, there is someone who
can help you with the writing of a grant pro-
posal; where are they? Surely, you can get
money from the children’s bureau; how, under
what circumstances? This suggestion was
made just as one might tell a child that he can
shake all of the money that he may need for
candy from his piggy bank. Yes, there is
money available from the children’s bureau,
but not the way it was suggested to us.

We were also told that a mere phone call

was all that was needed to gain the cooperation
of the Board of Education in our pursuit for
educational facilities for pregnant teenagers.
Isn’t it interesting that the whole summer
passed and this phone call was never made?
Despite the lack of cooperation by SHP ad-
visory personnel, the group persisted in its ef-
fort to setup this much-needed program. As a
result, a Committeee on Education for Preg-
nant Teenagers in the South Bronx area was

established so that these efforts may be contin-
ued. Persons from various cooperating health
agencies and community participants comprise
the committee.

The storefront office has remained open
through funds made available by one of the
participating committee groups. What shall ul-
timately become of this project remains to be
seen, but, thanks to our interested cooperating
groups, the mothers’ clinic has acquired a most
vital aspect, time.

I feel that this project could have made
greater strides had the group’s request for cov-
erage by the newspapers been supported. We
were made to feel that this could be accom-
plished simply by a telephone call, but for
some reason this call was not made either.

Based on my observations and participation
in this summer’s SHP, I do not feel that I
could in good conscience encourage future par-
ticipation by student nurses in this project.—
F.L.M., Program Advisor, Bronz.

Some of our project members were working
on a clinic which was supposedly for unwed
mothers. Because they could find no patients
and had trouble finding a place in which to
hold classes, they expanded their program to
any mother desiring birth control information,
and any pregnant woman, married or not, liv-
ing with her husband or not.

It was my understanding at the orientation
that we were to work with existing facilities in
the community, offering constructive criticism
where necessary. This would hopefully bring
medical inadequacies to the attention of the
powers-that-be and changes would be imple-
mented accordingly. Should a community need
exist which was not being met, an attempt
would be made to create an agency to meet said
need.

With this in mind, I could see no purpose for
the formation of this clinic. One of my advo-
cacy patients, while at the Fulton Street
Health Station, mentioned that she would like
to .obtain birth contro] pills. The prenatal
clinic at the health station gave me a referral
slip for the new family planning clinic in the
area which had just opened the month before,

18
 

SUMMER 1968

the research and illustration end of the book,
which will be distributed through Martland
Hospital and our newly formed Community
Health Council.—K.O., Nursing Student, Ne-
wark.

Brooklyn

I think we did meet favorable reaction. Of
course, a lot of what we were doing was ser-
vice-oriented, like in the hospitals. * * * The
people felt someone was taking an interest in
them, because someone was sitting down and
talking to them for 15 minutes, while usually
they would be sitting there and waiting for half
an hour, 2 hours, whatever, ignored. This was a
positive sign. A lot of these people invited us
to their homes to inspect housing violations,
and on some we got results, so there again we
met with favor. I don’t think we tried to do too
much in which we might have failed and thus
angered people. We weren’t promising much
that we couldn’t deliver.

In Brooklyn we had a group working with
Youth-In-Action. At first, we had hoped to
work on family counseling, birth control,
homework study (which is like a Head Start
program), etc., but it degenerated just to
homework study and we had three people act-
ing as teachers or tutors. I personally didn’t
feel that this was the best way for a health
student to spend his summer. But they thought
they were doing something that’s their bag.
You can’t tell them it’s not—W.S., Student
’ Coordinator, Brooklyn.

Lower East Side

From the very beginning our Community
Coordinator objected to the sex education pro-
gram on the basis that a Puerto Rican com-
munity would not accept it, especially for the
younger people. We were advised that it might
be possible to work out a program for mothers,
but that a program aimed at the younger peo-
ple was doomed to failure. At first we did not
heed the advice and we attempted to educate
the two Puerto Rican girls (NYC’s) working
with us. We tried to have them partially take
over some presentations to other groups of
Neighborhood Youth Corps; however, they
were not able to do so.

Our Community Coordinator was not sur-
prised and advised us again to direct our atten-
tion to parents’ groups. With the help of the
supervisor for the district of the Head Start
programs, we did organize a series of presenta-
tions for the mothers of the young children in-
volved in the Head Start programs. We had
one meeting with about ten mothers, most of
whom were Puerto Rican, who were the family
representatives for the different public schools
that were having Head Start programs. Their
response to the idea of available information
about family planning and sex education was
very enthusiastic. Some of them also felt that a
program directed at their children was a very
good thing. They did admit that the subjects
were ones that Puerto Rican parents did not
discuss with their children; however, they felt
that their children should be aware of these
things so that they would not face the same
problems that their parents had to face. In
other words, these mothers were expressing
the desire for more information concerning a
very important aspect of health care that was
at present impossible for them to give their
children and which the public health care in-
stitutions did not provide.

When we gave these presentations to par-
ents’ groups, we felt that the people were
really not terribly interested; yet we were in-
vited back to give more information. The fact
was that the women were very interested but
they were inhibited about discussing such ma-
terial in front of strangers. We were told that
after we had left they had a very open talk
about a subject that had not been discussed be-
fore. We had acted as a catalyst for these
mothers.

Another idea that we tried to work on was
an educational program for community

- workers from local action groups. Some of the

groups were polite and refused openly, while ~
others said that they were interested and then
the women didn’t show up for the appoint-
ments with us or they claimed that they were
too busy that day. We wanted to leave some-
thing of more permanent value. We wanted to
give the women the tools to help other women,
but the groups we visited rejected the idea.

75
GREATER NEW YORK

and arrangements were made for Mrs. M. to
visit it. I found the facilities at the Fulton
Street Health Station adequate and the staff
cooperative, and they encouraged us to bring in
any problems we encountered in the course of
our work.

In all fairness to the community, I do not see
the point of setting up a clinic which probably
will not endure past the summer. There was
trouble getting the rent approved for the build-
ing, and since most of the workers are stu-
dents, I wonder at the likelihood of its sur-
vival.

What I am trying to say here is that I feel
the SHP clinic is duplicating existing agencies
with no assurances that it will survive after
the summer. Therefore, I feel a personal lack
of support for it in terms of the interest of the
community.—C.B., Nursing Student, Bronz.

The following description of the Bronx SHP
Head Start health program was used as part of
a grant proposal for the continuation of this
program:

During the summer, the Bronx SHP oper-
ated, in cooperation with St. Joseph’s Summer
Head Start program and Fordham Hospital, a
complete physical exam and screening program
for sixty children, ages four to six. Under the
leadership of a medical student, one dental stu-
dent, two nursing students, two community
workers, and three NYC’s implemented the
following: (a) English-Spanish letters were
sent to all Head Start parents explaining the
program at Fordham Hospital, with a choice
of participating either through Fordham or
private doctors. (b) From July 23 to August
16, five children per day were taken with their
parents to Fordham Hospital. At the hospital
they were registered, given complete physical
exams, urinalyses, blood tests, and Tine T.B.
tests. Health students and community workers
were responsible for seeing to it that followups
were made for any abnormal findings in the
tests. During the week of August 19 to August
28, home visits to all Head Start families were
made for five purposes: (1) Explaining the re-
sults of the examinations and tests; (2) admin-
istering a two-page questionnaire containing a
family health survey and a survey on attitudes

14

pertaining to local health care delivery; (3)
making referrals where indicated ; (4) provid-
ing information on existing local health facili-
ties; (5) establishing a working file on each
family for subsequent use by medical students.

* + * Results: Of 60 children enrolled in the
Head Start program, 56 children were seen at
Fordham, and four children were seen by pri-
vate doctors, Twenty-one children had physical
examinations and accompanying test results
that were entirely within normal limits. The
following abnormalities were diagnosed and
acted upon: three underweights; two upper-
sites: two functional heart murmurs; two
minor umbilical hernias; one inguinal hernia;
one kidney infection; one urinary infection ;
one vaginal infection; one sickle-cell trait;
three subclinical anemias; eight eosinophilia
results; 12 albuminuria results; one ectopic
eczema; one asthma; two positive Tine tests
(X-rays negative).

The results of the questionnaires (40 returns
out of 56) have not yet been analyzed in detail,
but quick sampling indicated clearly a deep-
seated dissatisfaction with existing health fa-
cilities, and a willingness to organize around
the issues of Fordham Hospital and a neigh-
borhood health clinic.—J.G., Medical Student,
Bron.

Newark

* * * My other activities at Martland in-
cluded drawing pictures for the pediatrics
emergency room, and helping to alphabetize
the files for the medical and surgical clinic. I
also observed the functioning of several other’
hospitals and city clinics to see how Martland’s
could be improved. As you can see, most of
these tasks were just little service projects
that did not change too many lives or make
any radical improvements in health care.
These experiences were rewarding but not
really satisfying. This does not spell failure,
but I suggest that SHO must make a more con-
crete stand on what its place and service to the
community should and will be.

I think that the most positive and beneficial
thing that I did this summer was to work on @
health rights handbook which we will soon
have published and distributed. I worked on
GREATER NEW YORK

We are going to try to continue with this
program in the fall though I am not sure ex-
actly what we will do. We certainly could con-
tinue to provide the limited service of giving
presentations to various parents’ groups in the
schools. We also may try to work with some
younger people through local community
groups. I am more interested, however, in
working out some way of involving community
women in providing the education. One idea
that we have is to look into the possibility of
creating jobs for women through the services
in Bellevue Hospital. These women could work
in the hospital and in the community providing
much needed information about family plan-
ning and sex education.—P.S., Medical Stu-
lent, Lower East Side.

In order to educate ourselves in the field of
birth control, sex education, and venereal dis-
ease, we visited a number of organizations

such as Planned Parenthood, SEICUS and -

various drug companies. Most people tried to
be helpful and encouraging but those of actual
value to us were the workers at planned par-
enthood who put us in touch with the only per-
son on the Lower East Side who is actually
working directly with the community teaching
birth control. This convinced us that since
there is not an excess of people on the Lower
East Side dispensing such information, our
services were definitely needed.

We decided that our best approach was to
read as much as possible on our own and hold
discussions among ourselves so as to acquaint
the NYC’s with human anatomy, the mechan-
ics of reproduction, etc. We found that even if
the girls we are working with are not poised
and confident enough to give lectures and hold
discussions on their own during the winter,
‘they are still interested and willing to work
along with us.

We have had several speaking engagements
and have felt that these have been successful,
depending on our ability to sense the needs of
the group we were talking with.

On the whole, I feel a sense of accomplish-
ment so far, and see the rest of the summer
spent in increasing community contact and
trying to see if continuing work through the

76

winter isn’t possible. (The above from an un-
dated by weekly report; the following from a
Final Report.)

When our job began this summer, I felt that
there would be a tremendous amount of direc-
tion needed on my part in order to find out ex-
actly what contribution I could make.

I feel that if more work had been done. be-
forehand to decide exactly where we were
needed, our projects might have been more
fruitful. We didn’t realize that the community
in general was not ready to accept information
about sex education and contraception. There
are no community organizations presently
involved in sex education, and any organiza-
tions that were approached to see if they
would be interested in having us hold discus-
sions were polite to us, but inevitably, when
the time came for the talk or discussion, dates
were cancelled or groups didn’t show up—°r, if
they did, they politely listened to what we had
to say but showed no enthusiasm in joining
into discussions with us.

I feel that we did make one positive contri-
bution by arranging for discussions to be held
and a film to be shown throughout the public
schools.

One of the most helpful people on the pro-
ject, I found, was our community coordinator. I
felt that if we had heeded her warnings about
the subject with which we were dealing, we
wouldn’t have run into as many difficulties as
we did this summer.—S.R., Medical Student,
Lower East Side.

Harlem

The basic structure of our project revolved
around the school health referrals. We in-
tended to work at two schools, Public Schools
175 and 183 in Harlem and then branch out
from there to more referrals at Harlem Hospi-
tal. This was viable in the case of Public
School 175 only because we had previously done
a health study there and already had over 250
referrals to work on. At Public School 183 we
got virtually no co-operation from the school
health people, mostly because the director of
school health for the city of New York refused
to release any but a few nonessential referral
SUMMER 1968

cases. She claimed that we had enough to work
on from our previous summer.

Other institutions we worked with were
equally frustrating; the Department of Health
at all but the highest levels is staffed by defen-
sive, uncooperative people who seemed more
intent on giving us the runaround or refusing
to give information than anything else. Other
groups we worked with rather successfully
were Ministerial Interfaith Association
(M.LA.), a very cooperative private group
health facility, Harlem Teams For Self-Help,
which arranged for a job in the Harlem Hospi-
tal playroom for outpatients’ children, Harlem
Consumer Education Board, a member of
which came to a lunch meeting at our office
which was very interesting, Public School 100,
where we helped in a training program for
school assistants, Knickerbocker Hospital,
where we tried to organize a health council
around a proposed community health clinic,
and the Puerto Rican Guidance Center, where
we helped with research on the Washington
Heights community mental health center and
ran an education program for a group of
N.Y.C’s. In general, our relationship with com-
munity organizations was successful and we
tried to put ourselves at their disposal.

We provided specific referral help for about
150 of the Public School 175 cases from a year
ago. We also worked on about 25 referrals
from two clinics at Harlem Hospital, and an-
other 25 from Public School 100. We got a nu-
cleus of six persons interested in the pediatrics
clinic at Knickerbocker Hospital and worked
on several cases from the department of social
services there. Other assorted services included
providing black childrens’ books for doctors’
offices and clinics.—R.C., Student Coordinator,
Harlem.

PATIENT ADVOCACY

Last summer the concept of patient advocacy
evolved. The student fellow functioned as a li-
aison between the patient and the health facil-
ity. As our awareness of health problems
broadened, our concept of the role of the pa-
tient advocate grew to include dealings with
many institutions. We saw patient advocacy
as valuable for both the student fellow and the

patient. The student learned about the different
agencies that the poor must confront. This
practical knowledge, which enables the health
professional to give comprehensive care, cannot
be learned any way other than by direct ex-
perience. Most medical and nursing schools do
not provide these experiences in their curricu-
lum. The patient was able to confront bureau-
cratic institutions, whereas before he had been
confused and discouraged.

My feelings toward the benefits of patient
advocacy after last summer and at the begin-
ning of this summer were very favorable. Now,
at the conclusion of my second summer, I have
quite different feelings. At this point, I am not
sure where either party benefits. To substanti-
ate this feeling I will present incidents from
my experiences with three families.

My first example is Rebecca, a 64-year-old

‘Negro lady. My first introduction to Rebecca

was through a dental student working on the
project. Rebecca’s toothless smile had caught
his attention. After a brief conversation with
her, the dental student discovered that she had
not seen a doctor in several years. With this in-
formation, in addition to the fact that Rebecca
is elderly and quite heavy, it seemed very prob-
ably that she might have medical problems
warranting treatment. He suggested that she
be taken for a checkup. I decided that since she
did not have Medicaid or financial means to
pay for treatment, our only recourse was Mor-
risania Hospital. Not knowing which of the
clinics to go to first, we went to the screening
clinic. From there went to the medical
clinic twice, the eye clinic twice. Also, Rebecca
had blood work done twice, an X-ray, and an
E.K.G. The results up to this time reveal hy-
pertension, diabetes, degeneration of the re-
tina, a positive V.D.R.L., and longstanding
leftsided heart disease.

At first glance, and without much thought,
an initial reaction to the discoveries is that it
was a good thing that Rebecca went to the
clinic. After studying the situation, I am not

‘ sure this is so. Rebecca does not follow

through with her medical treatment; she can-
not remember to take her pills even after con-
stant reminders; she refuses to go on a diet.

77
GREATER NEW YORK

There are several other reasons why I think
patient advocacy for Rebecca may have been a
mistake. First of all, there is a problem about
getting to the clinic: Rebecca does not seem ca-
pable of taking two buses to get to the clinic; I
have always accompanied her so I do not ac-
tually know how well she would manage on
her own. I have always gone with Rebecca be-
eause at first it was necessary for me to make
sure that she found her way too the different
clinics, and that she had all the tests that were
medically indicated; later it was necessary that
I go with her to follow up on the results. I had
thought of the possibilities of an NYC taking
my place, but decided against this because I did
not have accessibility to the NYC’s and also
my medical knowledge was needed. (For exam-
ple, I was able to clarify questions concerning
Rebecca’s high blood pressure and poor vision
which an NYC probably would not have been
able to do.) My going with Rebecca to every
clinic appointment did not enable her to de-
velop her ability to be independent.

This case points up a crucial factor of pa-
tient advocacy, which is time. It took me 45
minutes to come to the Bronx from Manhattan,
which means that if we planned to go by bus I
had to leave my apartment at 6:45 a.m. to pick
Rebecea up for a 9:00 a.m. appointment. By
the time we finished in the afternoon some-
times it was 2 o’clock.

The logical solution to this predicament was
to find someone who can assist Rebecca to the
clinic. She is living with her granddaughter
who seems to be the likely person to assume
this responsibility, but they do not get along.
The granddaughter has tried repeatedly in the
past to get her grandmother to go to the doc-
tor; she very clearly told me that she had tried
and was fed up with Rebecca, and that if I
wanted to take her to the clinic that was fine.

Rebecca was also economically dependent on
my services. She does not have the resources
for cab fare as she only receives a small
amount from Social Security. I started paying
the cab fares because the first time she told me
she had no money to get there. I paid for all
transportation since, which was probably a

78

mistake because she will have to assume the
responsibility herself when I am gone.

There is still another form of dependency
that Rebecca has developed in the clinic set-
ting. She feels that she will be taken care of,
so pays no attention to the proceedings and sits
back and takes cat naps. I tried to overcome
this by always. telling her where we were
going and what was going to take place. On
our last visit I deliberately left her at the
pharmacy to fill her prescription. All she had
to do was wait for her number to flash, and
then walk up to the desk and hand the phar-
macist her prescription. When I returned, she
was sitting in a chair staring off into space and
her number had gone by. My attempt at mak-
ing her participate had failed. Also, the clinic
environment is not conducive towards promot-
ing independence in people like Rebecca. It is
geared for expediency, and slow people like Re-
becea just bog the system down, so it is much
easier for the staff to direct all comments con-
cerning Rebecca’s care to me, which just rein-
forces her dependency on me.

Is medical care without followup better than
no medical care at all? Would this woman
have been just as happy having never seen a
doctor? Looking back, I feel that Rebecca’s
real priority need was attention. She was
lonely, and by going to the clinic with her I in-
creased her personal interactions. Would it
have been better for her if I had spent my time
just visiting her and fulfilling her need for
companionship rather than dragging her from
one clinic to the next? Even if I acted only as
a companion, there would still have been a de-
pendency on my company. Maybe the best
thing for Rebecca would have been to have
found her a friend.

Gladys is an 18-year-old girl who has a 38-
year-old son, and is expecting another child at
any time. At the time I met her, she had not
followed up with her prenatal care. She saw
doctor once early in pregnancy, but after mov-
ing had not gone back. I ‘made arrangements
for Gladys to register at Morrisania clinic and
accompanied her there. But after straightening
things out for her at the clinic, I. no longer .
SUMMER 1968

went with her for her appointments. She man-
aged fine by herself.

Gladys’ dependency needs became apparent
through our dealings with the welfare depart-
ment. The rapport between Gladys’ family and
the investigator was very poor; the investiga-
tor was extremely nasty, making all dealings
with welfare difficult for the family. Being
aware of this poor relationship, I went with
Gladys to welfare to help her obtain a check
for a layette. Because of my presence, the in-
vestigator gave Gladys the check immediately.
But what will happen after I leave? The rela-
tionship between Gladys and the investigator
will still be poor. With Gladys I had more re-
sources available to me, so hopefully my ser-
vices will not just act as a temporary bandage.
Welfare Rights works with people to help
them deal with the welfare department, and
hopefully this group will take over my role as
an advocate. Also I referred Gladys to the So-
cial Service department which will follow her
case,

The most important point I have made con-
cerning patient advocacy in relationship to
both Gladys and Rebecca is that the individ-
ual’s resources must be utilized to the fullest
extent. To be able to develop the patient’s inde-
pendence a critical analysis of the situation is
needed, and with that information the patient
advocate should carefully define his role. For
example, I decided that my role with Gladys
was to see that she received good medical care,
but what was not my function, I decided, was
shopping with her for baby clothes and looking
for an apartment. I carefully reviewed with
Gladys what she needed for the baby, but told
her that she was perfectly capable of shopping
without me. She would have liked me to help
her with the shopping, but this was not neces-
sary and there would be no one to help her
shop in the future. The same was true of find-
ing her an apartment. I am sure that with my
higher level of motivation I would have been
able to make greater progress than Gladys, but
this would not have helped Gladys to become
an independent adult.

The last patient I would like to discuss is
Mildred. The important concept in my dealings

with Mildred was my role as patient advocate
and my limitations. Just as in Gladys’ case I
had decided that my role was not a shopping
assistant or a real estate agent, with Mildred I
decided I was not a social worker.

Mildred is a 14-year-old pregnant girl who
ran away from home 8 months ago and is now
living with a 29-year-old man. She is 5 months
pregnant and came to us to find out where she
could receive prenatal care. We decided that
because of her age and social problems the
prenatal clinic at Morrisania health station
would be the best for her. We. also have con-
tacts with the Social Service department from
which we can be sure that she will receive
good followup care.

At the clinic during the interview with the
social worker, several problems became imme-
diately obvious. The man she was living with
had been admitted the night before to the psy-
chiatric ward of Bellevue Hospital. Also, he is
married. His being in the hospital left Mildred
in a desperate situation; he did not leave any
provisions or money, and Mildred has none.
Her mother is on welfare and receives an allot-
ment for Mildred, but Mildred has not seen her
mother for 8 months. Considering that both
the gir] and her mother are in the Bronx, it ap-
pears that the mother hasn’t tried very hard to
find her daughter. Mildred did not express con-
cern about her situation. I asked her if she had
food to eat in the apartment, and she said that
she had two porkchops, a pound of hamburger,
and some cabbage. When I asked her what she
was going to do when the food ran out, she gig-
gled, rolled her eyes at the ceiling, and said
that she didn’t know. She made these same res-
ponses to other questions concerning her wel-
fare. From her behavior she appears to be a
very immature 14-year-old. The problem that
the social worker and I faced was what imme-
diate arrangements would be made for the girl.
Being a minor, she could not go to her boy
friend’s apartment because she would have
been picked up by the police. (Mildred had
written her mother a letter which her mother
had just received, and she had notified the po-
lice.) It was too late in the day to make ar-

-rangements with welfare concerning a foster

79

eames

 
SUMMER 1968

home or a maternity shelter, so the only solu-
tion appeared to be to take Mildred to her
mother’s apartment. The social worker asked
if I would take her there myself, but I said
that I would like someone to come with me.
Looking back, this was a wise decision; what I
was to encounter -in the home would have been
a lot for me to cope with. When we arrived we
were met by a very upset mother who did not
speak English. The confrontation between the
mother and the daughter was very tense. After
the initial confrontation, we had difficulty get-
ting any other direct communication between
the mother and daughter. Mildred said that
she had only come to see her mother and that
she was not going to stay, and the mother cer-
tainly did not want her to stay. The mother fin-
ally accepted the fact that Mildred was her
responsibility, whether she remained at home
or not, Mildred also accepted the fact that she
could not return to her boy friend’s apartment,
and decided to stay. After both parties finally
made a decision, the social worker and I left.
The social worker returned the next morning
to make more permanent arrangements.

This whole incident made me very aware of
my limitations. Not being a social worker, I
had not come across such complicated situa-
tions that demanded immediate decisions. I
might have, in a moment of confusion and in-
decision, decided to take the girl home with
me. This obviously would not have been the
way to have handled the situation. (I think
that patient advocates should always remem-
ber that in situations where a dependable
agency is involved, we should have enough
common sense to let the agency handle the
problem.) I know of situations where patient
advocates have gotten themselves into a bind
because they have tried to make decisions they
did not have the background or knowledge to
make, or the resources to carry through.

To summarize, I believe that the patient ad-
voecate needs to thoroughly analyze situations,
and before making any decision he should as-
sess his capabilities. Included in his analysis a
realistic appraisal of manpower and time
should be considered. With this information,

80

the advocate should use his skills to help the
patient become as independent as possible.

. Also, a critical analysis of the purpose of pa-
tient advocacy is needed, and a decision should
be made as to whether it should be a part of
the SHP services. If the decision is made that
patient advocacy is valuable, then how much
time should be spent in this area. In my opin-
ion, patient advocacy is a stop-gap service. The
real problem lies with the system that causes
the need for an advocate. I would like to see
SHP’s energy directed at the institutions.—
V.V., Nursing Student, Bronx.

Aside from supervising a restricted play
area with the help of four NYC’s, the remain-
der of my time was spent taking patients to the
nearby Fulton Avenue (Morrisania) Health
Center, and disseminating information about
the available health services. It was in this re-
gard that I felt most qualified to work in the
community.

I was involved with two families I had met
while discussing housing problems. One 21-
year-old mother of three was desperately in
need of medical help and will require the sup-
port of the advocate program in the coming
months. This woman had neglected her own
health and did not expect to get relief from her
chest pains and dizzy spells by going to any
city clinic. At first, I was more optimistic, but
soon became frustrated upon finding how diffi-
cult it is to get good care even when one know
how to maneuver through the administrative
labyrinth. This woman has now been to the
medicine, opthalmology, and neurology clinics
without getting a satisfactory history taken.
The fragmention of her condition into unre-
lated problems, as seen by each clinic physician
and generally a new face each time she visits
each clinic, works against any hope that she
might have of getting better. Despite her diffi-
culty in getting a diagnosis and therapy, how-
ever, there have been positive aspect to her
trips to Fulton Avenue: she is more aware of
her own needs and realizes that her children’s
welfare depends on her health; the Fulton Av-
enue clinic staff knows her and are more atten-
tive because of my intervention; she has been
given medication for insomnia and a prescrip-
SUMMER 1968

tion for eye glasses which she knew were
needed.

"Because of this one experience, I feel patient
advocacy is a meaningful experience, both for
the recipient and for the health student. There
are objections to the present modus operandi
which should, however, be raised. Successful
advocacy often depends upon the student as-
serting himself on the patient’s behalf and de-
manding services which might not be contin-
ued after the student returns to school, Some-
one must be available to see these families
after the students leave. One may ask if advo-
eacy works only because the student represents
the system. It would be much more beneficial
to the community if students were working
with community people who would continue
the advocacy work in their neighborhood after
the students leave. There is no question in my
mind that the student advocate gains a special
perspective by seeing health problems in a so-
cial setting which places little value on good
health; but the student would gain additional
perspective by working with community people
and thereby give more responsibility to the
community itself. Being realistic, however, I
realize that such a program would require
year-round supervision. If our efforts are to
have further significance, we must provide an
ongoing program geared to involving more
than just the student as advocate. Perhaps a
training program could be arranged through
- agencies such as the NMCD (Neighborhood
Medical Care Demonstration), which depends
for its success in large measure upon Ccommun-
ity health workers.

The needs for more organized pressure on
the health-care delivery system and the orien-
tation of LABOR offices to housing problems
both lead me to argue in favor of having stu-
dents work out of the clinics and maintaining
contact with LABOR only as a means of relat-
ing health issues to LABOR’s ongoing activi-
ties. The dichotomy of roles was definitely a
hindrance, in my opinion, as concentration. on

housing problems did not allow enough time ©

for learning about different health facilities.

I found it most worthwhile to take some of
the Youth Corps workers with me when visit-

.

ing clinics with patients. These teenagers,
however, were assigned to LABOR by the city
and were given housing assignments most of
the time. They would have done well as advo-
cates and certainly expressed enthusiasm over
the prospect of such a job in the future. —R.F.,

Medical Student, Bronx.

Patient advocacy over a short term has out-
lived its usefulness as a concept. True advocacy
implies a continuing personal/professional re-
lationship, which students (especially those
from out-of-town) are not able to build during
a 2-month period. The central hypocrisy of pa-
tient advocacy is revealed by the conscious
avoidance by students of further responsibili-
ties for their patients at the precise time when
they are promising these same patients guid-
ance on referrals, and encouraging militancy
with respect to hospital malpractices. Further-
more, without careful preparation, the pres-
ence of health science students in overly
crowded urban health clinics usually only
serves to reinforce health care fragmentation.

Advocacy has served the useful role of edu-
cating a critical number of health science stu-
dents about the injustices and kinks in hospital
and private medical care. Now it is time to dis-
card this tool and develop one with a better
cutting edge.—J.G., Medical Student, Bronx.

The hospital and welfare * * * will still be
the same after SHP has gone. They will still
give bad service to the people. The only thing
we did was get a little better service by saying
who we were. Now the people don’t have us to
speak for them any more. All I’ve seen SHP do
is get involved in people’s lives and then leave.
—M.H., Community Worker, Brons.

After spending a week earlier in the project
distributing information on the Lower Hast
Side about the new sliding scale for fees at city
hospitals, I was again faced with the problem
of a person who fails to seek medical help be-
cause he has no money. Our group spent a day
knocking on doors to find out what medical fa-
cilities were used by the community. When I
knocked at Mrs. V’s door she first refused to
speak with me because she was cleaning her
apartment and her small grandchild needed

81
GREATER NEW YORK

care. I assured her I just wanted to ask a few
questions and she agreed to speak with me. I
discovered that Mrs. V, who had ceased men-
struating for several years, was once again
bleeding, but felt that she couldn’t go to the
hospital because she couldn’t pay the eleven
dollars the hospital always charged. I became
very concerned when I heard of her problem
and urged her to see a physician. I offered to
escort her to the hospital along with my com-
panion, a Spanish-speaking NYC who ex-
pressed a wish to care for her little grandchild.
I called Bellevue to find out the hours of the
gynecology clinic; I was told to come early
that the clinic was open until noon. That was
all I was told.

We arrived at 10:10 a.m. the next day and
were told by the clerk at the information booth
that we would have to come another day be-
cause registration ended at 10:00 a.m. Feeling
exceedingly foolish and responsible for bring-
ing Mrs. V. to the hospital, I went to the clinic
to speak with the head nurse. She told of
the necessity of the registration period so that
sufficient time was allowed to send for the pa-
tient’s chart. This was reasonable. She also
said, however, that the doctors (three were sit-
ting in the room where we were, obviously
amused by my appeals to the nurse) were leav-
ing soon. Why, I asked, were the doctors leav-
ing if it was only 10:10 a.m., when the clinic
hours were until 12 noon, and there were still
patients to be seen? Surely there was enough
time to send to the record room for the chart,
and besides, Mrs. V’s problem seemed rather
immediate. I was told.that “rules are rules,”
and the head nurse asked me to leave her office.
One of the doctors followed me out and sug-
gested I take Mrs. V to the emergency room as
long as we were at the hospital. As’a result of
her visit to the emergency room on that day,
Mrs. V entered Bellevue the next week to have
a hysterectomy.

Our group has discussed extensively the
value of patient advocacy. What is accomplished
qualitatively by helping a few individuals?
What happens to the thousands of others? I
don’t know the answers but I do wonder
what would have happened to Mrs. V if I

82

hadn’t knocked on her door.—J.M., Nursing
Student, Bronx.

One of the things which disturbed me deeply
was that many of the people who complained
about bad experience in the hospital took it all
very passively instead of fighting for better
care. I found two women who were told to go
home from hospitals because they spoke no En-
glish. I find it alarming, of course, that this
should have happened, but what was equally
alarming was that they left. These people must
be taught to stand up and fight for their health
rights; no one is going to give it to them and I
don’t believe anyone should. If SHP really
wants to be effective, educating community
workers to educate the people will be much
more worthwhile in the long run than all the
patient advocacy in the world.—J .W., Nursing
Student, Bronx.

Throughout the summer we visited . the
homes of families we met at the pediatric
clinic or in the community, and very often be-
came personally involved with the family and
were always welcome in their homes. In the
case of Mrs. B. and her one and a half year old
daughter, who had suspected milk and egg al-
lergy and asthma, we were with her at all pe-
diatric appointments, assisted her in obtaining
additional welfare allowance for her daugh-
ter’s special diet, and visited her at home on a
number of occasions.

Although such successful advocacy was lim-
ited to a small number of families, it neverthe-
less provided us with better insight into com-
munity life and gave us the opportunity to con-
tribute concrete services to individuals in the
community. .

I feel that patient advocacy work could be a
rewarding experience for medical students
during their first year of medical education.
Providing an early exposure to physician-
patient relationship, patient advocacy would af-
ford the student: the opportunity to view the
side of a patient that is often overlooked, that
of his home and community life. Too often, a
patient is thought of just as he is in the hospi-
tal setting, and the knowledge of his life as a
functioning individual is lacking. The student
SUMMER 1968

health organizations in the various medical
schools should try to have some form of pa-

tient advocacy incorporated into the curricu- .

lum for the first year or first 2 years of medi-
cal study.—E.C., Medical Student, Lower East
Side.

I found the emergency room to be a good
place for patient advocacy work, for the people
were a captive audience while they waited for
treatment or as I dressed their wounds. I told
them of our SHP office, of our Community
Health Council, and of the Family Health
Clinic (just opened by New Jersey College of
Medicine and Dentistry students) which prov-
ides health care for entire families, including
physical examinations for all every 6 months,
and medical treatment when necessary, in an
attempt to give more personal health care to
families who can’t afford a private doctor. I
was able to refer quite a few people who came
into the emergency room to places where they
could get help with their problems.—K.O.
Nursing Student, Newark.

How much responsibility can or should SHP
workers have in order to get health care for
their clients? A community worker took it
upon herself to take a young boy with a leg in-
jury to a private physician, since his mother
believes in herbs and roots and is quite igno-
rant of health matters. A few days later I saw
this same young boy playing with his friends;

his leg was starting to swell again and he did

not have a dressing on as the doctor had or-
dered. When I -questioned him about this, he
told me that his mother always hits him on his
infected knee when she gets angry.

Another time, I had occasion to take his
mother to Bronx-Lebanon Hospital. She had
had breakthrough vaginal bleeding for 21%
years with the passing of clots. She was exam-
ined by a gynecologist who gave her medica-
tion to stop the bleeding and told her to come
back in three weeks for a more complete exam-
ination. The next day I saw this same woman

on the street. She told me that she was tired of

taking her medication because it made her sick
and caused pain (she had only taken one pill).

I tried to impress upon her the importance of -
her medication and follow-up care, but my in-
structions fell upon deaf ears.—M.J . Nursing
Student, Bronz.

A Mrs. J. had called our office in Newark,
having heard a radio announcement telling lis-
teners to contact us if they had any health
problems or complaints, In handling the case I
learned that Mrs. J.’s niece, a 22 year-old
mother of two, was suffering from cancer of
the cervix. Mrs. J. was making a valiant at-
tempt to comfort her niece at home, but B.’s
pain was constant and her cries kept the house-
hold awake night and day. B. needed prompt
medical attention. Conversations with our facul-
ty advisor at Newark City Hospital and with
B.’s doctors finally resulted in her readmittance
to the hospital.

While B. remained in the hospital, I visited
her daily. We became friends and I became fa-
miliar with the workings of City Hospital, its
facilities and staff. Although the wards were
crowded and impersonal and equipment out-
moded, more striking was the deplorable atti-
tudes held by several of the attending physi-
cians and nurses. In a short time after I began
to visit B., the staff began to accept me as one
of them—perhaps because I was a medical stu-
dent— and they soon “opened up.” I heard sto-
ries of the poor care and abuse they gave to the
patients. I could feel an attitude of “second-
class citizenship” permeate the welfare wards.
It is not uncommon for a patient’s cries for at-
tention to be answered with “shut up woman,
you’re lucky to be getting as much as you are,”
or, “for somebody who’s not even paying you
sure do expect a lot.” More commonly, their

pleas went unanswered.

In B.’s case, that of terminal cancer, the
nurses were particularly hard on her because
of her low tolerance for pain; her incessant
groans and cries kept the staff and fellow pa-
tients on edge. Her attending physician had no
idea of B.’s background or personality, and
neither did she care. Practically at the moment
of readmission, B’s doctor had said that she
would keep B. in the hospital only if we would

83

nna
GREATER NEW YORK

in the meantime make arrangements to put her
ina nursing home.

Now to B.’s nursing home problem. City
Hospital’s social service department sends its
requests to the local community welfare office
for placement of patients who need posthospi-
tal care in nursing homes. The placement pro-
cedure does not begin until the doctor actually
discharges the patient, so there is often a long
delay between discharge and placement. In the
interim, the doctor is unaware of the cause of
the delay and therefore cannot understand
why “these —patients stick around the hospi-
tal wasting valuable space—just a bunch of
good-for-nothing freeloaders.” City Hospital’s
social service department has no idea of the
quality of nursing care given by the institu-
tions to which the patients are sent. Occasion-
ally a patient will return to City Hospital with
bed sores, dehydration, or malnourishment, but
there is no direct information as to what goes
on in these nursing homes.

When B. was finally placed, I visited her
nursing home and found it dirty, crowded, and
utterly depressing. Maybe if B.’s doctor had
been aware of this she might have been a little
more sympathetic with her patient.

As I followed B.’s progress, I kept in touch
with her aunt. Mrs. J. had given up her job for
the last few months in order to care for her
niece. Being 61 years old and with a heart con-
dition, Mrs. J. was physically and mentally fa-
tigued from the entire episode. She responded
to the assistance I gave her with praise and
affection which I was at times embarrassed to
receive. In my visits to her home I got to know
Mrs. J., to see her style of life, to discover
some of her attitudes, and to meet her friends.

Thus, beginning with the specific problem of
helping Mrs. J. get medical attention for her
niece, it soon developed into a complex network
of exposure for me—all of which helped me
better understand the health care problems of
Newark. This knowledge was beneficial for
others who would call us for help, for in han-
dling this one case I had succeeded in making a
lot of useful connections which would be valu-
able in helping other clients of Newark’s SHP.
—B.W., Medical Student, Newark.

84 -

STUDENT HEALTH PROJECT ROLE
IN AGENCIES AND HOSPITALS

Newark

Our situation in Newark is quite unique
from all of the other areas in what changes we
realistically expect to effect this summer, for
the tide is changing its direction here, and all
things portend a new guard for this city. We
have tried to identify with infusion of renewed
life, the momentary depressions from lack of
instantaneous dissolvement of malingering
evils are but. split-second flickering trips
through disillusioned reality. However, on the
whole, a sense of project is developed and func-
tional.

July 1, 1968, a new administration, the new,
New Jersey College of Medicine and Dentistry
took over Martland Hospital and promised to
change much in health care delivery both at
the hospital and in the city as a whole. Newark
SHP feels itself in the position of helping push
the college into doing what it said it would do,
leading the college into areas where it has not
yet gone, and developing dialogues and action
experiences between the community and the
health services.

At the hospital we have begun several direct
actions: (a) specific patient advocacy in the
emergency room; (0) - admistering a question-
naire in the emergency room; (c) advocacy of
the several clinics, especially the prenatal
clinic.

Less direct but more meaningful and expec-
tation laden actions include: (a) Talk with key
hospital personal about specific immediate
changes in procedure—trying to be part of a
committee that will actually write up proce-
dures; (b) talks with key hospital personnel
about basic changes in staff attitudes (devel-
oped during the city’s administration) and
plans to develop program for training staff
about “where it’s at”, (c) actual development
of a committee of hospital, SHP, and commun-
ity persons to work on these points.

At the area board we have tried to develop a
health advisory and information service. How-
ever, as yet there has been a dearth of persons
wanting information, less than one per day.
SUMMER 1968

However, we are developing the body of
knowledge necessary to help anyone.

A community committee has been organized,
with exceptionally fine, able, committed local
persons in charge. Their main focus is on or-
ganizing persons to be aware of what is hap-
pening on the local health scene; ‘what is avail-
able on the local scene, and what they can do to
generally improve the care given,—to see about
getting decent treatment for whomever comes
to clinics—D.T., Student Coordinator, Ne-
wark.

I worked primarily in the prenatal clinic at
Martland Medical Center in Newark. My rela-
tionship with the institution can best be ex-
plained by my relationship with the clinic’s su-
pervisor. In the beginning she was very suspi-
cious of me and of the SHP in general, and she
sought to control everything I did. When I
asked about the hospital mortality statistics,
she sent me to a doctor who abruptly told me
not to question the nurses in the clinics.

As time went on, and the supervisor could
see that I was interested in improving the
clinic and willing to help rather than merely
criticize, she became more open with me. She
would sit down and talk with me about prob-
lems she was having in the clinic; although
we did not always agree, we seemed to be
able to share our feelings with each other.
She took the time to listen.

She disliked patients coming to SHP with
problems they were having in the clinic. She
prides herself in having a good relationship
with the patients and wants them to come di-
rectly to her with their problems. She is also
against a community organization to help pa-
tients with health problems; she seemed to be
fearful of giving the community power in the
hospital.—L.D., Nursing Student, Newark.

When I first started working in the emer-
gency room at Newark City Hospital I dealt
with patients, talking to them, calling their
families for them, helping them to contact so-
cial services, sometimes acting as an inter-
preter for the Spanish-speaking people. The
hospital employees in the emergency room
didn’t know who we were, Some of them
thought that we were hospital-employed

NYC’s, and they tried for a while to assign us
to useless jobs, such as removing carbon pa-
pers from duplicate copies of patient’s charts.
They wanted to keep us busy so we wouldn’t
“spoil those useless community people” by
trying to give good service.

We refused to do meaningless tasks. After
about a week, we made up a list of suggestions
for changes in the emergency room and clinics.
The changes we suggested were not unrealis-
tic; they were not changes which required ad-
ditional funding; they were simply reasonable
change. The hospital administration greeted
us, smiled at us, promised us everything, but
gave us nothing.

It had been my experience in the past that if
you could not obtain satisfaction at one level
you sometimes could achieve what you wanted
by going to higher authority. I went to the ad-
ministrative assistant to the president of the
college which runs the hospital. He found most
of our requests to be reasonable and granted
them. The hospital administrators were en-
raged.

Nothing really happened to any of us as a
result of this, and I believe it was because they
were not absolutely certain about the amount —
of community support we had. Actually, we
had very little. People in Newark generally
hate Martland Hospital, but are not unified
enough to do anything about it. Lack of knowl-
edge of the community by the administration
was to our advantage this time; they thought
we had more power than we actually had.

I have come to believe that it is useless to

‘play with a bad system. Nothing short of com-

plete overthrow will bring about major
changes. The black community must organize,
must seize control of the city and must bring
about radical change in order to survive.—
K.F., Medical Student, N: ewark.

Briefly, the New Well is a community drug
rehabilitation and prevention center located in
the heart of Newark’s Central Ward. It is a
storefront operation, open at all hours to all
people, and staffed voluntarily. by several medi-
eal doctors and approximately 10 former. ad-
dicts. No police supervision or intervention is
present to scare off those who need and seek

85

a rmmeaeresaamse aaa
GREATER NEW YORK

help. Addicts pay a $10 registration fee, re-
ceive a physical examination and get a pre-
scription for Methadone, a drug which helps
them come off their heroin-induced “highs”
without going through withdrawal. This pro-
cedure takes 4 days. The addict is then encour-
aged to attend the triweekly group therapy
sessions during which everyone talks of their
problems and encourages one another to stay
“clean”. I was impressed with the program and
the caliber and dedication of the staff.

As the New Well’s director told our SHP
group, addicts and Newark youth who may be
fooling around with drugs, often listen to him
because he is himself a former addict, and a
member of the black community of Newark.

A big problem at the New Well is lack of
funds. Since they only began regular opera-
tions in December 1967, they have not as yet
been funded, although they are now in the pro-
cess of applying for a grant. In the meantime,
they must rely solely on the $10 registration
fee and on scanty private donations to meet the
rent, repair their facilities, and keep their pro-
gram running.

To help alleviate their financial difficulties, I
organized a musical benefit whose proceeds
will all go directly to the New Well. I was able
to obtain a large hall located in the Central
Ward, in which to hold the show; I got Tom
McCray’s African Heritage Dancers, Art Willi-
ans’ Jazz Trio, Larry Young’s Organ Combo,
and Bill Testa’s band to donate their time and
talent. In addition to money coming in from
the ticket sales, I sent letters to all the
churches, doctors, and big industries in Ne-
wark asking for their contributions and sup-
port of our musical venture. In all, 1200 letters
were sent out. The response was gratifying;
about $40 poured in each day.

Not only is the money important, but so too
is the publicity which will come to the New
Well as a result of newspaper coverage of the
event and plugs for our show on radio station
WNJR. Many of the doctors and other com-
munity leaders who received our letter called
to ask for more information about the New
Well’s program and several wanted to find out
how they could be of help.

86

In all that I have done, I have tried to make
sure that the help would be of lasting benefit.
—B.W., Medical Student, Newark.

The attitudinal study among postnatal pa-
tients was almost wholeheartedly rejected by
the students in the project as something
“mickey mouse.” I was more interested in it
because I had helped formulate the question-
naire and realized it was one of the reasons
that the dean had let us enter the community
with the good blessings of the medical school.
Although it did not seem to be a constructive |
thing to many of the students, it was one way
of getting close to individual people from the
community in a medical and sociological con-
text with the possibility of followup. Actually,
it proved to be a better means of meeting prob-
lems than did our storefront at the area board.
Confined to bed, people were more receptive
and the questionnaire, if given properly, covers
a wide range of problems and is a beautiful ef-
fort at public relations to show the medical
school cares.—P.D., Medical Student, Newark.

Bronx

The members of the community organization
from which we worked were most anxious to
have SHP join them, but unfortunately had
not been prepared well enough in advance on
what SHP could or could not do in the com-
munity; not enough thought was given as to
the actual needs of the community. Perhaps if
representatives from SHP would come into the
community in early spring and explain SHP
and give the leaders of the community a
chance to go back to their people, then the
short time that SHP spends could be spent in
accomplishment rather than frustrations.—
E.F., Community Worker, South Bronx.

Working out of the LABOR storefront has
proved to be the greatest setback so far ‘in
terms of doing patient advocacy. This agency
supposedly has its fingertips on the pulse of
the community, but both students assigned
there have found organization and action al-
most totaly lacking. The reasons for this we
need not elaborate here; suffice it to say that
their problems of inertia have held us back.
Out of fear of usurping the staff’s power, I
SUMMER 1968

have gone along with their suggestions, adding
my own whenever possible, always looking for
any opportunity to get things going without
making it look as though we, the outsiders, are
actually directing —R.F., Medical Student,
Bronx.

Because our instructions were to work with
LABOR and because we did not wish to antag-
onize LABOR, we ended up working for them,
doing the work they wanted rather than the
medically oriented service we had envisioned
at the beginning of the summer. This had the
advantage that LABOR can follow up what we
did. But it meant that we did not function in
the way we were best suited; we were doing
work which people from the community should
have done. We ourselves learned a great deal;
. we served very little—N.A., Medical Student,
Bron«.

Health students should consider themselves
working for LABOR. They should submerge
SHO independence as much as possible and try
to work out within LABOR a suitable role for
themselves.

I think we ran into a lot of trouble when stu-
dents considered LABOR a parallel organiza-
tion and demanded independence. As far as I
can see, LABOR is flexible about letting people
do what they want to do, if good relations and
trust are established first. I think it’s the stu-
dents’ job as outsiders to work hard to main-
tain good relations with the community organi-
zation.

The alternative is rather paternalistic. It in-
volves, first, denying that LABOR represents
the community and, second, presupposing that
students know what the community wants or
needs.

I have not been impressed with suggestions
that students “run their own program within
the community.” Underneath those sugges-
tions, I think, are a lot of petty professional-
ism and a belief that the community doesn’t
recognize its own needs.—K.B., Medical Stu-
dent, Bronx.

Lower East Side
Too many times this summer, as I am sure it
must have happened in years before, there

have been people willing to help solve the
problems of an individual or of a community in
general, but the problem could not be defined
to the satisfaction of both groups. Having
heard so often, during orientation, that SHP
workers must be sure they are working toward
the betterment of the community in an area
that the community deems a problem, this
summer has shown the biggest difficulty to be
the definition of a “problem.”

On the Lower East Side, project leaders felt
it would be impossible to work in the area un-
less a liaison had been established between the
SHP and an established community group. The
problem is that in a relatively small area there
exists a large number of community agencies
which have notoriously vied for positions of
power rather than worked together. It did
seem to the project leaders, though, that one
organization, the Lower East Side Neighbor-
hood Association, was representative of the de-
sires of a majority of the community. This or-
ganization provided the Lower East Side pro-
ject with its community advisors as well as
serving as a base for communicating with
other organizations and their activities. I felt
that they tried to help as best they could but
were too involved in their own ongoing activi-
ties to be of any great help. This is not a criti-
cism, merely an observation, for lately they
have been working out the myriad details in-
volved in setting up the North East Neighbor-
hood Association (NENA) comprehensive
health service, scheduled to open in January
1969. This activity is indeed invaluable to the
community. SHP’s connection with NENA,
however, was such that we could only request
assistance if they had the time to spare. Un-
derstandably, they often didn’t. I believe that
any future SHP groups working in Manhattan
must have a close alliance with an established
group in order to be at all effective. The estab-
lished group offers the greatly needed back-
ground information, actual experience and
vital contacts without which a small group is
lost trying to challenge the bureaucracy of
New York’s health care facilities—J.M.,
Nursing Student Lower East Side.

Our contact with the Lower East Side ain

87
GREATER NEW YORK

munity was exclusively through the NENA
Health Council, a coordinating committee for
grassroots groups in the area. It is not a grass-
roots group itself, and is not involved in organ-
izational activity. I feel that white students
have no business in such a neighborhood unless
they are supportive in the effort of poor people
to organize themselves politically. NENA is
past that stage; they are now consolidating the
fruits of past organization and pressure. I
think it was a basic mistake to work through
them. They served to insulate us from the com-
munity. The members of the council, through
years of striving for a neighborhood health
clinic, have become very sophisticated about
health and politics. I think they still represent
the community, but they are not representative
of it.—J.M., Law Student, Lower Kast Side.

I worked with four other health science stu-
dents in helping the North East Neighborhood
Association (NENA) Intergroup Health Com-
mittee develop and write up a training pro-
gram for paraprofessional personnel who
would work in the health service; publicizing
the clinic in the community and asking the
community people for suggestions on how it
should be run; and trying to find ways in
which Puerto Rican nurses could be licensed by
the State of New York. * * *

I found that the health science students were
accepted completely by the people at NENA
who seemed very happy to have us working
with them. Since the health service had just
been funded, there was a great deal of work to
be done to get it set up and there were only two
people working on the clinic when we first
came, Thus we worked as a staff for the devel-
opment of the clinic. The project director of
the health service outlined what she thought
were the important jobs to be done and then let
us develop our own methods and goals; thus
we worked mostly on our own.

I think the group was quite successful in ful-
filling two of its three objectives. We com-
pleted the training program, our top priority
task, and hopefully a grant will be obtained so
that the program may soon begin; and we
reached a good many people and informed
them about the clinic, although, due to lack of

88

time, we did not reach as many as we had
planned. We found that there was no way
Puerto Rican nurses could ‘be licensed except
by taking the New York State examination.—
K.D., Medical Student, Lower East Side.

Those of us interested in fighting narcotics
addiction decided to produce a skit using NYC
residents of the Lower East Side, speaking the
slang of their peers and interacting on stage in
a manner to which their audiences could relate.

We realized that in order to be effective we
would have to associate ourselves with ex-ad-
dicts. We began. to attend daily sessions at
Daytop-SPAN, and remained there until the
end of the project. This association both helped
and hindered us in the fulfillment of our objec-
tives. Because of the close-knit group together-
ness of Daytop-SPAN, the orientation of the
organization was necessarily different from
ours. This situation created a certain amount
of tension, which remained between the two
groups for the duration of the project. Daytop
expected us to immerse ourselves completely in
their therapy program while we were only
there to gather information, background, and
atmosphere for the play, and to insure that the
portrayal maintained a certain amount of accu-
racy. Daytop, however, subjected our private
lives to their scrutiny and jurisdiction, and re-
fused to accept that we had come only to seek
advice and not to seek “salvation.” Perhaps the
burden of the blame lay with us. We did not
clarify our exact position and functions to
Daytop-SPAN and thereby melted too far into
the organization.

Once again, this emphasizes the rather seri-
ous lack of a clearcut identity on the part of
the SHP. Having formulated its specific objec-
tives, the SHP ought to have established its
autonomy as an organization vis-a-vis the
other community organizations with whom it
worked or from whom it sought advice. The
value of SHP as a link between the establish-
ment’s health and social services and the
Lower East Side community is too great to
allow SHP’s dissipation into simply another
free labor supply for various neighborhood or-
ganizations——D.S., Medical Student, Lower
East Side.
 

SUMMER 1968

We had a great deal of trouble fitting into
SPAN: we supposedly had a double allegiance
_—to SHP and to SPAN. SPAN is a very struc-

tured, rigid organization, as it has to be. As _

they say, “We are in the business of saving
lives; we can’t afford to compromise or let our-
selves slip.’ Coming into SPAN, we originally
agreed that we would do everything that every-
one else did, for example, help clean up and
attend all meetings, seminars, and group ther-
apy sessions. However, in some ways we were
treated with leniency, and for the NYC’s this
was bad because it decreased their sense of res-
ponsibility. It also caused SPAN to be upset
with itself and with us, because they felt they
were not living up to their own standards.

The second hangup was that no one knew
what the students’ role should be. We were
treated as supervisors, and fell into that role
too easily. The play was almost entirely con-
ceived and laid out by the students, without it

ever being explained to the NYC’s. When our

director finally straightened out the mess, the
pendulum swung in the other direction: the
students felt they had no authority at all, Once
the play got underway, the NYC’s were the ac-
tors and SPAN people the directors; the stu-
dents floundered for a purpose. Eventually we
settled on an administrative-organizing role;
we set up performance places, bought props,
phoned absent NYC’s, etc. But through this
long struggle toward a role, SPAN looked on
annoyedly, not quite knowing why we were
there or what their concern for us should be.
Generally, SHP seemed so disorganized and in-
experienced an organization that SPAN de-
cided to try to ignore it, and to take us into
their organization as individuals.

After many stops and starts, we got the play
going and performed it three times, once for
' the people at SPAN, once each for University
and Henry Street Settlement Houses; alto-
gether we reached about 100 people. We expect
that it will continue through the year. The five
remaining NYC’s who acted in the play are
very enthusiastic about doing it in high schools
throughout the year, and about coming down
to SPAN and participating in groups.

. It was a tremendously enriching experience
- to meet and get to know the people from

SPAN. They are all ex-addicts, who, through

their program of self-help, have become in-.
credibly self-aware and perceptive. I found it

easy to work with them; more than that, I

doubt that there could have been a play, or any

meaningful conception of what we were trying

to do, without their help—M.H., Nursing Stu-

dent, Lower East Side. °

Harlem

When I went out on referrals in Harlem I
did not feel that I was accomplishing anything,
because I was not connected with a community
organization. Once associated with the hospi-
tal, however, I felt that my service was more
organized and therefore more effective—M.L.,
Psychology Student, Harlem.

Referral work formed the body of my job
for the summer. Personally, I met with little
resistance from the community; most families
were cooperative and grateful for our
services. * * * Nonetheless, a sense of friction
arose in dealing with the clinics. Although we
were well received and complimented by all
health facilities we used in Harlem, I believe
there was some resentment of our arriving so
eager and fresh to do a job which the clinics
alone were not doing as best they could. An ex-
ample of this was the hypersensitivity of the
dental clinic staff in the Central Harlem
Health Center. I feel they were caught sitting
on their hands and that we forced them to take
on the number of patients they were actually
equipped to take but had not been receiving.
Goading clinics to give better service was one
of our goals, however, and in certain respects
we were successful.—C.W., Medical Student,
Harlem.

I was told by many of the health establish-
ment professionals that they felt they were
doing the best they could under very trying
conditions (for example, over-utilized and di-
lapidated facilities in Harlem hospital clinics),
and they felt that we posed a definite threat of
trying to “expose their inadequacies,” which,
although never stated, was implicit in our ide-

alistically trying to “make things better in a

hurry.” Many of them, of course, aren’t doing
their jobs; however, it doesn’t matter what we

89
GREATER NEW YORK

think we’re doing but rather how they inter-
pret our motives which determines whether or
not they co-operate willingly. Our handling of
this “domain infringement” problem often was
not very tactful (and other projects reported
similar problems), so this is one area we
should give more attention to in future efforts
to effect change from within institutions.—
W.S., Medical Student, Harlem.

Brooklyn.

I thought the nature of our involvement in
the hospital setting was extraordinarily appro-
priate in effecting our original aims. Per-
sonally, I do not believe that community in-
volvement is necessarily the best way to im-
prove health care. Recipients expect doctors to
act like doctors; that is, to render healing ser-
vices, and not to act as quasi-social workers or
priests.—-M.H., Sociology Student, Brooklyn.

We had hoped that the Youth-In-Action pro-
ject. would bloom out, because they’re a gigan-
tic organization in Bedford-Stuyvesant, and
they have many programs: social affairs, fam-
ily counseling, unwed mothers, sports—you
name it. We thought it would be a good oppor-
tunity. As it turned out, it was horrible.

The bureaucratic problem we met is proba-
bly typical of a lot of agencies, but even worse
at YIA. We made arrangements, really good
arrangements, with a couple of people at YIA
and then some of them left, and we were up in
the air. No one else had been told about these
arrangements, so we had to start from scratch.
We were trying to get involved in one of their
other programs (I think it was the unwed
mothers or the family planning section) and
we found that people over there never knew we
had been working in home family counseling.
—W:S., Student Coordinator, Brooklyn.

Most of the community groups in which the
Brooklyn SHP was to operate had been con-
tacted several months before the project began.
Model Cities was a last-minute addition, and
the role of the SHP in it was rather unclear.
We were to work for the multiservices commit-
tees whose social service interests stretched, as
our supervisor said, “from the womb to the
tomb.” -

90

The Brooklyn SHP felt that the student fel-
lows’ role in model cities would be to help the
multiservice committees prepare a health pro-
posal by the September target date. We should
have seen trouble ahead when, on our first
meeting at model cities, the supervisor pro-
posed that we learn Spanish for the first few
weeks in order to help recruit the Puerto Rican
community for the Model Cities program.

Following a week of orientation to the Model
Cities concept, we reported to work in Central
Brooklyn’s Brownsville office and were told
that our job would involve an investigation of
the health facilities in the Model Cities area.
We knew little of. the area and started from
scratch.

Investigating health facilities can involve
anything from making a list to conducting a
survey of patients’ opinions of the various
health services available. We tried to set a
course somewhere in between, realizing that
there was little time for in depth evaluation
since the committee were being asked to sub-
mit tentative proposals by August 15th.

On July 9th, our second day in the Model
Cities office following orientation, we walked
across the street to check on the activities of
the Ralph Community Center. We were curious
to see how community action was being han-
dled on a storefront basis. * * * The Ralph
Center is small, but it did have a group of wel-
fare mothers in a remedial reading program
and we spoke to them for a few minutes to
sound out their ideas concerning possible
health programs such as child psychology, nu-
trition, the psychology of drug addiction, etc.
The women were only mildly enthusiastic but
we arranged to meet with a larger group for
later that week. * * *

Model cities did not employ Neighborhood
Youth Corps workers. Instead, some 78 college
aides from the Brownsville, East New York,
and Bedford Stuyvesant communities were
hired. Three of these aides had attended the
SHP Orientation. Since the two girls were
black and the boy a native of Puerto Rico, I
asked our supervisor if they could join us for
the hour or so we expected the Ralph Commun-
ity Center meeting to last. Much to my aston-
ishment, I was not only told that they couldn’t
SUMMER 1968

join us, but I was forbidden to walk across the
street! I was told that we had enough to do at
Model Cities; and when I protested that we felt
we had time on our hands at this point the su-
pervisor told me not to get involved because
there will be much to do.

We had not expected this type of rebuff. It
had been our feeling all along that our role at
Ralph Street Center would be one of coordina-
tion only, and that the women themselves
would make the contacts and invite the speak-
ers. We felt that even should the program de-

velop on a weekly basis, it would involve only a.

couple of hours a week and we could not antici-
pate our ever being so busy as not to be able to
afford 2 hours. In any case, the commitment
had been made to meet the women and we con-
tacted an assistant to the director and he ar-
ranged for us to go to the meeting with two
Puerto Rican college aides in the office.

The significance of this encounter lies in its
total misconception of our role in model cities
that saddled and hindered us in all the weeks
we worked. We felt that our task to provide
health information to a planning agency de-
signed to improve community services in toto
was an important one. Given the scope of our
research, this assignment did not demand a 40
hour week. We spent every Monday evening
and one Tuesday evening trying to help the
Multiservice Committee of Brownsville and
East New York. The job involved a great num-
ber of phone calls, many meetings with directors
of health facilities, and an equal number of re-
ports for the Model Cities office. It did not, we
felt, involve a stranglehold on our time and in-
terests by a supervisor ill-equipped to direct us
efficiently and an agency burying itself under
the weight of its own memos. The net result
was a gradual alienation between us and our
supervisor, then the director, then ultimately
the task itself. .

* * * T had written a rather stinging report
for the SHP. It was written at a rather low
point in a day in what had been a rather low
week. I will quote the final two paragraphs:

“It is our feeling that, since a proposal must
be produced by September 1st, the committee
will have little to do or say but rubberstamp
ideas suggested by the staff. Model Cities is

grossly understaffed and equally uninspiring.
We have spent too much time writing reports
that are never read on resources that are being
listed for the umpteenth time by the ump-
teenth agency. Our job is to drown in bureauc-

racy.
Frankly, I think the job stinks. It is stupify-
ingly dull and nonstimulating. * * * There is

no doubt that Model Cities will benefit in some
way by our work; there is considerable doubt
that we will benefit from four more weeks of
boredom.”—J.R., Medical Student, Brooklyn.

There were two important areas of the
Kings County Hospital patient advocate pro-
gram that hadn’t been touched on by the 4th
week of the project. One was the problem of
how best to utilize the facilities of the pedia-
tric clinic to educate the mothers that visited
it, and how to make the clinic as enjoyable as
possible to the other children that had to tag
along. We needed to make the hospital admin-
istrators aware that much more could be done
for the people who visited the clinic * * *

The National Dairy Council let us use for 2
weeks a 6 foot by 4 foot electrical cow that
could “talk”, Along with this cow. came posters
about proper nutrition; and the importance of
drinking plenty of milk.

The cow served two purposes: the first thing
that it did was brighten up the entire pediatric
clinic for all the children. You should have
seen the excitement in their eyes as the cow
moved its head back and forth and mooed and —
wagged its tail. Many of the children had
never seen a cow up close and couldn’t help
touching the animal. Why the — couldn’t the
people in the clinic, the administrators of the
clinic, think of something like this? In order
to get the cow free for 2 weeks, in order to get
the posters and handouts for the people visit-
ing the clinic, all I had to do was write a letter
to the National Dairy Council. Can you imag-
ine how much could be accomplished if the
head of the department of pediatrics or some
other person in authority tried to use his influ-
ence ‘with various agencies in order to help im-
prove conditions in the clinic?—D.Y., Medical
Student, Brooklyn. Z

91
NU Avast basa

THE NEIGHBORHOOD YOUTH CORPS

A tentative program was developed in which
health science students and Neighborhood
Youth Corps would jointly structure a summer
“experience.” The objectives were : (a) To un-
dertake a program which would give the NYCs
a constructive and educational summer job
which in some way relates to health and to
medicine; (b) to enable health science students
to become thoroughly acquainted with the
health needs and health services in the com-
munity; (c) to develop one-to-one relationships
with several adolescents, thereby hoping to
have a positive influence on their further de-
velopment and goal expectations—L.K., Medi-
cal Student, Brooklyn.

Working with the NYC’s was both reward-
ing and frustrating. They contributed a
great deal and ran some of the projects en-
tirely. However, some of them were too imma-
ture and didn’t want to work. They didn’t want
to walk a few blocks when we were all going
door-to-door with health information; they
didn’t give us suggestions when we asked them
what was wrong with the summer work. They
said they wanted to talk to their age-group
about drug addiction, but when the opportu-
nity came they were too embarrassed to talk.

Many times, we climbed walls in order to
keep them busy. I don’t think, however, that
our project could have existed without them.
When they were interested in something, they
were creative and tremendously active.—E.B.,
Medical Student, Brooklyn.

The big problem for most of the people on
the project who were working with the NYC’s
was that they felt they were working to make
work for the NYC’s; that they were constantly
worried about what these kids can do, and
should do, and trying not to keep them bored.
A couple of the health students expressed to
me that the kids are wasting their time and
could be getting a better experience elsewhere.
Some of the kids worked out well. In Browns-
ville we had two kids who were really great
and they were interested. We had known one
of them before this summer and we requested
him, as he had indicated to us that he was in-

92

Vase

a varen

terested in medicine or an allied profession.
The other one I met before we hired him, and I
spoke with him for a while and explained the
project and he seemed interested. So both of
these NYC’s were screened. A lot of the other
people we got were just given to us. We had re-
quested that they have an interest in medical
sciences, but. in truth, when people assigned
NYC’s to us, I don’t think they took anything
like that into account. It was a real horror
show for a while.

We had to get NYC’s from three different
areas, because we were working in Browns-
ville, Crown Heights, and Bedford Stuyvesant,
and we had to get NYC’s from different agen-
cies within those areas. In the beginning there
were hangups in all of them—the kids didn’t
get paid and they had to register and re-regis-
ter—but after 2 or 3 weeks, Brownsville and
Crown Heights straightened themselves out.
Bedford-Stuyvesant Youth-In-Action has yet to
straighten out. We were calling and going
down there and seeing people, and we got no-
where. And last week we sent them a telegram
telling them, “We’ve been trying to get you,
and the NYC’s haven’t been paid for 6 weeks,
and it’s time something got done.” Two NYC’s
stopped coming to the office. Last week we told
them we would followup the telegram and go
down there and sit there until someone did
something, so we went down and we had, I'd
say, about 10 or 15 people there in that little
crowded office, so they saw us and we got it
straightened out as well as we could have ex-
pected.—W.S., Student Coordinator, Brooklyn.

When the NYC’s were working they did
work comparable to the work which was being
done by student fellows in the SHP. This is an
interesting observation and may shed some
light upon SHP’s place in the community.

If Neighborhood Youth Corps workers are
capable of doing much of the work which was
done by medical students this summer, then
why not set up an SHP in which the majority
if not all of the student fellows are teenagers
from the community. I’m sure with supervision
from the Public Health Service and a few med-
ical students such a project would work. Fur-
thermore, if the funding is through an estab-
SUMMER 1968

lished bureaucracy such as ours was, there
would be no financial problems.—R.J., Medical
Student, Brooklyn. .

On the whole, I found that working with the
NYC fellows to be a very worthwhile experi-
ence. Although they had much difficulty as far
as receiving their pay checks went, they still
continued to work with us throughout the sum-
mer. I discovered that these workers were very
imaginative and as eager as we allowed them
to be. That is, when we showed enthusiasm for
a project, then the NYC’s showed the same
eagerness to get involved. If they didn’t have
such a problem about getting paid, then it
would have been an even more productive sum-
mer for us. These youngsters know the com-
munity. They helped us get acquainted with the
area, the problems that the people had, and
’ the problems that they faced daily in their own
lives in the ghetto.—D.Y., Medical Student,
Brooklyn.

It appears that two factors contributed
greatly to the somewhat frustrating situation
with the NYC’s. First, the unstructured nature
of the work in the initial stages, the degree of
abstract thinking required, and the many
hours of rather uninteresting but necessary
busy work. To do this busy work both effec-
tively and with enthusiasm requires an under-
standing of and dedication to the ideology. By
utilizing a confrontation technique with the
NYC’s, some success was achieved in increas-
ing their interest and participation. Secondly,
the generalized confusion of the NYC program
hurt us—many youngsters were not hired until
quite Jate and the payroll mix-ups were numer-
ous.—L.K., Medical Student, Brooklyn.

In the beginning it was said that the health
students and the NYC’s were to be equal, but it
didn’t turn out that way. The NYC’s were the
slaves of the health students, because the
NYC’s didn’t have the same responsibility as
the health students. By this I mean the health
student did everything and the NYC did the
slave work, the dirty work.—R.P., NYC,
Brooklyn.

The NYC program was nearly a total fiasco,
a flop—the major failure of our project and of

my efforts. Relations between me and male
NYC’s were cordial but superficial. I cannot re-
member one truly frank or constructive con-
versation between me and a male NYC. The
boys are mostly high school students whose in-
terests and capabilities are varied. I had more
friendly, frank discussions with the girls, al-
though these did not come until the last 2
weeks of the project. Boys were more cynical,
less interested, and less vocal; they just didn’t
trust or like me and many other project mem-
bers, and I feel they had good reason. Some
stopped coming to work other than to pick up
paychecks.

Here’s how we let them down, as I see it. We
have a kind of Cinderella complex about
NYCs. That because they know their commun-
ity best we presumed they have highly devel-
oped social interests and ideas. We did not tai-
lor jobs to individuals carefully and, where
necessary, we did not provide well defined
tasks, thus giving NYC’s a feeling of impor-
tance and belonging; it has to be nurtured and
we weren’t able to do this. I don’t think they
felt important and necessary. We did. not use
them as consultants. One boy failed his sum-
mer school course, and we didn’t know about it
until after he got the grade.

With proper direction and attention, the
NYC program could be productive for them
and us, but more attention must be given to it.
We must learn from our past mistakes.—A.H.,
Medical Student, Newark.

Neighborhood Youth Corps teenagers were
essential as a direct line into the community.
They did not turn out to be secret agents at all,
but were frequently direct lines to the real
poor who need help the most. I did not develop
as close a relation with the NYC’s as I hoped
to, but some of the talks I did have with a few
of them were mutually beneficial. A basketball
game the health science students played
against them was a success, but it or a similar
activity should have been held earlier in the
project when enthusiasm was still high: I sug-
gest intensive individual tutoring of the NYC’s
two mornings a week with as many health sci-
ence students as possible participating and
keeping daily records of each NYC’s progress.

98
GREATER NEW YORK

We never made operational a suggestion that
instead of focusing our attention in the direc-
tion of what we could find for the NYC’s to do,
we instead charge the NYC’s with the respon-
sibility of informing us about what their
neighborhood and its people were all about and
bringing to us what persons they knew or
knew of who needed some help. I feel a keen
sense of disappointment that we didn’t make
our NYC’s experience this summer nearly as
valuable as I thought it should be. The most
certain thing I can suggest to remedy this in
the future is that in the first week or two when
enthusiasm is still high (assuming it begins
high) each NYC is made to feel important by
doing something constructive and meaningful,
and not just sitting around.—N.W., Law Stu-
dent, Newark.

The problem we have is that NYC’s and
health science students don’t relate that much.
The NYC’s don’t have a sense of the project
like the health science students do. One, the
health science students don’t have the same
problems, with day to day living, as the NYC’s,
so they don’t have the same objectives. We
have more intellectualized, jdealized objectives
of 2 better health service. The NYC’s are con-
cerned with summer jobs, keeping busy, get-
ting something interesting to do, and in the
winter having another job, getting more
money. Their interest in a way is very impor-
tantly, very basically, economic, They think of
that more than we do. The most important
thing we’re doing is making them think—how
many of these kids would otherwise be think-

. ing about hospitals and health problems?

They never would have thought about this. If
they have a job and they have to think about it
because it’s their job, they’re not going to stop
thinking when the job is over. One guy is
maybe going to get interested and one guy can
change ten people.—D.T., Student Coordinator,
Newark.

The most striking lack of communication
was between health science. students and the
NYC?’s..It got to the point where one NYC was
assigned to each health science student. I
thought this absurd, but shamefully necessary
in most cases, to establish this forced relation-

94

ship. By the end of the first week, the role of
the NYC’s was set in the minds of the glory-
craving, great white liberals as kids who were
to be dragged along. These “kids” are a lot
more mature, open, truthful, and real than
most middle class health science students. The
NYC’s are the most powerful organ of SHP.
They are the community and any student who
ignores or exploits them “to know what a
ghetto person is like” is ignoring and exploit-
ing the entire community that SHP is sup-
posedly established for. I myself underrated
the potential of the NYC’s initially. But for-
tunately, through one NYC who was “showing
me the ropes”, I realized their importance and
worked much more effectively with them.—
K.S., Nursing Student, Newark.

I feel the NYC’s were the most important
people in the project, and with most of them,
especially the boys, we failed miserably. First
of all, they were excluded from many of our
meetings concerning hospital services, meet-
ings which they should have attended as the
main speakers on poor medical care and bad at-
titudes in the hospital. Secondly, many of the
health science students went about their busi-
ness without the NYC’s. They were regarded
as little kids who had to tag along after you
and the biggest question seemed to be, “What
are we going to do with the NYCs?” Nothing
should have been done “with” the NYCs. They
were all old enough to understand why we
were there and what we were doing, and they
should not have been treated as kids. I found
the girl NYC’s to be the most genuine people
on the project. They were intelligent, alert
young ladies, more aware of the existing condi-
tions that they were often given credit for.
Had some of the health science students
stopped patting themselves on the back and be-
friended these boys and girls, they could have
learned a lot. If the NYC’s had been treated as
equals they could probably have proven invalu-
able to the project goals.—A.C., Nursing Stu-
dent, Newark.

This summer the Lower East Side dental ed-
ucational program was performed by only
NYC students. They wrote and directed their
own play and have received tremendous praise
SUMMER 1968

for their performances. All the Head Start
schools in District 1, daycamp schools, the
Poor People’s Campaign, Junior High 71, the
Boy’s Clubs, Sloane Center, and many other
agencies have all enjoyed and learned some-
thing from the plays. This group of 15 NYC’s
have reached about 3,500 children and young
adults this summer. As well as supplying a ser-
vice to their own community, they also had a
great time doing it. I have personally heard
that they are proud of what they are doing and
hope to have an ongoing program during the
school year. A few of them have come to me
and expressed their personal gratitude for the
summer.

I am presently submitting a proposal for
funds so these NYC’s can continue their activi-

ties during the course of the year. We hope to |

coordinate their activities with an exciting
program at NYU Dental School, where they
will continue to perform, to rehearse, to make
costumes and scenery, and to draft new plays
after school. They will perform their plays for
local agencies as part of the dental school pro-
gram. The NYC’s will also be offered a tutorial
program to aid them through high school and
entrance to college. They also will attend den-
tal educational classes where NYU faculty
members will talk to them about oral diseases.
From my own experiences and observations in
this community for over a year and a half, and
considering the recent summary of dental
needs by the Public Health Department, I feel
this group can provide a fantastic service to
their community, a service which is desper-
ately needed.—G.L., Dental Student, Lower
East Side.

We, as students, had a great deal of trouble
adjusting to working with the NYC’s. We al-
ternated between our ignoring their abilities
and their ignoring our abilities. In the end, we,
the students, moved into a cooperative, super-
visory role, and it worked well. Though it was
hammered into our heads that everyone was
“equal,” and that “no one bosses anyone,” we
finally realized that the NYC’s were 5 to 7
years younger than us, much less experienced
in the responsibilities of working, and needed

guidance.—M.H., Nursing Student, Lower East
Side.

* * * You see, one of the things about
Neighborhood Youth Corps is that it’s a syn-
thetic organization developed for a particular
purpose. If you have two synthetic groups re-
lating to each other, and the core of their expe-
rience is what happens between those two
groups, I think the community’s going to get
left off in the cold somewhere. And there’s
question as to what extent these NYC’s are re-
lated to the community: some of them are,
some of them aren’t; in fact, the coordinator of
the whole Youth Corps was in just as much of
a hurry to move out of the community as he
could be.* * * —S.D., Community Worker,
Lower East Side.

From my point of view, the SHP could have
been more organized if the students had been
more thoughtful in their decisions. For the
most part, I think that the SHP accomplished
what was needed in the community. I think
that we NYC’s were very effective and very
helpful to the work of the students because
since we were also from the community, the
people would be more attentive to what was
being said.

The students I worked with were, for the
most part, very nice. They made me feel ma-
ture in what I said and what I did. They some-
times disagreed on what was decided in meet-
ings, but I think this showed that they were
really interested in what they were doing.

I feel I got to know the community better be-
cause I personally went around to them, talk-
ing about the clinic. Yes, I really think that my
experiences this summer may surely change
my plans for the future in that now I know
what I would want to consider my life’s work.
—N.R., NYC, Lower East Side.

The NYC’s in our office had not been hired
by SHP, but by LABOR. The ones I worked
with were very good and responsible. LABOR
would like to hire them part-time after school
to work as block organizers. My relation to
them was primarily one of a teacher—how to
get complaints in a building, how to organize a
tenants’ council, how to do a title search. They

95
GREATER NEW YORK

were expected to work independently and come
to us as resources, an excellent relationship for
those who were capable and mature, a hopeless
responsibility for the others. I felt somehow
that NYCs should be treated as our equals, but
they seemed to want more direction than I ex-
pected. I think in a continuing relationship,
equality would emerge. But NYC’s really have
to be selected for the work. Just hiring any-
body off the street and giving him make-work
is quite damaging—K.B., M edical Student,
Bronx.

This summer found me working for LABOR
as a screening technician. It was not fun. First
of all, I don’t get kicks out of going from door
to door asking for urine. We didn’t help the
families as far as housing and bills, etc. are
concerned. I think that that is something that
SHP should have considered.

As far the other NYCs I worked with were
concerned, they felt the same as I did. We all
thought it was a big drag and we all knew that
we weren’t doing it because we loved our
neighbors, but because we were getting paid
$40 a week for what we were doing. Being a
screening technician didn’t give me an oppor-
tunity to get to know my community any better
because I wasn’t working in my community,
but I did get to meet new people.

My summer experiences didn’t help me as
far as the future is concerned, because I
wouldn’t want to do what I did in the summer
for the future.—J.R., NYC, Bronx.

To me, this past summer has been very help-
ful and educational. (I know I speak for my
fellow NYC’s as well). For instance, I never
really knew how bad the slums are until I got
out there and worked in them. It was pretty
depressing but that’s the only way of learning
about it. I was also blind to the fact that in-
terns work hard to become doctors and when
they become doctors they work just as hard to
help out the sick, the ignorant and the op-
pressed. How do they do this? By starting
community projects; or by opening public hos-
pitals, clinics, ete. Yes, this summer was a
summer I’ll never forget, for I learned a little
about a lot. Or a lot about a little, whichever.

96

In short, I am grateful to the SHP for what it
has taught me.—F.M., NYC, Bronx.

I hated every minute of it. It was the most
boring and the dirtiest job at times. This pro-
ject was also very unorganized, confusing, and
a lot of talk as to what to do. All I really did at
times this summer was fuck off in this project
because sometimes that was the only thing left
to do. SHP did not do much work on housing
problems in the community, for what I saw.
Besides, there aren’t enough workers for this
job anyway. Concerning the workers I worked
with, well that wasn’t much of a problem for

“me, but for the medical students, yes, it was.

They should have taken the job more seriously
but I don’t really blame them because there
was no one around to make them responsible.
for what they were supposed to do.

The most important thing I think I got out
of this summer job is knowledge of the poor
conditions the hospitals are kept in. They don’t
even look like hospitals to me. And also the
poor housing conditions some people live in. I
think there should be something done about
this problem, which some people don’t even
consider. The one thing I really liked about my
job was that I got to know some of the people
in the community which I worked in.—R.F.,
NYC, Bronx. .

As far as the Bronx project is concerned, I
think that there was very little unity, if any at
all, between the older members of the project
and the NYC’s. Most of the young people felt
as though they weren’t part of the project, but
more like an old shoe that someone found and
just happened to need. It is here, I felt, that
the project began to fall apart. I think that the

-NYC’s could have worked more harmoniously

with the community workers, medical students,
coordinators, etc, for a better understanding of
the community.—C.B., NYC, Bronx.

COMMUNITY WORKERS

This past summer I was given a job that was
supposed to be as community coordinator. The
reason I got this job was, I believe, because I’m
black, I made a good salary and I could use it,
but I want a job not because I am black but be-
cause I can do the job.
SUMMER 1968

I may be a little old-fashioned, but I take
pride in doing a job well, and when I’m given a
job to do I try to do it well. If I don’t know
how, I ask someone who does know how, and
then I try to do the very best I can at it.

But this particular job no one will ever be
able to say whether I can do well or not, be-
cause I really didn’t have anything to do. The
NYC’s could have done most of what I did, and
this was not the fault of the people I worked
with so much as the way the program was set
up. It was a sort of gentlemen’s agreement
thing —‘We must have these people in our pro-
gram or we'll look bad, so keep them happy
and we’ll do the real work.”—M.W., Commun-
ity Coordinator, Brooklyn.

As one of the community workers, I found
working with other community workers very
agreeable. In most instances, we were in com-
mon agreement as to how something was to be
carried out. This is not to say that our behav-
iour was stereotyped, but that a somewhat
common outlook on the aims of the project led
to closely aligned methods of implementation.
Much of our camaradarie came about through
a defense of the community and its legitimacy,
a defense provoked by the subtle attacks made
by some white members of our staff.—R.P.,
Community Coordinator, Newark.

Our community colleagues were indispensi-
ble in a project composed largely of white,
upper middle-class students who have very
little idea of what is happening in the ghetto,
what it’s like to live there, and what it’s like
to be black. Individuals and personalities and
the abilities and commitment of the commu-
nity people have a great effect on the success
of any community-wide efforts, but not neces-
sarily individual projects——-N.W., Law Stu-
dent, Newark.

Our two community workers were quite dif-
ferent people, and the way they came across
was remarkably different. I believe that they
may not have completely understood their rela-
tionship (power-wise) to project decisions.
This understandably difficult position to evalu-
ate may have contributed to a. mutual distrust

in SHO community-worker relationships.—
J.C., Medical Student, Lower East Side.

We found, unfortunately, that although one
of our community workers prefaced many of
her statements with “the community wants
* * *” wo were actually hearing what she
wanted. We found that she often had as much
difficulty in communicating with the Puerto
Rican and black community people as the health
science students themselves had. We were told
by another community advisor (who also is a
member of the Health Council) that often, since
the other community worker sounded so know-
ledgeable on such topics as city and state
politics, the Health Council accepted her word
on faith. And we behaved no differently at first.
Her self-assurance and seeming political know-
ledge convinced us that even though we felt

‘insecure about going upstate to do political

organizing to get Medicaid back, we would be
doing the community disservice by refusing to
try. In effect, she succeeded in removing us
from the community for the whole summer. I
feel that I was deprived of a valuable learning
experience. Hopefully, however, the primary
objective of the SHP is not to parasitize off the
community for our own enlightment. Consid-
ering that, the Medicaid project may contrib-
ute more of a long-range “concrete service” to
the community than those projects which were
more “community based.”—J.P., Medical Stu-
dent, Lower East Side.

The community workers were overall very
helpful. Our community coordinator seemed
less helpful than I hoped and expected. Her re-
luctance to give advice before it was too late
caused many a mishap. Her explanation of
community feelings concerning our difficulties
was helpful, but I feel many mistakes could
have been avoided had she interceded sooner.
Our other community worker, though involved
in much power play, constantly provided much
needed advice concerning the community’s
needs and fears.

Mobilization For Youth provided us with
one of our most valuable people, the crew chief
of the NYC’s. He assisted us in understanding
the NYC’s and them in understanding us.
Without this help, our project would have col-

97
GREATER Niiw

lapsed._B.G., Nursing Student, Lower East
Side.

I feel very funny working with professional
people, perhaps because I think they’re trying
to put something over on me; I just didn’t
want to work with them. Then I reconsidered
because of the fact that I was the only Span-
ish speaking coordinator in the whole project.
* * * Sometimes I am asked questions by the
students and I say, “I don’t know how to an-
swer you because I have not consulted the com-
munity ;” Then the project members would say,
“What do you mean, you can’t answer me;
you’re part of the community.”--H.K., Com-
munity Coordinator, Lower East Side.

There are community people who’ll give you
snappy answers. Some of us have lived there
long and worked with each other long enough
to know that on policy questions, the snappy
answer is not always the best answer. Like I’m
sure Mrs. K. has very definite recommenda-
tions on certain technical things, but at the
same time the students wanted snap answers
on things like broad-range policy to function
on, to force someone into giving them an an-
swer. and then say, well so-and-so said that.
Well, we don’t want to be used that way.—S.D.,
Community Worker, Lower Kast Side.

In the Bronx we were fortunate in having two
hardworking, intelligent and congenial women
as community. workers. One, the mother of
seven, was white and active already in commun-
ity affairs. She served as an excellent liaison
between us and the Tremont Council. She also
brought to the job strong. ideas about our ef-
forts and a willingness to do a job. She related
well to the group and became an integral, in-
terested member of the team. The other com-
munity worker was Puerto Rican. She was
very congenial and, like her counterpart, be-
came a friend as well as fellow worker.
Through her we were able to understand some
of the problems the community faced, as well
as her serving as a link to the predominantly
Spanish-speaking community. Both women
were made to feel entirely equal on the team,
and their opinions were respected and often
taken as gospel.—v.S., Dental Student, Bronx.

98

YURK

The most reactionary and self-seeking mem-
ber of the Tremont Community Council was a
white, female community worker assigned to
the SHP. She was a strong proponent of “com-
munity relations” (keep the niggers happy),
and constantly showed preference for SHP in-
volvements such as single-shot sex education,
narcotics, and dental education programs
which would reduce the envy of other commun-
ity organizations for the concentration of our
services in the T.C.C. This community worker
was very domineering, vocal, and argumenta-
tive, and managed to control somewhat the
range of action of two nursing students who
worked with us on the project. In addition to
being frequently late or absent from project
responsibilities, she was an expert at ducking
her own share. At the end of the project, when
nineteen Bronx SHP students, community
workers, and NYC’s signed a petition to reallo-
cate funds from the extravagant Final Confer-
ence to the continuation of the Unwed Mothers
and Head Start programs, she was the only
project member who refused to sign. With col-
leagues like this, who needs enemies? On sev-
eral occasions, this woman openly slandered
two black community workers assigned to the
Central Bronx storefront. Her influence over
one nursing student was so strong that this
student threatened to resign from the project
if one of these black community leaders were
transferred to her part of the project.—J.G.,
Medical Student, Bronx.

We had five community mothers working
with us in Harlem. We were told it was to be
our duty to “train” them to work with Public
Schools 175 and 183 health referrals. Three of
the ladies are experienced in the home-visit
type of work involved, and it was absurd for us
to presume to train them to function in their
own backyards, particularly when there were
20 of us where three or four would have cer-
tainly been sufficient. I, and I think many of
the other student fellows, overlooked the two
inexperienced ladies who could have benefitted
from accompanying us on home visits, to the
hospital, and on visits with local officials. We
spent the last 2 weeks trying to make up for
our earlier shortcomings, only partially suc-
SUMMER 1968

cessful, I am afraid. The two are still unsure
of themselves, partly due to our inadequacies. I
felt the mothers suffered somewhat from the
decision to hold the orientation and final con-
ference far out of the city, they being reluctant
to leave their families.—L.B., Medical Student,

H arlem.

Our community workers were pretty good;
they were better at making home visits than
the medical and nursing students. Two of
the five were working mainly to get them-
selves out of the kitchen for the summer
and weren’t ready to put out. The other
three were quite resourceful and critical of
things in the project or in health facilities in
Harlem that needed criticizing —R.C., Student
Coordinator, Harlem.

FACULTY ADVISORS

Health science students coming to a new
community from all over the country for a 10-
week summer work experience must depend
heavily on the advice and the orientation pro-
vided them by faculty advisors and precep-
tors who have long-term experience in the
sponsoring institution and the neighborhood.
The faculty member must be able to work
equally successfully with citizens, represen-
tatives, and institutions in the community and
with the students. The former are inclined
to be suspicious of this invasion of Jargely
middle class workers, and the latter are us-
ually highly idealistic and very naive. The
preceptors who have prepared the. ground
in the neighborhood must be extremely careful
to suggest and advise students without in any
way dominating their project or making deci-
sions for them. There are realistic risks, of
students antagonizing community people, or
their being discriminated against because of
class, race, or as “carpetbaggers.” Even their
physical safety may be involved at times. The
faculty advisors should be available at all
times and should be capable of facilitating the
planning and the carrying out of student pro-
jects, through a close-working relationship
particularly with the student directors. You
must be able to relate sympathetically to the
_ changing objectives of the students, while com-

municating to them whatever cautions are nec-
essary to prevent them from proceeding at a
pace which is unrelated to the sentiment in the
community. Student health projects are an im-
portant two-way educational program, with
communities receiving valuable augmentation
of manpower and students receiving an indoc-
trination and a sympathetic understanding of
neighborhood problems which will stand them
in good stead as professionals. The faculty ad-
visor can and should play a key role in facili-
tating this whole process.—J.W., Faculty Ad-
visor, Brooklyn.

One of our faculty advisors was almost: to-
tally removed from any contact with our pro-
ject. Her main concern was with a question-
naire which was given to postpartum women.
If I had had more contact with this woman, |
could say more. In summary, her role was one
of irrelevance. ;

Our other faculty advisor served more as a
hindrance to our project than as a boon. He ad-
vised our project members as how to best be-
come co-opted into the bureaucratic b.s. of
which he himself is part. He seemed highly re-
sentful of the fact that members of our project
saw fit to approach the top of the Martland
Hospital administration with suggestions for
change, which we saw as deserving immediate
attention. These proposals were based on com-
munity sentiment.—R.P., Community Coordi-
nator, Newark.

Our faculty advisor both expected and de-
manded that we remain docile, quiet workers
in the emergency room, and not make any
“waves.” When he and the hospital administra-
tor learned of our visit to higher authorities
and of the community organization we were
trying to form, we were screamed at accord-
ingly, threatened, and invited to leave the hos-
pital. This invitation, we learned, wasn’t to be
the last.—A.C., Nursing Student, N ewark.

Our faculty advisors were virtually nonexis-
tent. Unfortunately, both are extremely busy
people and just couldn’t put in much time at
project meetings; they both came to several
meetings at the start of the project, but not
much later. One advisor taught the pediatrics

99
GREATER NEW YORK

part of our training program for the mothers.
She came to weekly meetings at our office for
that. In the future, we should try to get advi-
sors who have more time, I guess, but I’m not
all that sure that we suffered from not having
faculty direction. I felt from the start that this

100

was one of the parts of the project that would
have been nice but that it was really put in to
satisfy Montefiore Hospital that we would be
“well supervised.”—R.C., Student Coordinator,
Harlem.
Part 4: OPINIONS ON THE ORGANIZATION

INTRODUCTION

The administrative organization of the 1968
project reflected the spirit of community con-
trol that was of great importance to the pro-
ject’s student leaders and to many of the stu-
dent participants. The result was a structure
that was both decentralized and chaotic. Each
of the five areas was directed by a health sci-
ence student (student area coordinator) as-
sisted by a local area resident (community
coordinator) and advised by a faculty member
from the local area medical school. These five
student-community-faculty teams determined
what projects students would work on during
the summer, who would work where, and how
day-to-day problems would be handled.

Above them in the organizational hierarchy
were officers for the combined five-area pro-
ject, two student codirectors, a student educa-
tional coordinator, and a faculty director re-
presenting the sponsoring agency, Albert Hin-
stein College of Medicine. Their functions be-
came defined as largely adminstrative (pay-
checks, mail notices, purchases of supplies,
conference arrangements, etc.), a role defini-
tion which caused considerable consternation
to these individuals who perhaps should have
exercised a greater role in project affairs, as
well as to those project members who did not
consider their administrative functioning be-
yond criticism. Finally, policy statements of
broad project significance had to be developed
and approved by a policy making council con-
sisting of the student-community-faculty repre-
sentatives from each of the five areas, the
three student central office staff members, the
faculty director, and ex officio, the director of
Montefiore Hospital in the Bronx and chair-
man of the department of community medicine
at Albert Einstein College of Medicine.

Given this administrative structure, project
decisions were usually made at the local-area

level, with the central staff being essentially
powerless and the policy making council too
cumbersome for immediate decision and action.

GREATER NEW YORK STUDENT
HEALTH PROJECT STRUCTURE

Bronx

I felt that SHP was five separate projects
governed by a sincere but unresponsive leader-
ship. This leadership failed to bring the pro-
ject together so that we could learn from each
other before the summer ended; failed to act in
accordance with our wishes regarding funds
for continuing programs, supplies, materials,
etc, (Billions for buttons but not a penny for
books seems to sum up SHP wisdom and fore-
sight.) Our own Bronx project split into sev-
eral projects, the result of weak leadership. In
fact, weak, unresponsive leadership seems to
be a major fault of SHP. Policy was not deter-
mined early enough to give direction to our ef-
forts. Individuality is great, but we must real-
ize our limitations as individuals.

Thus, in summary, SHP was in actuality five
SHP’s without a central policy or theme de-
fined enough to guide. Central staff failed to
bridge the gap between and within groups, and
lacked both the leadership and wisdom to run
the organization effectively. SHP was a ship .
without a captain or a compass.

SHP has no moral right to return to the
community this fall, next spring, or next sum-
mer unless it undergoes a radical change into a
student-staffed but community-run and respon-
sive organization. It must be decentralized
down to each local area and must have definite
plans for self-perpetuating programs, Other-
wise, its existence is unjustified and unaccepta-
ble.—V.S., Dental Student, Bronx.

Lower East Side

I feel that the student health project this
summer tried to be all things to all those in-

101
GREATER NEW YORK

volved; it cannot possibly be. It is foolish to
think that we can be successful on all levels of
involvement. In the future, student health pro-
jects should be more carefully defined before-
hand so that all those involved have some feel-
ing of direction and yet at the same time the
projects should be flexible enough for innova-
tions.

I also feel that there should be some method
of screening NYC’s so that those who are truly
interested (if this is possible) become involved.
This is not to say that students should not also
be more carefully chosen

One further suggestion: in the future, more
of an attempt should be made to increase the
interchange of ideas not only between projects
within the city, but also between those who
have been involved with SHP’s in the past and
those who are presently working. I, for one,
am sorry that more of us were not able to visit
other projects, but perhaps this is. unrealistic
in light of the time factor.—L.C., Nursing Stu-
dent, Lower East Side.

Newark

The whole program suffered from lack of
structure. People are used to working in struc-
tured conditions so I think they would be most
effective working under structured conditions.
I think it’s very important that the NYC's
work with health science students: Somebody
said to me that they don’t see a place for the
NYC’s unless they work by themselves. There
has to be structure somewhere, but not so it’s
going to put out the relationship between black
and white students. I think the project should
have some definite goals. White students and
nonwhite students should not be thrown
into a community and allowed to spend their
summer “finding themselves.” The leadership
of the SHP, together with community workers,
should have specific guidelines as to where stu-
dent fellows will work and what they will be
expected to accomplish.

I want to know what the central office does.
* * * As far as our project has gone, as a
meaningful thing, I don’t think the central
office has had a damn thing to do with it. I
figured that the people who were going to run
the central office were going to be the people

102

who invented this job before and had it clear
in their minds as to what we could do, what
wé couldn’t do, and where the mistakes would
fall. None of this really came out.—R.P., Com-
munity Worker, Newark.

I feel there was somewhat of a problem in
project communication which was mostly the
fault of our student area coordinator, but
which could have been remedied by the Central
Office. The remedy would be a calendar of all
project events in advance, especially the
weekly meetings. Meetings or events subject to
change could be so labeled, and we could con-
tact the area coordinator to learn of any
changes. This lack of communication was
partly where the participatory democracy we
began with broke down.—N.W., Law Student,
Newark. ,

Any future project should not try to consoli-
date five separate areas under one cover. Per-
haps application and selection of students
would be facilitated by one mailing address,
but there should be complete and absolute com-
munity decentralization (community-student
NYCs community people—in any order). This
will greatly increase the effectiveness of the
project.—S.G. Education Director.

SHP is leaning in the right direction but is
not democratic enough (in the Grecian sense).
The Policy Board is a good idea but should
function as a communications center for the
benefit of individual project members. This
year motions were made and voted at the same
meetings, therefore coordinators did not -dis-
cuss their votes with NYCs and fellows. I feel
that the following alternative would give mem-
bers a greater sense of participation without
necessitating their presence at endless meet-
ings: (a) Any member can attend policy board
meetings; (b) Any member can make a motion
at a policy board meeting; (¢) Policy board
members have the option only to second or not
second the motion; any one member of the pol-
icy board can accept a motion, (d) Motions are
not to be voted on by the policy board at the
same meeting that they are first made. Individ-
ual coordinators should return to the area pro-
jects and present motions to all members who
ee ————_—h

SUMMER 1968

then vote. Each coordinator then reports ma-
jority vote of his project by telephone into cen-
tral staff who tally and record it; (e) Central
staff has a vote equal to a community ‘project.
_—A.H., Medical Student, Newark.

Harlem

The “New Left” democratic process stinks
as a way of running an SHP. With thousands
of dollars of Government money to account for
a contract to fulfill, well-defined bureaucratic
structure is required, with a management hier-
archy of responsible. persons selected for
leadership and managment capability, who can
accept the responsibility for policy and plan-
ning (as well as day-to-day decisionmaking)
without requiring interminable meetings
where everyone has the right to speak his
mind no matter how rapid or irrelevant his
opinions. There is no guarantee that Grecian

_ democratic vote is the best way to make deci-
sions, especially in an organization whose
members generally lack sufficient information,
understanding, and experience in managing
large sums of money or supervising people at
work. Every form of government has estab-
lished an executive wing to administer day-to-
day matters as well as to make long-term pol-
icy decisions. Bureaucracy may have many,
many faults (whether capitalistic or commu-
nistic) but AT&T runs a damned efficient tele-
phone business and they don’t take a referen-
dum every time a decision is required. As long
as some checks and balances exist (such as
open-door policy making) we need not fear
power placed in the hands of managers.

So, next time, let’s establish definite organi-
zational structure, with hire-and-fire power in
the hands of project leadership, and a definite
understanding that an employee-employer rela-
tionship exists between the project fellows and
the funding agency. Sure, people are going
to object to doing things the way our fath-
ers did them, but since somebody will gripe no
matter how decisions are made, or how much
structure there is or isn’t, why not let them

- gripe about the most effective and efficient
method of managing an organization ! (N.B.
After the Revolution, the Russian army tried

democracy. No generals, no officers. They now
have officers.) —W.S., M@ edical Student Harlem.

The structure of the Greater New York stu-
dent health project this summer started on a
poor level. The project for a time seemed to. be
nonexistent. It had no headquarters, no rules,
no election of officers, no nothing. I met an indi-
vidual who said he was one thing, then I met
another who said he was what the first person
had said he was. In my specific project, I be-
lieve I encountered four persons each of whom
at one time or another said he was in charge.

Nearing the end of the project, however,
some structure seemed to have been in the
making. Directive after directive began to flow
into our local project. We read of the topics
discussed and passed. * * * Yes, some sort of
structure with a policy making body and vari-
ous sanctions finally seemed to have evolved.
At the end of the summer, the student health
project had just been created.—E.M., Law Stu-
dent, Harlem.

The central office staff (personalities ex-
cluded) served a dubious role. They seem to
have evolved, by appointment or election
(though not elected by the project staff), to a
position of policy-making and surveillance.
Their only visible activities seemed primarily
to consist of floating from project to project,
and rapping the day away. (The importance is
not whether or not this is all they do, but this
is the impression they give to many people on
the project not otherwise informed.)

Most policymaking council decisions were
reached without consulting the general project
staff, and although meetings were alleged to
have included representatives of the group,
these meetings were sometimes announced 1 or
2 hours beforehand, when it was impossible to
get these “representatives” together. Often we
were not told the purpose of the meeting and
could make no provisions to attend. The cen-
tral office also saw fit to bless us with favors—
picnics, educational programs. It might have
been a better idea to consult the community
they intended to serve.—J.A., Medical Student,
Harlem. ~

My relationship with the central office staff

103

meee
GREATER NEW YORK

was one of frustration and anger. They tried to
pass this off as some sort of a participatory or-
ganization and then they would send out an-
other “order”. It is not that what they wanted
was so unreasonable, but rather the way in
which they did it. For example, they asked for
biweekly reports without an explanation of
why they wanted or needed them. In addition,
they imposed no penalty for not writing one,
so those of us who did write them felt rather
foolish. To make things run more smoothly, we
should have been able to elect a representative
with an equal vote to sit in on the policy-mak-
ing meetings. The Central Staff members
should not take out their anger on the student
fellows because the response to something that
the central staff is interested in was not shared
by the project members. The black history
classes are a case in point. Furthermore, the
central staff’s penchant for trying to combine
business with pleasure is annoying at best. If
and when I want my leisure time planned for
me, I will send a request for such a service. If
the NYC’s want a vacation in upstate New
York, they can have it. But to foist this upon
the rest of us is just not fair. If we have not
done our job, fire us, but to threaten not to pay
us if we do not attend a Final Conference that
everyone knows is being held at an inconven-
ient place for many of us because the NYC’s
want it, is just economic blackmail of the
worst sort.—F.V., Law Student, Harlem. .

Brooklyn

One of the faults with the structure of the
SHP was the lack of communication between
the different areas of the project (7.e., Brook-
lyn, the South Bronx). What was really needed
was a newsletter to inform the people in the
different areas of what was happening. Per-
haps the program next year could include one
day in each week in which each group went to
visit another group to see what other areas
were doing.—D.Y., Medical Student, Brooklyn.

LOCAL PROJECT STRUCTURE

Lower East Side

First of all, I feel there is a future for SHO
on the Lower East Side, but if it is to continue,

104

structural changes should be made. Some of
the frustration and feeling of being at “loose
ends” and not knowing how to direct our ener-
gies was due to the fact that SHP was new to
the Lower East Side. However, much of the
frustration and wasting of time could have
been avoided if the project had been more care-
fully organized before the summer began. It
was fine to say wait and discuss community
problems with people in the community such
as Neighborhood Youth Corps workers and
other community preceptors, but this could
have been done before the summer began. It
took many of us as long as three weeks, includ-
ing orientation, to decide what we wanted to
do, organize material, and to begin doing some-
thing. I also feel that placing us with already
existing organizations or agencies provides a
structure which is essential at least in the
early stages. One must also consider that the
Lower East Side is a highly sophisticated and
well organized community in many ways, and
that for SHP to become merely another sepa-
rate organization is a poor idea.

Many of us were also frustrated by the lack
of unity within the group. Perhaps it is unreal-
istic to think that twenty students plus Neigh-
borhood Youth Corps teenagers could be ex-
pected to work together as a team. Perhaps if
students were required to live in the commun-
ity and to become involved in as many aspects
of community life as possible, there would be
more community concern over health care in
the broadest sense. By this I mean that we
should be concerned with all aspects relating
to and influencing health care. One of the most
valuable experiences I had was door-to-door
work. Health care is a basic and nonthreaten-
ing subject which can serve as an “in” into the
family setting. Once into a home, we could dis-
cuss other areas, such as housing or education,
with individual families and try to help the
family in whatever ways we could. It is
more of an overall understanding of the many
factors influencing health. It is for this reason
that I feel that future SHP workers should at
least experience, first-hand, neighborhood and
family settings.—L.C., Nursing Student Lower
East Side.
SUMMER 1968

There was no feeling of an SHP structure
this summer, either on a citywide or a neigh-
borhood level. There was only the SHP name,
and it interfered with our work. We were sup-
posed to feel allegiance to an organization that
barely existed as such. The whole Lower East
Side SHP met together once a week, mainly to
criticize each other’s work. These discussions
were not very constructive, because none of us
knew enough about each other’s work to make
meaningful judgements or suggestions. The
meetings became a kind of free-for-all in which
one found oneself either attacking or defending.
The only goals pronounced by the Lower East
Side SHP were goals that each one of us, as in-
dividuals, had: to sensitize ourselves to the
needs, problems, and attitudes of the commun-
ity, and to produce some meaningful, immedi-

ate contribution to the community.—M.H., ©

Law Student, Lower East Side.

I think the Lower East Side had several
problems. First, each of the several separate
projects seemed isolated from the others, ex-
cept for infrequent progress reports. Second,
there existed an atmosphere of tension among
the student fellows. As well-expressed by one
student, “I don’t think we really want to get to
know each other.” I feel there is a place for
SHP on the Lower East Side next summer, but
in view of this summer’s events, it should be
better structured. Each student fellow should
be made aware, before being accepted, that he
is taking on a full-time job, not a nine-to-five
responsibility. If a student has other obliga-
tions, he must either adjust them so they do
not conflict with SHP activities, or not work
on the project.

All SHP members should live in the com-
munity in which they ‘will work, preferably
nearby or together. This would help improve
interpersonal relations—we would get to know
each other better and be more cognizant of
what each other was doing. There should be a
store-front which not only serves as a meeting
place for SHP, but which offers some service to
the community.

If people in the community want informa-
tion about health care, housing, etc., we should
be able to offer‘it or direct them to the proper

sources, Also, I think that there should be two
student co-directors for each project area, so
that they can share the responsibilities and
lend greater objecfivity in handling all mat-
ters. Finally, I think more concrete community
job placements should be made. I think more
of an effort should be directed towards work-
ing within specific community organizations;
we have learned, maybe the hard way, that
community structure does exist.—L.G., Psy-
chology Student, Lower East Side.

Newark

Project structure was not deficient in any
way that I noticed. I thought the lack of struc-
ture in our Newark project was very beneficial
as it allowed people to gravitate to or seize
upon that which they liked best and thought
would be most beneficial. The only place where
lack of structure was really detrimental was in
the case of the NYC’s who often sat around
doing nothing until the last couple weeks of the
project when, I suspect, the guys, at least,
didn’t show up at all—N.W., Law Student,
Newark.

The local project is basically a great idea.
We maintained our integrity as a group and
were able to coordinte our efforts in several
areas. We were able to put our heads together
nearly every day. We all worked out of our
UCC office space. It facilitated communication ©
and kept morale higher than it would have
been if we were separated. When we met with
hospital personnel we had at least 15 to 20 peo-
ple there. The benefits of a cohesive group are
many when operating in a resistive environ-
ment. I think people had more confidence and a
large fund of ideas and opinions were availa-
ble. We stimulated each other.—A.H., Medical
Student, Newark.

The structure of the project should have
been more carefully laid out and adhered to. I
went to Newark expecting to work as a nurse
in a clinic, in a storefront, in the emergency
room, anyplace; I wound up painting signs and
not at all utilizing the one sure. skill I have. I
recognize some degree of unpredictability is in-
evitable, but we were almost totally without
structure in pursuing the vanishing hope of

105
GREATER NEW YORK

“Improved Medical Care.” Several different
groups evolved, divided along racial lines, and
pursued what they thought was the goal of the
_ project. This might even have been acceptable

if there had been some coordination, some feel-
ing of unity. There was not much among the
factions, just a sort of palid coexistence.—
A.M., Nursing Student, Newark.

Bronx

In addition to problems with cohesiveness
and communications, there were difficulties
with job descriptions. This seemed particularly
evident in the Bronx unwed mothers’ program.
The community workers seemed the most con-
fused. Since this is the first summer that there
have been community workers, it is under-
standable that there was some confusion. An-
other reason for confusion was poor orienta-
tion.

One of the roles which I thought needed
clearer definition was that of the project coor-
dinator. I see the project coordinator as a per-
son who spends a lot of time visiting the vari-
ous programs in the projects and setting up a
rapport between institutions and community
groups. Our coordinator spent most of her
time in the office, and I think she would have
been of better assistance if she would have
spent more time in the community. She also be-
came too much of a director instead of a con-
sultant. She seemed afraid to delegate respon-
sibility which inhibited our making plans and
decisions on our own.—V.V., Nursing Student,
Bronx.

Harlem

Concerning the structure of the Harlem pro-
ject, one important thing was overlooked. The
students who organized it wanted a loosely
structured organization with abstract duties
and responsibilities taken on by the individuals
themselves, with no real power structure. This
would have been fine if the organization had
consisted only of students, but in dealing with
members of the community we were made

aware that they demanded much more of a .

structure. They wanted to know who the
leaders were, what everyone’s duties were, and
to whom they were responsible.

106

As far as the leadership is concerned, I feel
that a better system might have been the ap-
pointment of provisional coordinators and Cen-
tral Office staff, and after the groups had be-
come acquainted with each other, elections
could have been held, giving somewhat of a
democratic structure to the “governing” body.
—J.A., Medical Student, Harlem.

Although some of the nonhealth science stu-
dents didn’t get properly integrated into the
group right away because the whole thing was
so unstructured, I think the Harlem group had
the least group interaction problems of all the
projects. I don’t think the inter-disciplinary
team question every really arose. We worked
together as individuals—not “professionals”
—and since the mothers were adults rather
than NYCs, there was never a question of con-
descension between students and community
people. Some of us at first (myself included)
were condescending toward some of the non-
health science students because we felt that
they didn’t really care enough, but after the
air was cleared on that I think things worked
well.

I think it was especially important that we
all worked out of the same house. We were
able to maintain a much better group sense
than some of the other projects that were
spread around in different agencies, and we
were all able to keep sufficiently in touch with
what everyone was doing so that we could lend
a hand when necessary. Because people were
always in touch, we didn’t have the typical
kinds of confrontation or sensitivity sessions

_ (that some people think are essential in SHP

projects) because things often got talked out in
small bull sessions before matters came to a
head: There was a disadvantage to this, how-
ever, in that some things concerning the phi-
losophy of what we were doing and how we
were going about it didn’t surface until the
end.—W.S., Medical Student, Harlem.

Brooklyn

I feel that there were too many small groups
in the Brooklyn area, and that in the future
these small groups should be incorporated into |
larger area priority groups which need man-
SUMMER 1968

power, or have people “float” from group to
group as each group needs extra help for spe-
cific projects, ¢eg., the lead poisoning cam-
paign. I would like to see an area such as
Brooklyn develop one or two priority goals and
spend the entire summer developing these
ideas and then wind up with a concrete plan,
proposal, mass meeting, etc., so that these
ideas can be carried on by other than SHP peo-
ple—S.P., Dental Student, Brooklyn.

FUNDING

The structure of an organization can often
make for success or lack of success of its activ-
ities; there were many elements of this sum-
mer’s SHP which I felt limited one’s ability to
act effectively. By “structure” I mean any deci-
sion which is made regarding how the project
is to be run, who will run it, etc, Thus, any lack
of organization is part of the structure of the
SHP.

The first bad decision made was for the stu-
dents to be funded by a Government agency.
This put us in the position of another group
vying for funds to “help the poor people,” and
immediately set us apart as a group who was
being paid to be in a poor community. It was at
least fortunate that we did not get funds from
OEO, as we might then have been taking
money from other groups composed more of
grassroots people. Our advantage in getting
funds would have been that we were mostly
middle class people with a good idea rather
than community people trying to get money to
increase power over their own lives.

Another problem that goes along with writ-
ing up a grant for government funds is that we
become responsible to the funding agent, and
are no longer answerable strictly to the com-
munity. Several instances have come up where
it was necessary to consult our funding agency
as to whether or not we could undertake a spe-
cific project recommended by community con-
sultants, or whether or not we could use funds
for various purposes not outlined in the grant.
This limits the degree to which we may use re-
sources given us through funding.

There is also a problem inherent in writing
up a proposal for Government approval in that
we begin to think in terms of a task that must

be fulfilled. It is good to sit down and plan
what we are going to do; but it is unrealistic
for people with little knowledge of what it is
possible to accomplish in one summer to. sit
down and write something up in order to get
funded. What they write up may often have
little relevance to what they actually - do.
They then begin to feel that they are not
fulfilling their jobs and they have the tendency
either to get upset or to work harder towards
their original goals, without sitting down to
evaluate whether or not their goals are realis-
tic. What I am trying to say is that people with
comparatively little experience should not ex-
pect themselves to accomplish very much in
two months. When they write up some impres-
sive goals they soon begin to expect themselves
to accomplish these goals and are not as flexible
as they otherwise might have been, I feel that
students should first familiarize themselves with
their community and then have tasks outlined
by responsible community groups. It should be
up to these groups to decide whether or not the
students are performing effectively ; this is hard
to do if a proposal is on file with a Government
agency that is paying and therefore ultimately

controls the students whether they like it or

not.

While we’re on the subject of money, which
after all is what separates rich people from
poor people, I feel that all salaries were too
high this summer. This prevents effective ac-
tion for several reasons. First, community peo-
ple tend to be suspicious of white middle-class
students who are paid a very high salary to
enter their community. There is very little that
a student can actually do in two months and
this increases hard feelings towards students
who “aren’t doing anything.” It is bad enough
when people ask, “What are those students
doing, anyway?” But it is much worse when it
is discovered what their salary is. I feel that it
was similarly wrong to pay community co-
directors and workers such a high salary. It is
commonly known that one of the best ways for
bright community people to get ahead is
through one of the antipoverty agencies, which
actively seek community people as partici-
pants, but not as administrators. I think that

107
GREATER

this system creates resentment among the rest
of the community which is “left behind,” and
tends to separate good leaders from their com-
munities. I feel that all workers on the project
should be paid the same subsistence salary. In
this way it can be seen that the students are
not in the community for the money, but be-
cause they really care. And community people
will not be reluctant to work with us for fear
of being resented by their fellow community
members for sticking with the white people to
get high pay.

It has become evident that with our present
personnel and structure it is impossible to ac-
complish the things we had hoped to do. As
long as people are here for money, and are res-
ponsible to some superstructure which rewards
or punishes them for their actions with a sa-
lary, they cannot honestly tell people they are
here because they care about them. It seems to
me that the same setup that denies people
down here many opportunities (including the
opportunity for good health care) is the set up
which gives us a more than equal chance to get
a good education, good pay, become doctors,
ete.

If we want to correct this situation as it per-
tains to health care, we must present ourselves
as concerned individuals who recognize that
our advantages are the other side of the coin of
others’ disadvantages. If SHO fellows continue
to benefit from this system by being paid a
large salary for “helping’ the poor people,
‘they are propagating the very set of inequali-
ties they want to destroy. They therefore must
decide to reject the beriefits and make some
sort of personal sacrifice, in order to be free to
see other people’s situations, and to be free to
talk to them as people. I realize that my ideas
are hard to explain in words, but I do feel
strongly that this way of conceptualizing is ap-
propriate, and we must learn to conceptualize.
I don’t want to put across a sense of “guilt”—
just a recognition of our position. As members
of the SHO, paid $900 by a Government
agency, we are limited by being representa-
tives of a bad structure. We are distrusted by
the people we wish to reach.

A final problem in this area was that the

108

NEW YORK

NYC’s were paid by a different organiza-
tion, which added another voice, at least poten-
tially, as to what could be done during the
summer, Also, the NYC’s should be paid the
same salary as everyone else. Otherwise our
talk about being colleagues and being equals,
and the students’ not being the NYCs’ bosses,
is nonsense. The argument is sometimes raised
that the NYCs are younger and don’t have the
same educational and job experience. If this
is valid, then students should be paid less than
community workers who are twice their age. If
the argument about education is valid then we
are building inequality into our project, for
many poor and nonwhite people are denied a
chance to compete with white middle class
people on the basis of not having had enough
education; furthermore, they are consistently
denied the chance for a good education. If we
didn’t learn that this summer, we may as well
not come back. A project designed to overcome
inequalities should put all its members on an
equal basis, answerable equally to one another.
All of us should be colleagues, each with some-
thing different, and something valuable, to
offer for the common good. We must set one
standard for all of us to live up to, so that we
all finish the race at the same time, not some
of us ahead and others behind.—Student Co-
ordinator, Lower East Side.

One ongoing argument that we have had in
the Lower East Side project has centered
around the money that we have been paid this. .
summer as a major factor in the loose, unstruc-
tured, and often unsuccessful project. In my
opinion, the fact that we have been paid for
our work has little to do with how well our
project proceeded.

* * * The other argument made about our
earning so much and the NYC’s earning too
little has also bothered me. The NYC’s are
young people, and when we were their age it
was also difficult for us to earn. The fact is
that we are not the equals of the NYC’s in just
about every way, and the concept of treating
them as if they were our equals has seemed to
be one of the greatest farces. It is one thing to
respect someone’s opinion and to give them an
equal opportunity to express themselves; but it”

 
SUMMER 1968

is another to expect the same maturity and the
same concentration from considerably younger
people,—P.5S., Medical Student, Lower East
Side.

My suggestion is that student fellows should
start at $60 per week, serve a probationary pe-
riod of five weeks, and after evaluation by the
staff and community workers, as well as area
coordinators, be given salary raises computed to
pring their total summer’s earnings to the allo-
cated $900. It is a hell of a bad situation not to
be able to control the miserable rabble who de-
cide that student health project is an easy way
to make money for the summer. Before I be-
came involved with SHO a nursing student
said to me that “Student Health is a good
way to earn $900 doing nothing!” Every effort
must be made to eradicate this idea and up-
root this attitude if the job is to be approached
with the honesty and dedication it needs and
deserves. There must be a method or device
for firing people.—B.B., Student Coordinator,
Bronx.

SHO should strive for joint-funding with
community agencies such as LABOR and plan
a project based on the twin issues of health
and housing. SHP should also get funding
from foundations to begin work on changing
the institutions that project fellows come from,
specifically continuing programs to get ghetto
residents into professional gchools.—K.B., Med-
ical School, Bronz.

STUDENT FELLOW SELECTION

In late April 1968, twelve or so students
from the five Greater New York areas met and
read all of the 300 applications received. We
agreed to accept as many black students as we
could, and accepted all the applicants from
Howard and Meharry medical schools. Jroni-
cally, as a recruitment device for black stu-
dents, this did not work 100 percent. Two out
of seven such students were white. We also ac-
cepted all other people who indicated that they
were black or Puerto Rican. The students from
the five areas were very concerned about conti-
nuity after the summer, so they were asked to
draw up lists of students they wanted to “re.
serve”. (Subsequently this proved to be a

bogus play because the one area that com-
plained the most about needing their own stu-
dents developed the least potential for com-
munity projects.) Approximately half of the
project participants were on the “reserve list”.

Applications of out-of-city students and non-
reserve New York City students were read by
groups of our students and rated highly desira-
ble, acceptable, and undesirable. The distillate
of these applications (the “highly desirable”
group) was read to the entire group and rated.
The highest scorers were phoned and asked to
come to New York. Not all of these applicants
accepted so the lower scorers were called and
subsequently the “acceptable” group of appli-
cations was delved into.—S.G., Education Di-
rector.

Interview

Someone told me the other day that the SHO
doesn’t rehire the same students each year,
they have some policy where they want to give
everyone a chance to come and see what com-
munity medicine should involve. That’s stupid,
because the first time the medical students are
here they go through a lot of changes, a lot of
hangups, annoy a lot of people, and it may take
them a long time to get straightened out. But
after they’ve reached that point, if you don’t
bring them back again, you’re making a mis-
take. The new students have to start from
scratch all over again. If you brought the expe-
rienced ones back, they wouldn’t have all these
hangups as to the black-white issue, and they
would know what they could do, and start im-
mediately doing it.

This policy indicates the student health or-
ganization’s orientation to this thing. They
want students to learn about black people—
which would be for their penefit. And it would
make them feel good that they had done a little
something to help the cause, and these kids are
supposed to go back and stir up other students
in their medical school. But that’s a pile of
rubbish because there’s thousands more white

- medical students who hhaven’t got the least in-

terest in coming here. And even if all of them
had a chance to come here for the summer,
first of all they don’t have to live like the peo-
ple live here. They may be able to sympathize

‘109
GREATER NEW YORK

with these people, having seen the conditions
and what people have to go through, but if you
don’t come back again, if you don’t stay, it’s a
waste, All you do is understand the problems,
maybe, and you can go and talk to your friends
about them, verbalize the problems, but you
won't be able to do anything.

I would say, based on one summer’s experi-
ence, that I don’t think SHO is useful in the
long run. Take these white people that work
here in the summer, or work here all year
round, like these hospital people; they’re here
with this problem all the time, and they still
offer bad medical service. They haven’t learned
a damn thing. As a matter of fact, they’re the
ones who’re responsible for the bad service.

So you bring some white kids in here, and
they’re going to see a few things. But when
they go back to school they’re going to start
studying, they’re going to fall for the set-up
which was already set out for them, and
they’re going to say, “Well, I had the experi-
ence.” But they won’t be able to do anything
about it.

What SHO should do is see about getting
programs for black people which will be black
run. One of the first things I noticed when I
came in here was that we need some more
black people in this thing. —R.P., Community
Coordinator, Newark.

Hiring: Not fair to ignore rejected applica-
tions when first choices decide on other em-
ployment. We hired one student about one
month into the project. He was the nephew of
Dr. Important. This guy did little, said noth-
ing, and was rarely seen.

Firing: In a project such as ours every free-
dom should be given; an atmosphere of confi-
dence and optimism is essential for any cre-
ative unfolding. People should never be fired
for failing, only not working, for not doing
anything. If complaints are made against a
member, the policy council should consider the
complaints and vote to drop the complaint, or
warn the individual in question, or request the
individual to appear and explain his position.
Where or how someone is working is irrelevant
—only if he is working —A.H., Medical Stu-
dent, Newark. —

110

I wish to take issue with the composition of
SHP. I sincerely wish to register a strong pro-
test. Here are my feelings and recommenda-
tions: I think project composition should be as
close to 100 percent black students as possible.
At this point in black history in this country,
black people need black leadership to give
them any meaningful stimulation and incen-
tive. In a situation where conditions are So ex-
treme and time so short, the time spent batter-
ing down the color barrier between yourselves
and that community is too dear —A.M., Nurs-
ing Student, Newark. ;

I think SHP might work next summer if
project members are selected differently. There
must be more community people in the project.
There should be at least one adult community
worker to every health science student and
NYC. In selecting applicants, students from
the surrounding area should be given first
priority so that SHP can be a continuing thing.
Students should not be selected on the basis of
an essay on “why I should be a member of the
project.” Every applicant should have a per-
sonal interview before final selection.

Selection of members for the project should
not be so final that once you're in, you’re in for
good. Members who do not want to work with
and for the project should be fired and re-
placed. It’s fine and dandy if members want to
do their “own thing” but they must also spend
a major part of their time with the entire pro-
ject on a united effort to improve health care.
Doing your “own thing” may help to make
small improvements and give you personal sat-
isfaction, but no massive changes are going to
occur unless the project members unite their
efforts.—L.D., Nursing Student, Newark.

There is a definite need for some changes in
policy so that SHP of 1969, if existent, can
function more effectively with less wasted
money and energy. There should be a hiring
policy that attempts to accept only those who
are sincere to the cause. Interviews would seem
to be more revealing (than essays) and perhaps
interviews with a member of the specific com-
munity who is working on the project would be
most productive. .

A firing policy should also exist to rid the

 
SUMMER 1968

project of any phony liberals who are goofing
off or just there to exploit the community for
their own gains.—K.S., Nursing Student, New-
ark.

The students who were assigned to this pro-
ject, with the exception of a few, should not
have been included in a program of this na-
ture. Some of them came into the community
only for personal advancement; the narrow-
ness of their motivation limited the effective-
ness of their work. Two students in particular
caused me great concern. They needed constant
direction, not only about what to do, but how
to do it, and at the end of ten weeks were just
beginning to show anything that could be
called initiative and creativity. A short-term
project suffers when it is staffed with liabili-
ties.

Medical people who are usually far removed
from grassroots community work need to be
sensitized and attuned to the problems of the
urban poor areas, but not at the expense of the
community they profess to serve. A 10-week
program cannot sustain the inconvenience of
being burdened with out-of-state students who
have to be taught how to communicate before
they can operate effectively. Students who come
lacking skills in contact with the urban poor
should come in as volunteers in order to learn,
not as paid personnel in order to experiment.
The experience they gain is pay in itself, for
they certainly get more out of the exposure
than they can possibly contribute.

Next summer if there is a project, students
and community people who worked effectively
this summer should be given priority when
staffing begins. A project of this sort can func-
tion more effectively if the same people com-
bine their efforts to identify the causes for fail-
ure and the reasons for success and make con-
crete plans to restructure the program.—B.B.,
Student Coordinator, Bronx.

From the experiences and observations of
this summer, I do not feel that there should be
another SHP like this summer’s. Any health
professional student not having a good deal of
involvement in the community doesn’t have
any business in the community. Such students
only hinder and screw up the projects and

for some of them to realize what’s happening
goals. After all, it takes over half the summer
for some of them to realize what’s happening
in the community. The others never know. I
feel that only students having at least a full
year’s experiences in a community can go and
work there during the summer. Students who
want to become aware of community health
and needs can learn initially through seminars
and discussion workshops outside of the com-
munity in their schools. Those who are still
more concerned can apply for part-time jobs
during the summer with a community agency.
They would then be under the responsibility
and authority of that agency. I would never
like to see another SHP go into a community
area where very few of the fellows personally
know what the hell to do and when to do it.—
G.L., Dental Student, Lower East Side.

For next summer, it is important that the
SHP attempt to bring back people with experi-
ence in community health in the areas they are
located. A single summer on the Lower East
Side is no more than an introduction to the
problems of health care in this community. It
is on-the-job. training in community health,
with an emphasis on the training, not on the
job. Involving students in programs this win-
ter, or having them return to the SHP next
summer, will enable students to use what they
have learned for the benefit of the community.
If this is not done, the summer will have been,
in the words of the black caucus, “two months
in the sun seeing how the niggers live.”—J.A.,
Medical Student, Lower East Side. ,

The majority of the students chosen for the -
SHP should be from the area in which they
will work in order to insure a transition staff
for year-round work. Allowances should be
made where necessary to preserve the interdis-
ciplinary approach. New students should not
have to go through some of the basic. orienta-
tion for half of the summer in the areas where
projects have already existed. Structured. dis-
cussions and seminars with experienced
workers are suggested to help prepare them. It
is advisable that the project be planned.so as
not to require needless repetition at the ex-
pense of the community.—L.K., Medical Stu-
dent, Brooklyn. S a

111
GREATER NEW YORK

INTERDISCIPLINARY TEAM

-[T found that working with students from all
different fields was a very worthwhile experi-
ence. Each of the fellows had something
unique to offer the project. The interdisci-
plinary team at Kings County Hospital worked
very well together and used the combined tal-
ents of the members, with their individual con-
tributions, to a great extent—D.Y., Medical
Student, Brooklyn.

The concept of an interdisciplinary team is a
sound one and in practice is both stimulating
and enlightening. The availability of legal ad-
vice was helpful on several occasions, and edu-
cational. In the lead poisoning project and at
the hospital-based projects, nursing, dental,
and social work students, with their different
outlooks and approaches, complimented each
other.—L.K., Medical Student, Brooklyn.

This aspect of the project was one of the
most valuable factors for the success of the
project. I felt, as a sociology student with a
background in education, that I contributed
much towards making my colleagues more
aware of the importance of role relationships
and informal organization in the hospital—
M.H., Sociology Student, Brooklyn.

The medical students whom I worked with
were quite understanding and easy to get along
with. Anything which I thought would arouse
any difficulty, I directed to the students I
worked with, and they’d explain it to me until
I was able to comprehend and direct it back to
them. They treated us as equals to them, and I
grew to respect them for it—LJ., NYC,
Brooklyn.

The interdisciplinary team was helpful as it
brought together a variety of skills and out-
looks that helped in solving or at least recog-
nizing causes of problems. An example is the
highly charged atmosphere of the emergency
room where people were often treated as some-
thing less than people. One student had a Mas-
ter’s degree in psychology and recognized that
- jt was the tension of their work which caused
many of the employees in the emergency room
to occasionally treat people without dignity. He

112

and two nursing students were familiar with
the technique of group catharsis whereby per-
sons who-work together under tension can get
together for an hour a week after work to dis-
cuss all their likes and dislikes about each
other and their work. Properly conducted, such
a session can act as a real help in reducing
friction in their work.—N.W., Law Student,
Newark.

The interdisciplinary team is a good
thought, but relatively meaningless once put
into operation. Personality problems can occur
anywhere in the team. Having a law student
on hand is worthless unless the student is al-
ready familiar with urban politics and law. In
the case of the city of Newark, the “team”
loses even more relevance. People on the un-
dergraduate level could function just as well,
They would spend less of their time trying to
use clinical procedure; they wouldn’t use the
project as hustle for medical or dental schoo!.—
R.P., Community Coordinator, Newark.

I think the biggest problem among the
health science students was lack of communi-
cation. Some of the health science students I
barely saw all summer. I had vague ideas what
they were doing, but did not know how, if at
all, we could be of help to each other. Many
times I felt there were hard feelings among
the health science students and we were unable
to communicate these feelings to each other.
Many times a lot of people did a lot of talking
and no one did any listening. I think the inabil-
ity to listen on the part of many of the health
science students created the big communication
problem. A weekly sensitivity session might
have helped this problem. By sensitivity ses-
sions, I do not mean a meeting where people
give their philosophies of life, tell about their
general gripes and throw a bunch of vague
nonsense at each other. By sensitivity, I mean
the group should sit down together and express
specific feelings about the project, ‘individuals,
their work, and problems they’ve encountered.
This requires not only the ability to express
your feelings freely, but also the ability to lis-
ten to others express their feelings.—L.D.,
Nursing Student, Newark.
SUMMER 1968

My “working” relationship with our law
student was not profitable. I could not seem to
fit his work in with anything I was doing. I en-
countered a patient who had fallen downstairs
in her apartment building for the second time
and hurt her back because the landlord would
not fix the stairs. I thought the law student
might be interested in the case, but he seemed
to think there was nothing he could do about
it.

I think the other project members were able
to use me when they came up with a problem
concerning prenatal care, postpartem care,
birth control, or anything else related to nurs-
ing —L.D., Nursing Student, Newark.

My contact with the three medical students
working on this project was constructive and
very enjoyable. I picked up much of the needed
medical background on lead poisoning from
them. This project was, of course, particularly
well suited for interdisciplinary work. My ex-
periences with our NYCs were scanty, since
they were almost totally utilized for the medi-
cal screening program. I liked what I did see
of the high school students, more or less in
passing. In short, relationships within the pro-
ject seemed very good, and I feel that we’ve
gotten quite a bit done with sufficient interac-
tion but a minimum of mutual interference.
AK., Law Student, Bronx.

I think that working with the various disci-
plines was a good experience but one handled
in a haphazard way. If some organized way of
displaying the “uniqueness” of each discipline
in alleviating health problems and establishing
total health care were available, I would have
felt elated. Nevertheless, the nursing students
found out what makes medical students tick,
and vice versa.—J.C., Medical Student, Lower
East Side.

I found that the students I worked with had
a disturbingly little amount of initiative, en-
thusiasm, or devotion to accomplishment of our
goal. To too many of us, the project was just
a job, and that accounts for at least some of
our failures to accomplish our goals in and for
the community.—M.H., Nursing Student,
Lower East Side.

It’s a funny thing about the interdisci-
plinary team, We nurses are-very touchy crea-
tures about getting stepped on by doctors, and
often, since we are very dedicated to the idea
of the “team”, get very up-in-arms about doc-
tors’ attitudes. At the beginning of the summer
before we started working, before we knew one
another, the situation was very tense, but once
work progressed, except for the “norma ” jok-
ing, we worked as one group, not as students of
nursing or students of medicine. We did make
one mistake; because we worked as health sci-
ence students I wasn’t always cognizant of the
different disciplines, so when my group was
having some difficulties on a legal matter, we
never thought to consult the law students
among us. We really didn’t make the best use
of our team.—J.L., Nursing Student, Lower
East Side.

The interdisciplinary team really did not
exist over the summer. None of us worked in
any kind of professional capacity. Whatever I
did, a nursing student or a law student could
have done. It was a good experience for the
various health professional students to work
together, though I don’t think that it was as
necessary as finding competent people to work
on the project.

* * * One fault of some of the people on our
project has been that they have not made an
effort to work well with everyone, but rather
they desire and seek the advice of their close
friends. It seems to me that one doesn’t have to
be best of friends with someone to work well
with him and to respect him. Being in the SHO
has always seemed like being in a kind of
clique, especially at NYU. I believe that the at-
titudes that many of the students have devel-
oped over the summer of not caring and of
feeling left out are derived from the “in” or
“out” feelings that are so clear on our project.
—P.S., Medical Student, Lower East Side.

Overall, my feeling for my colleagues was
one of high respect. I have never been asso-
ciated with any project in which I personally
liked and admired so many of the people con-
nected with it. They impressed me as an intel-
ligent, dedicated group whose frustrations
were not the result of any inner shortcomings

113
GREATER NEW YORK

but rather due to external factors. (There were
people here, however, that I felt should have
been fired, not only because they were not
really doing anything, but because they were a
demoralizing influence on others in the pro-
ject.)

The interdisciplinary team was a very good
idea as far as interaction goes. I don’t know
what positive aid this was to the community,
but I felt that I personally gained something
from being involved in it. The real problem is

114

that the work is reduced to the lowest common
denominator so that everyone can do the work.
Therefore, I don’t feel that the project capital-
ized on the individual talents of the partici-
pants. In the long run, however, I think that it
is difficult to overestimate the positive effect of
this interdisciplinary team approach. Profes-
sionals are so impressed with and caught up in
their own world that any contact with those
outside that world is a. benefit to all—F.V.,
Law Student, Harlem.
Part 5: EVALUATION

INTRODUCTION

During the summer of 1967, slightly over
fifty medical health science students partici-
pated in the Student Health Project of the
South Bronx, a federally financed summer pro-
gram designed to involve students in the
health problems of a Negro and Puerto Rican
poverty area in New York City. Almost every
member of the 1967 project finished the sum-
mer with a smile—students, faculty, and eval-
uator.1 Thus, it was not surprising that dur-
ing the fall and winter of 1967 considerable ef-
fort was spent by students and faculty in se-
curing funds for a “bigger and better” student
project for the summer of 1968. These efforts
were rewarded with success, as approximately
$200,000 was granted by the Division of
Regional Medical Programs of the U.S. De-
partment of Health, Education, and Welfare
for a 1968 summer project.

The 1968 Student Health Project of Greater
New York consisted of five separate projects:
the South Bronx, Harlem, the Lower East Side
of Manhattan, the Bedford-Stuyvesant,
Crown-Heights, and Brownsville sections of
Brooklyn, and the Negro slums of Newark,
New Jersey. In structure, each was modeled on
the previous summer’s Bronx project pattern
of placing students in diverse settings and al-
lowing them considerable flexibility to pursue
(or not pursue) their interests. Thus, the stu-
dents worked on such varied programs as men-
tal retardation, narcotics addition, illegitimacy
and unwed mothers, hospital services and pa-
tient advocacy, medical services for school chil-
dren, and various community action programs
for health care improvement. Not only did
they work in traditional health settings (hos-
pitals, clinics, doctors’ offices), but they also
worked out in the community, with action

groups interested in health care problems. In
essence, the only common ingredient in the pot
pourri of student activities was health—de-
fined broadly enough to include the social and
political interests of ghetto inhabitants.

The major focus of this evaluation will be to

‘document the primary sources of satisfaction

and dissatisfaction with the project (other
than administrative problems) and to offer
some explanations for the change from a to-
tally satisfactory experience in 1967 to the
somewhat less satisfactory experience of 1968.
Most of the following discussion is based upon
self-completed questionnaires given to the 1968
project student participants immediately be-
fore the project began in late June 1968, and
then again during the final conference held at
the end of August. Interviews with project
personnel during the summer also contributed
to this evaluation report.

The Student Fellows

Table 1 below indicates the disciplines and
backgrounds of the seventy-six (76) students
who responded to both the June and August
questionnaires.? Clearly, the majority of stu-
dent fellows come from health science schools
in the New York City area, and from white
middle and upper class backgrounds. The stu-
dents were not, however, without experience
with poor patients before the summer program
began, although wide variation existed in this
respect also. Thus, thirty-nine percent (39%)

+See Ronald Miller, “The Project Evaluated,” The Student Health
Project of the South Bronz: Summer 1967, eds. Stan Fisch and
Jody Williams, privately published under a grant from the Office
of Economic Opportunity, pp. 181-97.

2In general, the responses of these 76 students reflected almost
perfectly the responses of the 99 who responded to the first ques-
tionnaire. Appendix I contains comparisons of the respondents who
answered both and those who only answered the first, and shows
minor differences. Attitudinal and information comparisons (not
shown) also indicated similarity of responses. Thus, it is felt that
the analysis based upon these seventy-six respondents can be gen-
eralized to the total project membership. ,

115
GREATER NEW YORK

had no experience or just a little bit, twen-
ty-nine percent (29%) had had some experi-
ence, and thirty-one percent (31%) had had a

good deal or a great deal of experience with

poor patients before the summer program

began.

’ Table 1.—Student backgrounds.

Discipline % Religion %
Medicine __________.-- 54 Protestant .....
Nursing -.--_.-------- 24 Catholic _....-.
Dentistry ......-.-.-- 7 Jewish __-_-__--
Law ..-__------------ 9 Other .......__.
Social work,

Sociology _-.-------- 4 None .-.--__---
Other _...._--.._----. 3 No response -..-

Total .....-.-.-.--- 100 Total _...--

Race Sex

Caueasian _.....-.... 82 Male _.........
Spanish __._....--.-- 3 Female _....---
Negro __..---.--_--- 12
Other _..._.2.-22 _-_ 3

Total _......_._._- 100 Total ______-.

Family income %
aeons 17 Under $5,000 yr. -.-- 5
wo-ee 29 $5,000-$ 9,999 __._.. 26
woe 42 $10,000-$14,000 ...... 29
weeee 5 $15,000-$19,999 .. .. 9
weeee 5 $20,000 and over ..-- 26
wane 1 No response ..------ 4
a 100 Total _._......----100
School
weeee 100 New York City area .. 67
a 41 Non-New York area ._ 33
aeons 100 Total .__.....-------100

3 While percentages may not add to 100% because of rounding in these and subsequent tables, totals are always reported as 100 percent. All

1968 table percentages are based upon 76 respondents.

Finally, the students had different reasons for
joining the 1968 project (table 2). Given this
divergence in student backgrounds, experience,
and expectations, a major problem of the pro-
ject’s student leaders was to organize the pro-
ject to satisfy the desires and expectations of
all student project members.

Table 2.—Reason students joined 1968 project.

Percent giving reason
Reason joined in June 1968
To help initiate and continue

political action for social

change in a poverty area ___.____-.---------- 28
To help poor people get better .
medical care ___..._...--------------..------ 42
To learn about the health problems of the poor _-._ 28
To learn about disease, health and
medical care during the summer __..__._...... 1
No response .....__._.--. 2 nai ee eee eee 1
Total _...__.-2------------------- eee eee 100

The Project as an Educational Exper-
ience

The educational aspect of the summer pro-
ject, the sensitization of students to the health
care problems of ghetto residents, was a prime
consideration in the development of the pro-
ject, The project was viewed, in effect as a con-
tinuation of the student’s professional educa-
tion, although qualitatively different in the
process of learning. In order to measure this
learning experience, the potential educational
content of a course in community medicine was

116

divided into 31 subareas after discussions with
both faculty and students. Student fellows
were asked in late June and then again in Au-
gust to indicate how much they knew (almost
nothing, a little bit, some, a good deal, a great
deal) about each of the items. As table 3 indi-
cates for a selected sample of these informa-
tion areas, the students learned a great deal
during the summer.‘

For example, while only fourteen percent
(14%) of the students said that they knew a
good deal or a great deal about the organiza-
tion of health services for the poor at the be-
ginning of the summer, seventy-two percent
(72%) said they. knew that much at the end of
the summer. While similar results were ob-
tained for most of the information areas, a few
showed almost no improvement in knowledge.
Two of them, cancer and heart disease among
the poor, were the two major areas of interest
to the Regional Medical Programs Division, the
agency which granted the project funds. ~~

Thus, in almost every one of these areas
(with the exceptions noted) a definite increase
in student knowledge was evident. Table 4

‘The other areas which are not shown but generally also indicate
increased knowledge are malnutrition, (Bex education among teen-
agers, lead poisoning, prenatal care, pediatric care, geriatric. care,
dental care, educational problems, family-domestic problems, folk
medicine, Medicare and Medicaid, organization and problems of city

hospitals, new innovations in health care, and new health careers
for non-professionals, ,
SUMMER 1968

summarizes this increase in knowledge by the
students as it combines all 31 areas into an in-
formation index.’

Table 3.—Student learning experience during the summer.

Percent saying they know
a@ good or great deal

Area of Knowledge About the Poor about each area

June 1968 August 1968

Organization of health services __._14 12
Quantity of health care received .._.22 76
Quality of health care received _--.._- 30 74
What professional practice is like

for poor --__-..--_-.------------ 12 41
Narcotics and drug problems .. ---- 33 61
Birth control _........2--.------- 29 54
Illegitimacy and unwed mothers ....29 | 47
Welfare services __......--......--- 26 50
Rat bites ...._.....--00-.-------- 16 25
Housing conditions _.........------ 47 80
Job problems _............------.-- 37 61
Community attitudes toward health

problems __.__-..-...-2.-------- 17 66
Community groups concerned with

health problems ...-. ...-..- _...17 65
Mental illness _.....:..._..- a 20 25
Mental retardation _.._..._._.__.-- 10 17
Cancer _....___-2 2-21 eee 8 7
Heart Disease __........._-...---- 9 9

5 The information index was constructed by giving arbitrary scores
of 1,2,3,4,6 to the five information response response categories
noted in the text. The total score for each respondent on the 31
items was then classified as either low (scores under 80), medium
(80-99), or high (scores over 100). No responses were counted as 3;
if there were more than two no responses, the respondent was
classified as no response.

Table 4.—Information index June and August, 1968.

Information Index Score June 1968 August 1968
Low information __.._.--..-------- 44 12
Medium information .....--------- 46 51
High information ____...--.----.-- 10 37

Total _._.._- 2.  --_.. eee. 100 100

Additionally, the information level of the stu-
dents was directly related to their membership
(or nonmembership) in the Student Health Or-
ganization (SHO), a loose amalgamation of
medical and health science student organiza-
tions which are especially concerned with the
health problems of the poor (as well as with
political-social issues such as community con-
trol and black admissions to medical schools).
SHO was largely responsible for the genesis of
these student projects, and much confusion has
existed for the past two summers over the rela-
tionship of the student health organization and
the student health project. SHO members (see
table 5) had higher information scores in
June, 1968 than did non-members, and main-
tained this differential at the end of the sum-
mer. While nonmembers became sensitized
during the summer, organization members also
increased their knowledge about the health
problems of the poor.

Table 5.—Iinformation index scores and membership in the student health organization.

June 1968 August 1968

Information Member ota Member Nota

index score of SHO member of SHO member
Low information ..........-.------------------- 34 59 4 25
Medium information.______..2.._-_...-----..----- 53 35 55 : 45
High information __............_.-.----2-------- 13 qT 40 31
Total _...._._-.-_---- eee verses 100 100 100 100

, (N = 47) (N = 29) (N = 29) (N = 47)

Besides this objective data on the educational
value of the summer project, the students also
felt subjectively that the summer had contrib-

uted to their professional education. In August, ©

seventy-four percent (74%) said the summer
contributed a good deal or a great deal, seven-
teen percent (17%) said some, and eight per-
cent (8%) said the summer contributed only
little bit or something to their professional ed-
ucation.

Thus, educational gains should certainly
have contributed to the satisfactory nature of
the Student Summer Health Project of Greater

New York. In 1968, however, one must ask, “Is
education enough?”

A Clash of Perspectives

The educational aspect of the summer pro-
ject—the sensitization of students to the vari-
ous health care problems of the urban poor—
was seen by the faculty members from Monte-
fiore Hospital and the Albert Einstein College
of Medicine (through which the grant was
submitted and funded), and most of the faculty
members concerned with the project, as. the
prime reason for the project. To them, educa-

117
GREATER NEW YORK -

tion was of greatest importance. To the “edu-
cationalists,” radical political action for re-
form of health care services was an alien and
threatening concept—and widespread improve-
ment of current health care services was im-
plicitly discounted as unrealistic. In fact, early
in the spring of 1968 (during the project’s
formative stage) a direct confrontation of the
education and political action perspectives re-
sulted in the two then student leaders (both
highly politically oriented) resigning their po-
sitions as they felt the faculty sponsor was res-
tricting their actions and redirecting the focus
of the project. As the faculty sponsor later
noted in his reaction to a student manifesto
about the political action necessary for
improving health care, “With regard to the
manifesto I noted that in the preamble there
was no mention of education and as far as I
was concerned it was an educational program.”

The two new student codirectors felt com-
pelled to “give in” and accepted the educa-
tional philosophy formally. They noted, “Stu-
dent placements will be on the basis of the po-
tential educational value of the experience to
the student.” However, the students also main-
tained their interest in the reform of health
services as they noted that the dual goals of
the project were the education of the students
and the reform of health care services. Infor-
mally, however, the student leaders and the po-
litically radical (and vocal) student fellows
stressed over and over during the summer the
need for radical political change to achieve
health care reform—especially, community
participation, community control, community,
community, community! Witness some of their
statements at the end of the summer which ne-
gated the value of the project’s educational
goals:

The community should be served, not the students.
The project is educational, but does this validate
using ghetto residents?

I don’t think it should be the purpose of SHP the
student health project to sensitize. I don’t approve
of parasitizing off the community for our enlighten-
ment. :

Thus, while educational achievement may
have been an accepted goal in and of itself in
1967, it was not so accepted in 1968! Emphasis
upon political action for health care reform,

118

especially community control, made education
a secondary (although still important) aspect
of the project.

Community Control and Political
Radicalism

The controversial issue of community con-
trol—community control of education, com-
munity control of welfare services, community
control of medical services—-dominated the
ideological interests of the students during the
summer, especially the leaders and the (vocal)
politically radical student fellows. Education
was not their primary goal; the improvement
of health services for the poor via control by
the poor was their slogan. This is not meant to
imply, however, that all of the health science
fellows favored community control. In fact,
wide disparity existed on this issue during the
summer, and was a major source of conflict
and internal project debate.

Since the issue of community control was
clearly important to the student leaders during
the spring, several questions on community
control were included in the June question-

naire. The students were asked what relation-

ship community people should have with medi-
cal personnel in making decisions at a neigh-—
borhood medical care center; they. could
strongly agree, agree, disagree, or strongly dis-
agree with each of the nine possibilities listed
in table 6.

Table 6.—Student attitudes toward community control of
medicine.

Percent strongly agree, or
agree with each statement

Community people should June 1968 . August 1968
Advise medical personnel on

budget decisions -...------------ 16 72
Advise medical personnel. on

decisions about the scope and

practices of the center _...--..-- 18 79
Advise on the hiring and firing

of medical personnel -..._.------ 57 67
Have an equal vote with medical

personnel on budget decisions -.-.-67 63

Have an equal vote with medical
personnel on decisions about the

scope and practices of the center ._71 74
Have an equal vote on the hiring
and firing of medical personnel - 52 64

Have the final controlling vote
on budget decisions . :...--------- 26 36
SUMMER 1968

Percent strongly agree, or
agree with each statement

Community people should June 1968 August 1968

Have the final controlling vote on

scope and practices decisions ----29 45
Have the final controlling vote on

the hiring and firing of medical

personnel 20 37
While the majority of students felt in June that
community people should either advise or have
an equal vote with medical personnel on
budget, scope-practice, and hiring-firing deci-
sions, less than one-fifth of the students felt
that community people should have the final
controlling vote on these issues. Therefore, a
community control index. was constructed by
combining answers on these three final control-
lining vote questions.* As show in table 7, fifteen
percent (15%) of the students were communi-
ty control radicals in June, while another nine-
teen percent (19%) were community control
moderates.

Table 7.—Community contro! index.

Community Control Score June 1968 August 1968
Community control radicals .------- 15 36
Community control moderates ------ 19 16
Community control conservatives - --.65 45
No response ------.--------------- 1 4

Total ...---------------+-- 100 100

By the end of the summer, however, many
more students had become advocates of com-
munity control, based on their experiences dur-
ing the summer and the proselytizing behavior
of the pre-summer community control advo-
cates. Thus, community people were always
given a larger role in hiring and firing deci-
sions (either in terms of advising, an equal
vote, or a final vote); and, community people
were seen as competent to have a final vote on
all decisions by an increased number of stu-
dents.

-This view of increased radicalism among the
students as a result of the summer project is
reinforced by data on political attitudes
which was also incorporated into the two ques-
tionnaires. Students were asked to express
their opinions on five issues of current impor-
tance to political radicals:

(1) Violence and rioting by Negroes in slum
areas are justified if they result in so-
cial change;

(2) The seizure of administrative buildings

by Columbia University students was
justified by their cause and ideals;

(3) The burning of draft cards by oppo-
nents of the Vietnam war is morally
justified ;

(4) The seizure of factories by French
workers and the French general strike
should be emulated in the USA by poor
people; and,

(5) Black militants are right in excluding
white newspapermen from press confer-
ences,

Student responses became more radical (that

is, the percentage agreeing with each state-

ment increased) from June to August. This is

clearly shown in the Political Radicalism

Index, (table 8) which shows the same radical-

ization as on the issue of community control.’
Table 8.—Political radicalism index.

Classification _ Sune 1966 August 1968
Political radieal _...-...---------- 87 51
Political moderate ._..------.----- 40 25
Political conservative ._.----.------- 21 16
No response ___....--------------- 3 8

Total ......----------2---- 100 100

The debate over community control created
serious problems for the project. Not only did
the call for community by some students op-
pose the views of others:

The community people are more important, in-
telligent and trustworthy than the health science
students; versus. ,
The “community” is a myth used, by those who are
afraid to make real changes, to stifle action.
but, the radicals resented the project’s less
than total commitment to the theme of com-

munity control:
It was set up, of, by and for students, not to really
help the community. It took more than it gave.

It was too tied into the medical establishment and
not to the community. SHO lacked a real commun-
ity philosophy and failed to be militant enough for
the community or to listen to it effectively. ,

¢Each respondent was scored 1, 2, 3, or 4 on each question
corresponding to strongly agreed, agreed, disagreed, or strongly
disagreed on the three final vote questions. Scores then classified as
radical (1-6), moderate (7-8), or conservative (9 or more). No
responses counted as 2.5; no response to more than one question
resulted in the respondent being classified as no response.

7 Respondents were given scores of 1-6 corresponding to very
strongly agree, strongly agree, agree, disagree, strongly disagree,
very strongly disagree with each item. Added scores then classified
as radical (14 or less), moderate (15-19) and conservative (20 and
over). No response counted as 8.5; if there was more than one no
response, the respondent was cassified as no response. ,

119
GREATER NEW YORK

SHO ... is a liberal, white service organization.

As such, I don’t think it should be in a black com-

munity at this point.
As such, the ideological involvement of some of
the students in political radicalism and com-
munity control contributed to the undercurrent
of tension which permeated the Student Health
Project of Greater New York, and contributed
to the feelings of discontent, dissatisfaction,
dismay and disappointment which many pro-
ject members felt at the end of the summer. .

Satisfaction: An Overall Evaluation

As noted in the introduction, almost all of
the student and faculty members left the 1967
summer project with smiles on their faces.
Faculty members were enthusiastic about the
gains of the summer, and worked. diligently
with the students during the winter to prepare
for the next summer’s project. The same can-
not be said now. In fact, thoughts of another
summer project are presently far from the
minds of the Einstein faculty members who
supported the 1967 and 1968 projects. Student
reactions to the two projects followed this pat-
tern. As table 9 indicates, the 1968 summer
was a disappointing experience for project
members, when compared to the previous
year’s project.

Table 9.s—Student satisfaction with the summer projects.

Project was August 1967 August 1968
Highly satisfactory -_.------------- 83 43°
Slightly satisfactory -------------- 4 28
Slightly unsatisfactory ------------ 6 5
Highly unsatisfactory ... .--------- 4 18
No response ..-------------------- 4 5

Total ___..-.--------------- 100 100

This shift in attitudes toward the summer pro-
ject from 1967 to 1968 is clearly shown, once
again, in the percentage of students who would
recommend that a roommate or close friend at
school apply to a similar project the following
summer. (Table 10). While ninety-six percent
(96%) said they would recommend a room-
mate-friend apply after the 1967 project, only

8 The number of cases upon which percentages sre based for the

1967 project is fifty-three (53); aa usual, the base for the 1968
project is seventy-six (76).

120

Table 10.—Student attitudes toward recommending that
a roommate or friend apply for project
the following summer.

Would student rerommend

roommate-friend apply? 1967 1968
Definitely yes -------------------- 99 33
Probably yes -.-------------------- 17 20
Not sure ._....-------------------- 2 22
Probably no ..-------------------- ~ 9
Definitely no __--.----------------- - 14
No response ._-------------------- 2 1

Total _.....---------------- 100 100

fifty-three percent (53%) said they would do
so after this summer’s project.

Finally, one must assume that a satisfactory
project would have resulted in more students
wanting to work in poverty areas (when they
become full-fledged professionals) after the
summer than had wanted to work in poverty
areas before the summer. However, this did
not occur in the 1968 student health project;
no gain in the percentage of students who
wanted to practice their profession in a pov-
erty area occurred. In fact, there was a very
slight negative shift from the seventy-two
(72%) who wanted to work in poverty areas
in June to the sixty-eight percent (68%) with
the same desire in August, 1968. In brief, the
1968 Student Health Project of Greater New
York cannot be considered an unqualified suc-
cess.

The reasons for this less than totally satis-
factory experience have been alluded to before,
but can be placed in proper perspective now.
First, the positive aspects of the educational
gains of the summer were minimized by the
conflict over considering education as a pri-
mary project goal. Since the “education-lists,”
both student and faculty, were constantly. as-
sailed by the vocal politically oriented stu-
dents, this tension no doubt lessened the stu-
dent’s satisfaction with the knowledge gains of
the summer project. And, it resulted in many
faculty members feeling that the educational
gains just were not worth the ‘aggravation.
Second, the students were dissatisfied with the
limited nature of those changes that were ac-
complished during the summer. While more
students reported that they had achieved some
change in the community in 1968 as opposed
to 1967 (67 percent said they accomplished
SUMMER 1968

hange in 1968 compared to 58 percent in
967), almost all of these changes were either
ndividualistic as they helped one patient or
ne family, or they were temporary and of lit-
le significance. Broad, widespread change was
tot accomplished. In 1967 this was permissible ;
n 1968 it was not. As several students noted,
‘There should be no summer projects. They
should be all year or not at all.”

Third, the controversy over community con-
rol (and political radicalism) and its relation-
ship to the reorganization of medical services
for the poor served to supply the tension
needed to minimize the positive aspects of the
summer program. The Spring confrontation of
education-oriented faculty and political ac-
tion-oriented student leaders foreshadowed the
summer’s conflict over community control, po-
litical radicalism, educational exploration of
the ghetto, and “meaningless” piecemeal
change “with the system.” .

What had been a highly successful project in
1967 had become a much less successful—even
unsuccessful—project in 1968. Why? The rea-
sons given above are part of the explanation;
but, they are only part. Perhaps it was the stu-
dents, the faculty, the radicals Or, perhaps it
was America in 1968 as compared to America
in 1967. Perhaps it was not the Student Health
Project of Greater New York, at all. Perhaps
it was Vietnam, Lyndon Johnson, Hubert
Humphrey, Richard Nixon, and Mayor Daley.

Appendix [s—Student backgrounds: Comparison of those

who answered both questionnaires and those
who answered the first questionnaire.

First First and second
A. Discipline questionnaire questionnaire
Medicine .._---------- 54 58
Nursing _.------------ 24 24
Dentistry ~----------- q 6
Law ----------------- 9 8
Sociology, social work -. 4 4
Other ._.-..---------- 8 3
Total ._.------- 100 100
B. Religion
Protestant _.---------- 17 22
Catholic _...--------- 29 27
Jewish _.._------------- 42 39
Other ...------------- 5 5
None __--------------- 5 5
No response ----------- 1 1
Total .---------- 100 100

C. Family income

Under $5,000 ---------- 5 6
$5,000-—-9,999  --------- 26 25
$10,000-—14,999 ---.--- 29 27
$15,000-—19,999 ------- 9 10
$20,000 and over ------ 26 27
No response ---------- 4 4
Total _.-------- 100 100

D. Race
Caucasian ..---------- 82 19
Spanish-speaking ------ 3 3
Negro ---------------- 12 15
Other .-_.------------ 8 2
No response ----------- 1
Total _.--------- 100 100

BE. Sex
Male __..------------- 59 61
Female _...----------- 41 89
Total __.-------- 100 100

F. School attended

__New York area ------ 67 66
‘Non-New York area -.- 33 33
No response ---------- 1
Total _.------- 100 100

 

. 9 The number of respondents to the first questionnaire was ninety-
nine (99), while the number responding to both questionnaires was
seventy-six. (76). The percentages given in this appendix are based
on these numbers. The main text of the report. using the data abased
upon the rsponses of the 76 who responded to both questionnaires.

THE STUDENT HEALTH PROJECT ASA
LEARNING EXPERIENCE

Those of us who worked to develop a 1968
Student Health Project in New York City saw
the 1967 California project as a partial model
and tried to incorporate as much of it as we
could into the planning. A tacit assumption we
all made was that students would be brought to
New York City to work in “medically disad-
vantaged areas,” for example, black and
Puerto Rican ghettos. In this way the students
would:

(1) Learn about these communities, their
sights, sounds and smells; but more im-
portantly, the students would realize,
from first-hand experience, how the
community environment determined the
people’s life-style and their percetion of
all things, especially health. This
proved to be one of the most invalid as-
sumptions one could make. T realize now
that it is grossly unfair to bring two-

121

 
(2)

(3)

122

GREATER NEW YORK

month “summer trippers”, most of
whom do not live in the community, and
view their summer as nine to five job
exposures to poor people, into someone’s
home and expect the people to unburden
themselves to the student, relate to the
student. in any other than a short term,
ad hoc manner and it is most reenforc-
ing to the student’s subtle feeling that
he can act in this role with poor people,
but would never dare go into his own
community and ask what he asks, or as-
sume the role he answers in poor com-
munities..

Help the community get better health
care. This goal was our number one
goal, but attached to it is the subtle idea
that it is all right for a student, to act
as a “patient advocate’ and take the
community person to the hospital and
use his own knowledge of the systems to
help the community person. Students
were also supposed to work with some
community organizations, either
through them (using their office and
phones to contact people) or to become a
summer apprentice to the community
group and. offer specialized assistance
where possible—and where decided by
the organization. I am happiest about
the last type of task, where the student
works with a community organization,
because it is the least condescending to
the community people, and makes the
most efficient use of the student’s special
knowledge of the system or of uniquely
medical matters (for example, dental
hygiene, birth control).

Work with a member of the Neighbor-
hood Youth Corps (NYC), making it
easier to come into a community, finding
out about a ghetto youngster, and
maybe interesting the teenager in a ca-
reer in on of the biosciences, but cer-
tainly helping the youngster with high
school subjects. This was the most dis-
appointing aspect of my summer. Work-
ing with the NYC organization was im-

possible. I know that New York City

NYC program was having its difficulties

(as witnessed by the constant turmoil

and investigations, but trying to deal

with the confusion, inefficiency, and

lack of understanding made it almost
impossible to have NYC youngsters in

the Bronx and Brooklyn projects. Many

health students were interested in. the
NYC’s, but could not treat the young-

sters as equals on the job. Maybe it was

that the students received $900 for the
summer and the NYC’s received $320

but probably it was that the health sci-

ence students could not accept the idea

that their summer problems required
creativity in setting up tasks compatible

with the community’s needs, the NYC’s
capabilities, and their own abilities, The

best relationships between NYC’s and
students were in Brooklyn where sore

. Students. encouraged the NYC’s to take

an active role, and the NYC’s accepted

this involvement and functioned beauti-

fully.
Unfortunately, much of what I have said
thus far, places pivotal emphasis on the per-
sonality of the student, NYC, and community
person. Our project was set up this way under
the guise of “creativity” and “flexibility,” but
for these assumptions to hold, the parties con-
cerned must have some knowledge of what is
expected of them. One of the glaring faults of
this summer’s program was poor project devel-
opment. The project descriptions were reassur-
ing, but what backed them up? In Harlem and
in Brooklyn, most of the problems and pre-
ceptorial contacts were valid and existed. In the
other three areas (especially the Lower East
Side), the students were constantly confused
and frustrated by a lack of direction and a
paucity of personal contact who understood the
Student Health Project or what they, as precep-
tors, were supposed to do. I can, however, offer
a theory as to why this happened. We were not
sure of our funding until two weeks into May,
after students had been accepted and plans for
Orientation set into motion. Being unsure of
the status of our venture, or if we would have
an SHP at all, students probably found it diffi-
SUMMER 1968

cult to make firm commitments, When the con-
tract was finally agreed to, I’m sure that stu-
dent coordinators in all the areas had to
tighten up loose arrangements, but in Newark,
The Bronx, and the Lower East Side the ar-
rangements never jelled and remained amorph-
ous for the better part of the summer. Through-
out the summer new preceptorial arrangements
were constantly being made. This was a
drastic mistake. If the supporting structure
had existed, and if the project staff from the
top down had felt more secure in our roles and
was clearer about direction, much of the confu-
sion and frustration could have been avoided
and more would have been accomplished.

As for the educational function I was sup-
posed to direct, this started with Orientation,
which was in two parts. From June 23-26 we
met at Bader’s Hotel in Spring Valley, N.Y.;
the remainder of the week was to be spent ori-
enting the five student groups (with NYCs
where possible) to the five communities. In
general I thought the project Orientation ses-
sion was adequate and accomplished my inten-
tions. The first full day was devoted to an over-
all view of the communities SHP would be in
during the summer. Films, speakers, discus-
sions, and lots of free time were used to help
the students obtain an overview of community
feelings and problems in the Greater New
York Area. One full: afternoon was spent talk-
ing about NYCs (the twenty or so NYCs who
attended the Orientation spoke to the students
in a wonderful two-hour open discussion). The
second day brought ‘health professionals who
had some notion about community health. The
students and community people asked many re-
vealing questions and I think received a rea-
sonable superficial exposure to some of the cur-
rent thinking in Community Health (none of
it was radical, however). The third morning
was taken up by a great discussion of “Com-
munity Control of Health Care Facilities” ;
this seemed to be the logical culmination of the
previous Orientation topics. However, this last
discussion was all rhetoric. In fact, one of the
community people spoke to me during August
and said that some of the promises made at
Bader’s by the health professionals were sim-

ple bullshit and she was unhappy with their
deception (she gave me no particulars). On the
whole, Orientation had. given the group a
needed esprit de corps, and a very low-keyed
introduction to the community health scene in
New York City. This was not a radical Orien-
tation, merely an easing into the summer’s
problems. Some people resented the site of our
Orientation and Final Conference sessions
(both were held at resort hotels outside of
New York City). The problems inherent in
finding a place to feed, provide meeting facili-
ties for, and house participants (which is not
necessary, but we felt this would be optimal)
at a reasonable price in the New York Area are
HUGE. This was one of the greatest stumbling
blocks all summer. We were a large group and
needed large facilities. Bader’s Hotel was ideal
(even though it was not in the community) be-
cause we were the only group in the hotel for
the three days it was the hotel’s off-season and
the price was right.

The educational programs per'se during the
summer never really achieved my goals. I fast
realized that the project participants were re-
luctant to travel very far to hear a speaker and
were not really bristling with ideas as to the
kinds of speakers that would interest them.
There were two lecture series, on black and
Puerto Rican history, given by Mr. S. L. and
Miss C. M. Mr. L. presented the problem of a
self-appointed black historian. His treatment of
black history was interesting but not extremely
substantive. He certainly knows quite a bit but
his digressions confused matters and took the
group away from the factual matters. Miss M.
was excellent. She not only knew a_ vast
amount about Puerto Rican History and Cul-
ture, but she was an eloquent example of the
second generation Puerto Rican in the United
States. In Newark, R. P. (the Community Co-
ordinator) arranged a discussion group with
his NYC’s. These groups met twice a week and
discussed Before the Mayflower, a black history
text by Lerone Bennett Jr., and Black Power,
by Carmichael and Hamilton. These were far
from militant discussions, but merely an at-
tempt to help the NYC’s become more verbal
and less afraid of expressing their ideas. These

128
GREATER NEW YORK

books were chosen because they deal with the
one inescapable attribute felt by all black
people in America—blackness, its origins, and
its consequences.

The Bronx project attempted weekly tutorial
sessions. For health science students there was
instruction in Spanish, and for NYC’s there
was instruction in science, mathematics, and
music. However, many of the students did not
have time for these afternoon sessions, and the
NYC’s could not always attend because of their
responsibilities,

I am convinced that each area has to have its
own educational coordinator who is in constant
contact with the area people and is acutely
aware of their desires. I attended area meet-
ings once a week but received little feedback as
to the type of programs the people wanted.

The Final Conference was steeped in dis-
agreement, good intentions, and subjectivity.
Many students did not care to attend the final
conference (August 26-28) because they needed
a rest before starting school in the fall and they
wanted that week for part of their vacation;
many people felt the conference should not
have been held at the Sha-Wan-Ga Lodge in
upstate New York; indeed, many people felt
very strongly that the final conference should
have been held in-New York City, in one of the
five communities SHP was working in. In
choosing a site for the final conference we were
faced with many more problems than with ori-
entation. We felt that if people were to com-
mute each day to the Final Conference we
would be ending the sessions early and begin-
ning late in the morning—the logistics would
be much simpler if everybody was in one place
for the entire three days. Sha-Wan-Ga Lodge
was far from the ideal location, but it. was the
best we could find in terms of space, facilities,

food, convenience, and price. If I seem to be ©

harping on seemingly trivial issues, it is only
because much of my time this summer was
spent worrying about just such details and pre-
cious little time was spent in a nonbureaucratic
bag. Much of the “central staff’s” time was
spent patching up situations that arose because
of poorly functioning area leadership, and sim-
ple confusion caused by poor planning on our
part. Coupled with a student ignorance of the

124

ways of a bureaucratic system, and our lack of
assurance as to which decisions we could make
and which decisions required a policymaking
council vote, this kept us in a very confusing
and confused state of affairs until we were al-
most through with the project (maybe we
never got out of it).

The Final Conference relied almost exclu-
sively on health science students and commun-
ity people to lead discussions, present working
papers, and determine the focus of the Confer-
ence. Much of the discontent and frustration
was vented at this Conference, as well as the
crystallization of the issue that had been crop-
ping up throughout the summer: Reformists
vs. Revolutionaries in the health care field.
That is, should the SHP and SHO try to re-
form a bad, though not unsalvagable, system
or should the thrust be to work with any and
all allies to totally revamp this system. This is
the major. decision of any activist-minded per-
son and was coupled with a crisis in choosing
allies for health students. We asked each other
should students work in communities or should
they only serve as advisors to community or-
ganizations (someone suggested. that our name
should be Community Health Organization).
The fallacy of the first assumption enumerated
at the beginning of this report was exposed
and much introspection and soul searching fol-
lowed. The Final Conference was not orderly,
people complained about “to much talk,” no di-
rection, and no continuation of projects
throughout the year (however, three area pro-
jects have been funded through the winter).
This was not unexpected and merely reflected
the clashing of ideals, none of which have ab-
solute worth and all of which might be tried.

We ran into a problem in our project because
the five areas and the participants seemed at
times to be less important than the unified Stu-
dent Health Project. We talked about auton-
omy and creativity, but were faced by poor
support on the local level, many willing stu-
dents but some not willing at all, much money,
and a bureaucratic structure second to none be-
hind the project (Montefiore Hospital runs a
very efficient bureaucracy, and their staff was
invaluable) which often. did not function as
responsively as we would have liked. The ten-
SUMMER 1968

sion was between the five individual areas and
what each thought was important, what could
be allowed to permit proper functioning of the
project, and what Montifiore and Washington
were willing to allow. These three power
groups were never at direct odds, but the com-
munication between the three was not good
and this lead to much ill will —S.G., Education
Coordinator.

If SHO does continue, which I hope they do,
they should do some serious thinking about the
summer’s experiences. Unfortunately, many of
the comments I have to make this summer are
the same ones I made last summer.

First of all, Orientation should be more spe-
cific. For example, those working in the Bronx
need to know about the Bronx. Mimeographed
sheets of all community groups, health facili-
ties and service agencies should be made avail-
able to each project member at the beginning
of the summer. This summer, halfway through
the project one list of medical facilities and
community organizations was available in our
office. This list should also include such things
as clinic hours, how to register, and who the
heads of each department are.

It is also important to know basic functions
of the community groups. Last summer there
was an excuse for not having this information
available because it was the first summer for
SHP. This year it was not excusable, and next
year we should not attempt a project without
having this information readily available. It is
rather astounding to find out that. a student
working one block from the N.M.C.D., can go
half way through the summer without know-
ing of its existence. Equally astounding is that
a community worker in the last week of the
project can admit to not knowing about Wel-
fare minimum standards forms.

Orientation should also include a discussion
of roles. For example, community workers
should be told that they are to be involved with
welfare and housing problems. Part of their
introduction to their new role should include
specific information about welfare. They need
to know the lines of authority, the rights of
the clients, the procedures of the different cen-
ters, etc. This summer everyone did a little of

everything without benefitting from anyone’s
specific knowledge. By defining roles some
needless overlapping can be eliminated. A clear
definition of a role does not limit initiative or
creativity. It should enhance it. If the commun- —
ity worker knows how the welfare department
functions, this in no way stifles his ability to
work with welfare clients.

* * * Tt seems that if students were given
a specific orientation, a definition of their role,
and started the summer by defining their focus,
then the level of frustration would be lowered
and the feeling of accomplishing higher.—V.V.,
Nursing Student, Bronw.

My reaction (to orientation) was negative.
Most students who go to work in projects like
this already have some awareness of ghetto
problems. The resource people do little more
than tell us in more vivid detail what we al-
ready know in general. Specific names of pro-
grams and people are lost on me, as I have no
way to connect them with their environment.

The Orientation seemed to be trying to give
us a feel for the ghetto in a resort hotel at-
mosphere. It should have concentrated on the
organization of the power structure , and the
poverty organizations, and left the ghetto feel-
ing to a time when we could experience it. I
want to become “sensitized,” too, but not at
Bader’s Hotel. It was like going to France to
learn German.—R.H., Law Student, Brooklyn.

To me the orientation was unnecessary be-
cause I now how it is to live in a ghetto and I
need no one to tell me how it is. The only thing
the orientation did for me was to give me a
chance to know the people I would be working
with. Also to find out what their personalities
were like so I would know how, to approach
them.—W.F., NYC, Brooklyn.

My only criticism of the project was the pre-
and postsummer meetings. They seemed to
have too much of the “party atmostphere.” I
am certainly not one to dislike parties, quite
the contrary. But I prefer my parties to be
paid for by me and not out of funds allotted
for the urban communities’ problems.—B.W.,
Medical Student, Newark.

In improving SHP for next summer, the

125
GREATER NEW YORK

most apt suggestion I can make is that the stu-
dents in each specific project familiarize them-
selves with the community and the project be-

fore the summer so that when June comes they .

can start work immediately without first
spending a great deal of time learning about
the problems of the area. This of course would
necessitate much time during the school year,
something medical students may not be able to
do.

I believe the orientation session at Baders
was most useful and should be continued;
though much of what was said there was per-
haps not necessary (for example, what is a
ghetto?). There were two films shown, one of
SHP in California and one on the South Bronx,
both of which gave us an idea of ghetto life,
and, perhaps more important, explained atti-
tudes we might face while working in these
areas.—D.K., Medical Student, Brooklyn.

The orientation program at Bader’s may
have been costly to SHO and boring or useless
to old SHO members but to anyone newly ac-
quainted with the organization, it held three
opportunities: to learn a bit about SHO, its
goals, philosophy, etc.; to learn the exact plans
and expectations of the various projects (with
chances to reconsider choices!); and to get a
feel of some attitudes the next ten weeks might
support or struggle against.

Local area orientation, on the other hand,
might have been a little more diligently done.
In the future, such proceedings could serve as
a guiding push into the summer’s activities and
save the student fellow from wasting precious
time learning what old project members could
easily pass on. Admittedly, some things will re-
quire a certain amount of time for each student
to get on his own.—A.G., Nursing Student,
Harlem.

We found that our goals were somewhat dif-
ferent from those of the citywide SHP. In the
introductory remarks and the comments on the
1967 California SHP film the first night of ori-
entation, it became evident that much of the
purpose of the New York SHP was “sensitiza-
tion.” Our primary goal was to improve the
school health program in Harlem public schools
by demonstrating that a model for using com-

126

munity people as health workers can work.
“Sensitization” of student fellows had a low
priority.—R.C., Student Coordinator, Harlem.

I fee] that we were also severely limited in
designating ourselves as a project to “teach”
other students about poor communities. While
this is an admirable and necessary task, many
of the more experienced of the students were
not capable of structuring a project which
could provide useful service to the community
while giving uninitiated students first expo-
sure. This is because most of the students who
set up the project didn’t have very much expe-
rience themselves. I don’t think that in several
weeks or a month or even a year a health sci-
ence student can be knowledgeable enough or
accepted enough by the people he is working
with to take it upon himself to bring other stu-
dents in to get a feel for what is going on. In
my opinion, all projects which are beginning
for the first time should be composed only of
local students with some experience, who share
some attitudes about “health care as a right,”
the economics of poverty, the poor educational
system, etc. Their goal should be: (1) To prov-
ide themselves as consultants to the community
on whatever projects are underway—they
should not start their own projects; (2) to
meet people in the community and become
knowledgeable about the special problems and
resources of that community; (3) to discuss,
say at the end of the summer, with the com-
munity people they have worked with, ways
in which more students and community people
may work together in the fall.

I do not think that students new to an area
should identify themselves as SHO or SHP or
anything else; this marks them as another
group with something to do, Their only task
during the first summer should be to help out
existing community groups. If this were the
case there would not be a city-wide SHO as far
as community work goes. There might be some
central staff to arrange seminars, confronta-
tions, etc., but it should not be concerned with
individual projects, which at least at first
would be directed strictly by the individual
community. I think that the central staff this
summer was very ambivalent about its role—
SUMMER 1968

supervisor—director or facilitator—but this
would be eliminated if they did not decide
things for the individual projects.

I should state here that the idea of bringing
out-of-state students to various project sites,
which goes along with the idea of educating
students and creating other SHOs, is overambi-
tious and hampers activities. Aside from the
difficulty of getting a group with such diver-
gent views together to do something, it is diffi-
cult to think in terms of ongoing projects when
75 percent of the project staff leaves almost as
goon as it arrives. This also rubs in the fact
that students can and will leave the commun-
ity, but residents are stuck there. Along these
lines we might also say that students should be
required to live in the communities in which
they work.—S.D., Student Coordinator, Lower
East Side.

The first few weeks on the project have been
so full of different kinds of experience that it
would take me many pages to relate all that
has happened. . . . One moment I feel as if
there is real purpose to our work and then the
next hour I feel as if the entire effort is a
futile one. There is very little structure to my
project other than that which I make. Nothing
in my educational or work experience has been
this way. The past year at medical school, es-
pecially, convinced me that it was unnecessary
to have to think and to be creative in one’s
work, but this summer has been as much the
opposite of last year as possible. Every day is
different and is only as meaningful as the ef-
fort which I put in. In some ways this is good,
I am learning how to work in a loosely struc-
tured job and how to create something of value
in the summer’s work.

I wonder, however, if we are actually going
somewhere as an organization of professional
students who really do have talents and knowl-
edge to offer the community. I feel as if I am
going to come away from a meaningful experi-
ence with a much greater understanding of the
problems of the poor and a feeling of sympa-
thy for the people, a feeling acquired only by
walking the streets, by smelling the air that
people breathe, by seeing the homes in which
they live, and by talking to people with whom

one has never spoken. Yet I feel frustrated be-
cause I know that sympathy on my part does
nothing for those people. I feel frustrated be- .
cause I see that the problems are so enormous

’ that I can do almost nothing. I also feel frus-

trated because many of the limited goals that
we have established will not be achieved. But
then I think about how I felt after the first
time I sat with a group of Neighborhood Youth
Corps teenagers, trying to make boys and girls
confront each other about their ideas on male
and female anatomy in a sex education class. I
felt very good because I say that these young-
sters could respond to me and that we could
work together; that I could bring _something
new to their lives—P.S., Medical Student,
Lower East Side.

After 2 years of working as a student in
Metropolitan Hospital I really cannot say I
learned anything new about the delivery of
health care. I spent the summer in another
area of New York City where most of the
problems were basically the same, but I did ex-
perience more about the delivery of health care
and hear more of the actual feelings of the
people. What I had learned before was learned,
dressed in white, as part of the hospital struc-
ture; what I experienced this summer was ex-
perienced as part of a community organization
(NENA) fighting health rights issues on its
own grounds. I found this completely invaluable
to my understanding. When a person is sick and
must go to a hospital, he comes to you (the
nurse, the doctor) on your grounds: you are
the controlling factor in the relationship; he
has no voice and does not say what he feels.
When you go to him and meet him on his
grounds, you are a guest in his home; he has
more authority and can meet you on a one-to-
one basis.—M.L., Nursing Student, Lower East

‘Side.

You fight a deadline because you don’t want
to disappoint the community, and then they
don’t showup; you can understand it, but it
doesn’t help your feeling of that big come-
down. Now you know how the people of the
community must feel when they get promised
things and don’t get anything. I was too naive
going into it; I didn’t expect any hitches; we

127
GREATER NEW YORK

kept our end great and this guy had promised
he would get the kids for the physical exams
and I took him on his promise. I now know you
can’t do that. If we were to do this again, we
would arrange for the kids to come ourselves,
and leave nothing to anyone else. That is one
thing I have learned this summer ; I’ve learned
to rely on other people a lot less —W.S., Stu-
dent Coordinator, Brooklyn.

I have heard our SHP advisor say more than
once that it is difficult and almost impossible to
assess the effects of any community service.
Bearing this in mind, I think that the major
accomplishment of my summer’s efforts has
been my own education.

This education began in family counseling
where I learned about welfare, housing, and
mental health problems that affect some ghetto
residents. I also saw how these problems are
interrelated and how they affect ghetto resi-
dents’ health and well-being. In the VD educa-
tion program, I learned about venereal disease
and also how little is known about it and its
cure in the community. It also became evident
that even though people had many misconcep-
tions about VD, they were well aware of the
social stigma involved with having contracted
syphilis or gonorrhea.—E.C., Medical Student,
Brooklyn.

There had been many arguments concerning
the wording used in our questionnaire. For ex-
ample, we wanted to know if the person was
living with his or her spouse. One could simply
ask: “Are you living with your husband?” We
did not want to do this. These people have been
picked on too often. They have been constantly
questioned, often with too little compassion,
about their personal lives; questioned by people
who have different value systems and different
concepts about what life really is like. By ask-
ing the number of children in the house and
the number of relatives, etc., we would figure
out by a person’s response to the question
about the total number of people living in the
house whether she did indeed live with her hus-
band.

One of my first lessons learned was that all
this beating around the bush was quite unnec-
essary. It wasn’t as important to concentrate

128

on the wording of the question as it was to con-
centrate on the way it was asked. These
mothers are not stupid. They can tell when
someone is sincere and when someone really
cares about the well being and safety of their
children.—D.Y., Medical Student, Brooklyn.

The huge Brookdale medical complex was
considered not worth a damn and all I knew
about it was what I heard and all I heard was
bad. Validity is not inherent in universality
and because all of the gung-ho people from
both SHP and the community had climbed
aboard the “Bury Brookdale” bandwagon, I
didn’t believe any of it.

When the opportunity was presented to
work at Brookdale with complete freedom, I
secured the position. Seven weeks’ of examin-
ing programs, speaking to patients, and quietly
observing the procedures and handling of pa-
tients’ convinced me that the blowhards I'd
heard at the summer’s beginning did not know
firsthand what they were talking about. In
fact, they had fallen prey to exactly what they
so staunchly warned against: the blind ac-
ceptance of stories which, as I later found out,
should have been either buried long ago or
never even begun.—J.G., Dental Student,
Brooklyn.

. * * * T gnent most of the time talking with
the three boys, about my age, who work as_
guards in the office. I quickly learned that they
were quite as complex as I. I was interested
and surprised to learn that the reality of the
ghetto, with its junk, crime, and imminent

‘death frightens them as much as it would me if

I lived there. And these boys are by no means
powder-puffs—one is an ex-addict, and all are
fully in the midst of the Bedford-Stuyvesant. .
“scene.” I was. very discouraged by their bland
acceptance of everything that occurs around
them; the universal gambling, dope, and steal-
ing from one another is a depressing reality
that is acknowledged fully but left unchal-
lenged in their thought or conversation.—J.T.,
Medical Student, Brooklyn.

’ For people on the outside, there is a feeling
that the black community in Newark is dan-
gerously unified and ready for complete revolu-
SUMMER 1968

tion. When I walked into Newark this summer,
I was afraid. My orientation had never before
been that of a revolutionary; I had always
been a reformer. I didn’t believe in violence as
a solution to any problem. I didn’t like the idea
of “black power” because all it meant to me
was separation. I believed that everyone had to
get together to solve racial problems. After
about 2 weeks in Newark, I changed my opin-
ions and my orientation—K.F., Medical Stu-
dent, Newark.

Although I have lived just outside of Ne-
wark for most of my life, I found myself
spending the first few weeks of the SHP pro-
gram getting familiar with the city-—objec-
tively and subjectively. There were streets to
know, bus lines to learn, names to memorize,
landmarks to note, people to meet, etc. There
were also attitudes to recognize and to under-
stand—mine, as well as those of the com-
munity in which I was to work. My pre-
vious life in the suburbs had not exposed me to
the real working of Newark; initially I was in
a state of overwhelming ignorance. But as I
came to know more about Newark and its peo-
ple, I was able to participate in the SHP task
of improving the medical care offered to the
people of this community.—B.W., Medical Stu-
dent, Newark.

The problems of health care delivery change
quickly revealed themselves to me to rest more
with the medical establishment of the hospital
and New York City health department, than in
community apathy, lack of sufficient informa-
tion about health services in the community, or
lack of parental concern and cooperation. (I
was surprised and pleased to discover how well
ghetto mothers do take care of their children’s
health needs, within their limited means,.even
though not up to middle class white America’s
standards.) —W.S., Medical Student, Harlem.

I really didn’t expect to receive too much
“sensitization” as far as the community was
concerned, since I was born in Harlem and
have spent several summers there recently.
However, I was surprised to find that my rela-
tionship with white people was greatly im-
proved. It seems that every time I manage to

become somewhat prejudiced against white
people, I meet one I really like. From past ex-
perience, however, I try not to forget that I am
black and he or she is white. The other day I
was walking down 125th Street with one of my
coworkers. I noticed that some people were
staring at us; then it hit me: “I’m black—she’s
white.” I had forgotten. It’s much easier and
more comfortable to forget. I’ll have to do it
more often.—C.R., Medical Student, Harlem.

The people who came to work in the project
should have already had a meaningful attitude
toward the people they would be in contact
with, for example, the community, before they
went into the community. And if some students
didn’t have these attitudes, or there was some
doubt that they did, then the students should
have been screened out. This is not the place to
develop attitudes. This is the place to work for
the community as a result of these attitudes.—
C.R., Community Worker, Bronz.

WHAT NEXT?—SUGGESTIONS FOR
THE FUTURE

I think there may be a place in ghettos for
white liberal medical and nursing students
next summer but it is a rather specific and con-
ditional one. I think students should only go
into a community at the request of a commun-
ity group. I think the students should see their
role as primarily that of support for groups al-
ready working on health, or who are trying to
build an awareness of health issues in their
communities.

I would personally suggest that there be no
more SHPs like the ones we have had for the
last 2 years in New York. It is just too expen-
sive and too exploitative of the community (we
learn more from them than we provide) to jus-
tify taking government funds. If we could fund
a large number of community people, as they
did in New Haven, that might be better. On
the other hand, I think it would be better if
SHO concentrated on what it could do year-
round to raise significant issues in health in
the community where the medical schools are.
SHO. should concentrate on providing human
medical care that is responsive to the needs of
the community and at the same time should

129
GREATER NEW YORK

turn other medical students on to the concept
of medical care as a right, not a privilege.
SHO should develop the attitude of standing on
the side of the consumer of care and criticizing
the facilities from that point of view, not from
the point of view of the professional deciding
what is best for a community without consult-
ing them.

The last thing I want to say relates to the
people I have seen on the SHP this summer.
These remarks fall into the “I love humanity
but I can’t stand people” category, I guess. I
think that SHP is in a dilemma; it was started
by a group of people who were much more rad-
ical (in the sense that they were willing to ad-
dress themselves to “root” problems) than the
people who have climbed on the summer pro-
ject bandwagon. For example, we’ve talked
about alternative structures that seem to get at
the problem of community control, but most of
the SHP medical students are suspicious of
community control. We’ve talked about the
“politics of health” but most of the students in
the summer projects are essentially apolitical ;
to wit, the Detroit SHO convention declined to
take a stand on the war in Vietnam. So what
we have is a liberal service organization, for
the most part, that tries to sound radical but
that has no real sophistication or understand-
ing of root causes.

I think that there will probably be more SHP
summer projects, simply because there are a
lot of liberal medical students who would like
a chance to prove something by “doing their
thing” in the ghetto. Dealing with realities,
then, we have to decide how to make the ser-
vice projects as good as possible while leaving
the smaller group of more political students to
deal with the issues of decentralization to
neighborhood clinics, community control of
health facilities, redesigning health care sys-
tems in ghettos so that they take into account
the life styles of the poor, and the fact that
even if the New York City hospital system
were run efficiently (an impossibility in a bu-
reaucracy wracked with union and personnel
problems). it couldn’t provide decent medical
care because the budget allocation isn’t big
enough. All these issues we have to leave to the

130

small group which may serve as the “cutting
edge” to anything SHP can become.—R.C.,
Student Coordinator, Harlem.

I now believe that the best thing SHPs (or
more appropriately year-round active SHO
campus groups) can do is to focus all availa-
ble manpower on a single significant ground-

- floor objective (as determined by the needs of

the specific community through prior discus-
sion with people in the community)—be it ser-
vice-oriented (for example, a health rights and
resources community education campaign) or
activist-oriented (such as assisting some spe-
cific community group in forming a community
health advisory council). Otherwise, we can do
the most good working within the medical care
delivery institutions of which we are a part to
effect changes in practices and policies.

Medical student activities (whether
SHO/SHP or not) should be directed toward
two important and closely related objectives:

Communication: We can work to facilitate
communication between health service estab-
lishment, professionals and community people
(and vice versa), example, liaison with hospi-
tal administrators where community people
couldn’t get a foot in the door, or working to
develop formal hospital “community relations”
programs so that the “real” public (not just
the news media reporters) can know what
good and bad things are going on inside our
ivory towers. At present, as clearly demon-
strated in Harlem, rumors about the hospital
are allowed to run rampant in the community .
and rumors about the community run rampant
in the hospital. ;

Responsiveness: We can work to convince
health professionals of the pressing need to re-
spond to community requests for information,
cooperation, suggestions for services or modifi-
cations of existing services, etc. (How long
must the community keep asking for evening
clinic hours before someone listens?)

We also can work to increase community
awareness of the facilities and services availa-
ble (community education programs) or oppor-
tunities. they should not let pass (available
jobs or positions on advisory committees, etc.).
Specific SHP service projects should only be
SUMMER 1968

initiated at the request of some responsible ele-
ment in the community which has existed long
enough to have some real feeling for the com-
munity’s needs and desires (PTA’s, health
councils, ete.)}.

Dropping twenty or so health science stu-
dents (and some unmotivated NYC’s or com-
munity workers) into as complex a situation as
exists in urban areas like those in New York to
tackle whatever problems can be found in ten
weeks just can’t go on. The idea of sensitizing
health science students to the urban health
care problem in this manner is too selfish an
objective to justify spending several hundred
thousand dollars. It’s immoral to use the com-
munity for our own educational purposes with-
out providing it with something enduring of
significant benefit.

I don’t see how we can continue bringing in
a new group of students each summer to sensi-
tize them, each summer attacking the same
problems to no avail, repeating the previous
year’s mistakes, alienating the same establish-
ment functionaries (who soon come to view us
as a joke), and leaving behind the same com-
munity disillusionment with student projects.
Not to mention the health professional at Har-
lem Hospital who commented that we should be
paid no mind because we’re just another bunch
of mixed up kids having an identity crisis, who
all are in the bottom third of our class!

In the first place, most of the students se-
lected for SHP’s are already somewhat aware
or they wouldn’t be here, and a summer of
foul-ups and frustrations doesn’t really have
sensitization value for them anyway. As for
the others, who do need such exposure: is a
10-week SHP the right time and place to do
it? I agree with the Harlem community
worker who told me that future SHP’s should
consist of five committed students and twenty
mothers, rather than the twenty students and
five mothers that we had.—W.S., Medical Stu-
dent, Harlem. :

The only SHP organization relevant to these
distinctive problems is one which minimizes
city-wide student and faculty political infight-
ing and which maximizes local student involve-
ment in the issues of community control over

entry into health professions and over health
care delivery.

Future SHPs, therefore, should develop au-
tonomous organizations to attack the problems
in each borough. Borough leadership should be
shared equally by one militant student and one
experienced community-leader. Funding should
be entirely independent of either Federal Gov-
ernment or medical schools. The ultimate pur-
pose of such an arrangement would be the
ouster of the health science student leader and
the assumption of complete control by com-
munity spokesmen. This is the strange political
dialectic that white health professionals will
have to learn to accept: Success means getting
kicked out.—J.G., Medical Student, Bronx.

I suggest that SHO ought seriously to consi-
der making the relation between itself and the
community more explicit and formal so that
the team of community worker and health stu-
dent could be developed more easily. For exam-
ple, SHO could try to form an alliance with
LABOR for joint-funding next summer ; hous-
ing and health problems go naturally together.
The basic idea would be that health advocacy
is a good way to build up the number of ser-
vices LABOR can provide, and that LABOR is
a good entree for working in the community as
health advocates. The idea seems to me to have
advantages over the present funding and or-
ganizational structure:

(1) SHO would be clearly allied with the
community and not with the Establish-
ment. From what I’ve seen this summer,
the SHP funding agency and policy
making committee haven’t made any
contribution to the project. If anything,
they forced unnecessary compromises
on us in the planning stages. A clear al-
liance with the community would give
us a sound and practical basis for learn-
ing what community health will have to
mean in the future, and for working out
that meaning.

(2) An alliance with LABOR based on
joint-funding would give project fellows
a larger role in defining how they will
work out of LABOR. The ambiguity of
the present relationship created - prob-

131
GREATER NEW YORK

lems this summer; joint planning of the
project and joint training of project
members would give us a chance to
work out conflicts on a realistic basis
and strengthen our relationship with
LABOR.

(3) LABOR employees could provide better
continuity after the summer is over.

(4) Joint-funding with a community organi-
zation would give SHO a good opportu-
nity to get LABOR involved in health
issues and aware of the problems that
must be solved. This opportunity to ex-
pose and develop our thinking shouldn’t
be lost. We simply cannot go on educat-
ing ourselves, believing that when we
are the medical establishment, we'll
make the needed changes. Nor can we
continue to try to dream up community
groups (ie., by calling meetings) that

- we can then manipulate to support our
positions on health care. We must begin
working on a mature, realistic alliance
with community groups, with sharing
of power.—K.B., Medical Student,
Bronx.

There is definitely a place for SHP in my
community. However, there would have to be
major changes made in many of the organiza-
tion’s basic ideals. First, the program must be
organized well in advance. The community
should give SHP certain ideas for the project,
but SHP should also have its own ideas. And
be ready to act on them. The leaders of the
project should be able to tell the student fel-
lows and other workers exactly what they will
be doing. This was one of the main drawbacks.
I spent most of the month of July looking for
the things to do, then when I finally really got
started August was half over. Secondly, SHP
must have strong leadership. With an organi-
zation as large and spread out as the Greater
New York Project, you must have leaders who
are able to make a decision without taking a
poll of all the workers, I would also suggest
that instead of spreading the project all over
the city, SHP should concentrate on one area
and try to have large successes there instead of

182

small ones all over.—J.W., Nursing Student,
Bronx.

I’d suggest that skeleton ideas for projects
be worked out long before summer, and that
project fellows be asked to apply for particular
projects and, as part of their application, give
some idea of how they think the project might
be organized and implemented. In this way, the
Orientation session could get down to decisions
as to how each group of eight or ten student
fellows was to operate, and discussion of un-
derlying philosophy would take place in the
most useful context of real alternatives and the
effects they would have. I suspect one reason
why the lead poisoning project will leave con-
crete results, aside from the nature of the pro-
ject, was that project fellows formulated goals
and thought about methods before the summer
work began.—A.K., Law Student, Bronx.

I don’t think that there should be an SHP
next summer, in the form it took this summer.
Rather, SHP should be a kind of liaison, or
coordinating body, to place health professional
students and perhaps NYCs in various com- .
munity organizations throughout a_ specific
area of the city. I do not believe that SHP can
accomplish anything worthwhile (in terms of
immediate contributions to the community) if
it tries to function as an autonomous body in
the community. Students simply do not have
the experience, the know-how, or the time to
produce something in a 10-week period. We
can become more aware of the needs and prob-
lems of poverty-stricken people, and benefit
them more, by offering our manpower services
to organizations which the people themselves
have created out of awareness of their own
needs. Perhaps that way we can also convince
them that.we are not flighty, well-meaning but
do-nothing kids, who have come slumming for
the summer.—M.H., Law Student, Lower East
Side.

A place for SHO in our community? I look
around Crown Heights and I say yes. Perhaps
a coordinating employment project for biomed-
ical careers and paramedical professions. Why
not extend the patient advocate position to
other hospitals and other communities. We
SUMMER 1968

could establish some liaison with hospitals in
the area and ask them for _ their
opinions. * * *

As lead poisoning cases in the area continue
to rise, we could make a project of checking on
apartments that are serious enough to warrant
immediate emergency attention by the city and
try to get loose paint and plaster on the city’s
list of emergency conditions that must be taken
‘care of immediately.—M.H., Sociology Student,
Brooklyn.

Thus far the student health project func-
tions only during the summer months. This
means that every summer a new relationship
has to be fostered all over again and that the
new students have to learn all over again how
to cope with the problems and the people of the
community; while the people of the community
have to iearn how to trust the new students.
With this type of short-term relationship, the
onty ones who are benefitting are the students.
So far, nothing concrete has been left in the
community. Why can’t student health projects
be run on a year-long basis so that there will be
continuity of care, personnel, and trust?—
M.J., Nursing Student, Bronx.

My most immediate suggestion in continu-
ance of the program throughout the year. The
success of this project has been in becoming
aware of the health needs of an impoverished
community and in becoming so involved with
poor people and their unceasing problems that
one’s commitment to community medicine is
strengthened. However, these successes do not
begin to initiate the radical reforms that are
urgently needed in the administration of
health care to the indigent. Reforms will come
only with constant pressure on the existing
system of health care. This point was illus-
trated vividly in the Newark Project by ad-
ministrators of Martland Medical Center, the
established center of health care for the indi-
gent of Newark, constantly giving evasive res-
ponses to suggestions for better health care de-
livery, knowing they would only have to listen
to these suggestions for a limited period of
time. , :

-Another factor illustrating the limitation ‘of
a ten-week program and the need for a year-

round program is community trust and sup-
port. To merit community trust and support a
program cannot pull out at the end of a 10-
week period. To effect changes in health care
an organization must have community support.
Although part of the Newark project is con-
tinuing in the form of planning a health advis-
ory council, made up of community people, this
is not enough. Although the students must re-
turn to their respective schools, communica-
tions and activities could be continued through
the work of the NYC’s, community workers,
and faculty advisor, and possibly previous
health science students who have completed
their education—K.S., Nursing Student, Ne-
wark,

I believe any future projects should seek to
make themselves available to assist directly
any already existing organizations in need of
help. This would provide us with the needed
background information to avoid trial and
error learning which we had little time for. It
also would serve as a lever to get us into the
community quicker, and in an already respect-
able way.

It was my feeling, in the beginning of the
summer, that I would be living right in the
area. It was a mistake not to do so. Though a
few individuals did, I think future project fel-
lows should try living in close proximity, man-
aging the affairs of a home and job together.
All money should be pooled to go for rent and
food. Any leftovers would be divided up at the
end among the workers as salary. I believe this
would really lead us to experience, first-hand,
what it means to exist on a restricted budget.
Granted, this is an idealistic view, but maybe
some of the ideas can be modified and put in
working order.—J.M., Nursing Student, Lower
East Side.

* * * Perhaps one person could be specifi-
cally in charge of NYC activity for two to
three weeks. This person might arrange for
one or two NYCs to work alongside some per-
son in the community whose job they are inter-
ested in learning or aspire to: surgeons, anes-
thetists, X-ray technicians, attorneys, police,
firemen, etc. Another suggestion to ponder is
whether two community workers would be bet-

133
GREATER

ter than one because some competition might
develop between them to see who could do the
better job. Or at least each might, out of a
sense of pride, strive to accomplish a body of
acts which they can point to—N.W., Law Stu-
dent, Newark.

RECOMMENDATIONS

Recommendations From Community
Worker Workshop

(1) Questioning of the concept in practice of
the patient advocacy role: (a@) A feeling
that the outsider (usually middle class
white) is further deepening the psy-
chologically debilitating dependency po-
sition of the person being helped. Doing
everything for, and failing in the teach-
ing function which will enable people to
advocate for themselves; (b) The con-
cept of confidentiality is frequently vio-
lated. Isn’t this a reflection of an uncon-
scious racism?

(2) On the selection of community workers
and coordinators: Selection should be
done by a community screening group
who reflect the highest aspirations of
that community. Priority should be
given to those community workers who
have worked with the project before
and demonstrated their value.

(3) On the question of whether students
have anything significant to offer, or
whether their presence is irrelevant, the
group was split. For those who felt stu-
dents had no place, reasons were: (1)
Their presence is a perpetuation of
white power; (2) they are not needed
because when they leave the community
is in the same bag. For those who felt
they had a place, it was believed that:
(1) Students could open up doors; (2)
students did provide services where
none previously existed. But this group
still felt the issue was community con-
trol, and believed that the proportions
between community staff and students
must be reversed. Following further
discussion, it was agreed that this ques-
tion was best answered by each individ-

134

NEW YORK

ual community since factors such as de-
gree of organization and level of politi-
cal sophistication had to be considered.

(4) There were some complaints that some
students become impatient working
with lay people and would revert back
to a reliance on other professionals de-
spite the talk of equality.

(5) It was unanimous that the project
should take responsibility to send to
every project staff member in advance
of the program a list of what project
funds can and cannot be used for.

(6) Everyone should have job descriptions
before starting the work.

(7) Finally, community staff want, psychol-
ogically, to know that students cared
and really are with us. “Even a student
who goes back to California could send
a card to say ‘I was thinking about
you’.”

Recommendations for Community
Control

At this morning’s workshop on the role of
the white medical student in black communi-
ties, an important question was raised but not
resolved. It was mentioned that the only way
the health care delivery in ghetto areas could
be significantly improved would be for the
community to take control of the hospitals and
health facilities and run them. A medical stu-
dent suggested that that was impossible—it
takes ten or twelve years to become a doctor,
how can community people do the things that
doctors do? This completely missed the point,
we think, and we would like to set out our
views on what community control means, how
it could be accomplished, and how SHP could
relate to the movement toward community con-
trol that is taking place in so many areas these
days.

The philosophical basis of community con-
trol has its roots in this country at least as far
back as Thomas Jefferson. The classic liberal
ideal of Jefferson, the faith in the individual
and the commitment to participation in self-
government, is one of the foundations of our
political system. What we have seen in the
United States is the rise of institutions which
SUMMER 1968

were immune from the political system and
were unaccountable to the people who were af-
fected by them; hospitals in ghetto areas with
boards of trustees who didn’t live in the com-
munity are a good example of this, because
they so often become unresponsive to the needs
of the people they serve. The two chief benefits
we see from community control of health facil-
ities, then, are that they would be made res-
ponsive to the needs of the community and that
by having elected health councils or boards
they would be accountable to the people they
serve.

We suggest the following ways to set up a
community health council or board for either a
neighborhood health center or a community
hospital :

1. Make contact with a few active individuals
in the community who are concerned about health

and want to do something to improve the delivery.

system.

2. Set a date for a mass meeting to discuss the
health situation and what can be done about it;
disseminate information about the meeting as
widely as possible, using radio, newspapers, leaf-
lets, and contact with community groups. The
community people could make the personal con-
tacts and the initiating group could provide the
funds and produce the leaflets.

8. At the mass meeting, suggest mechanisms
for electing a board or council and let the as-
sembled group decide which method to use. Pos-
sible mechanisms would be representatives from
all community organizations in the area, a one-
third community, one-third professional, one-third
organization representation, an election from a
slate of all people who had submitted petitions of
support, ete.

4, While the board was being elected, assign a
group to explore means of funding the clinic or
cooperating with the hospital system.

We suggest the following powers for the
community council or board; the obvious as-
sumption is that community people do not need
to be doctors to contro] non-medical decisions
about the health facilities:

A. Control setting of priorities—the com-
munity groups should be the one to assess the
needs of the community and set the priorities of
care provided by the facility in orderto meet those
needs. For example, if there is a serious narcotics
problem in the community, the community groups
should be able to put narcotics treatment high on
the list of priorities; also facilities for premature
babies, or screening for lead poisoning may be

more important for the community than more
glamorous things like open-heart surgery or
sophisticated research.

B. Hiring and firing of medical and ancillary
staff—the community group should be able to con-
trol the hiring of medical personnel after they have
been screened for professional competence by the
medical board or director and ancillary person-
nel on the basis of interviews. In both cases, the
community groups could concern itself with such
things as the attitudes of the employees toward
the community from which the patients come, their
sensitivity to people, and their dependability. Fir-
ing could be done on the basis of staff and patient
complaints.

C. Control of the finances of the health facility
—we contend that community control implies fiscal
control. Administration of the finance could be in
the hands of a comptroller or manager employed
by the clinic or hospital, but decisions as to where
the money wil be spent should be in the hands of
the community group.

We feel that community control is where
things are headed these days and decentraliza-
tion of health facilities in neighborhood health
clinics is one of the most significant trends in
medicine. SHP might involve itself precisely
where these two trends meet; it might set it-
self up as a resource to community people who
want to develop health institutions that are
responsive to community needs or who want to
assume control of existing institutions. Stu-
dents might be able to research other facilities
that have been set up under control and find
out if they are working; they could help with
the organization of the first meeting; and they
could know enough to get out when they are
not needed or when they are getting in the
way. Indeed, if SHP is to have any relevance to
what’s happening, and not be just a liberal ser-
vice organization where future doctors and
nurses get sensitized, then it must embrace and
relate to the concept of community control.

From Workshop on the White Student
in the Ghetto
1. Black people have depended on whites

too long. Any program has to create a
black economic structure in a “together”
community. Blacks don’t want to be used
any longer, to be studied, or to be filmed
—especially to their own disadvantage.

-2, White students can do more by going to

185
 

SUMMER 1968

effective means of approaching the goal
(depending on project site, previous his-
tory of successes and failures, etc.)

. Necessary sensitization should be pri-
marily in winter programs and only sec-
ondary in the summer projects. Summer
should be for doing work and accom-
plishing project goals.

. A special point in the winter program
should be the recruiting of black and
Puerto Rican high school and college stu-
dents who show inclination towards med-
ical and paramedical professions.

Two types of project actions are recom-

mended:
A. Working with independent agencies

doing whatever they want (i.e. foot-
work, research, etc.)

. Setting up projects whose aims are to be
continued by a community group. The na-
ture of the project to be decided and
structured during the winter months.

Summer projects:
1. Structured service projects.—Summer

projects that are specific in design and
are staffed by highly selected students
with similar ideological views. Students
could work in hospitals or with commun-
ity groups where significant preparations

have already been made. This would.

avoid the period of picking out a course
of action and working out of group dy-
namics problems which past SHP’s have
had to go through.

Affiliation with a community organization.—

Projects which could be funded jointly
with a community organization so that
the health students are putting them-
selves at the direct disposal of the com-
munity. The project would have to be de-
signed by students and community organ-
izations together from the start.

. Funding community people.—Projects
would be made up mostly of community

residents who are interested in health is-
sues. The students would use their exper-
tise to get a grant and would support the
project by doing research on issues that
the community workers raise. There
should be more community people than
students in such projects.

4. SHP fund-raising and research.—The as-
sumption is that SHP should try to get
funding from private or local sources.
Students or community groups who are
working on improving health services or
raising political issues in health would
apply for funds for their projects. SHP
might work with law students or civil
liberties groups to research legal implica-
tions of the projects. ‘

5. A Live-in Project—Students would live in
a community, at the request of a local
group and do direct community organiz-
ing around health, organizing neighbor-
hood health councils, bringing direct ac-
tion against hospitals, etc. The prototype
for this is the Cleveland SHP.

6. A Work-in Project.—Students would get
jobs in hospitals or summer research sti-
pends (in community medicine, if. possi-
ble) and would raise issues of inadequate
health care. They would seek alliances
with community groups that could mobil-
ize support for improvement in health
care provision. Year-round projects at
schools: :

We feel that any projects should aim at edu-
cating fellow students about the inadequacies
of health care provision, especially in low-in-
come areas, and should try to correct injustices
that exist in their own medical centers. Pro-
jects could include courses in the “Politics of
Health” or the “Crisis in Medical Care,” hold-

_ing workshops for community people to build

an awareness of health as a right, and devising
means of direct political action to bring about
change in the local health facilities.

187
GREATER NEW

their own white communities. Tf they
want to be involved in the black commun-
ity there have to be safeguards to guar-
antee sincerity and loyalty to the com-
munity.

_ White students are interfering with ex-
isting community structures. People
don’t want whites there all the time
(especially on a summer basis) doing
what blacks should do for themselves.

_ SHP has initiated actions which can be

pursued by the community—legal suits,
advocacy, patterns of reforming the
structure.

. The pattern of action may be reformist
or revolutionary. The revolutionaries
among us regard advocacy as patchwork.
There are health councils galore in a lot
of communities, but what is needed are
law suits, picketing. Medical, nursing,
and law students may disseminate infor-
mation, but the community should take
over the hospitals.

_ Perhaps the Student Health Organiza-

tion should be retitled the Community
Health Organization, run for and by
black students. It is suggested that black
communities select the professionals who
will be trusted, using a greater number
of community people rather than risking
getting insincere health students. It is
unfair to the community to send in ‘fresh
troops’ each year just so they can be sen-
sitized, and then leave, returning to their
schools (to a white structure) where, in
fact, they will be coopted.

. Health professionals are needed because
there aren’t enough black doctors,
lawyers, nurses. In certain cases,
organizations employ professionals they
themselves respect. Health professional
students know what good health care is
and can point the injustices out ‘to the
community, who, in turn, can do what-
ever they want to do to correct them.

Recommendations from NYCs
4. Students need more experience as to com-

munity happenings, i.e., better orienta-

10.

YORK

tion to the community before working in
it.

Working relationships weren’t estab-
lished because of health student atti-
tudes of superiority and lack of interest
in the NYCs.

NYC’s feel that if they are to be consider-
ed equal as stated at Orientation, they
should be given the same wages as the
students. Opposition to this means that
orientation statement was idealistic and
not worth a bag of beans.
Late wages discouraged NYC’s from
working. .

Equalization of work between the NYC’s
and health students: Students -shouldn’t
ask NYC’s to do anything they wouldn’t
do, e.g., Bronx lead poisoning project
where NYC’s had to collect urine speci-
mens from house-to-house; the students
collected a few times but not to the ex-
tent that they made the NYC’s collect.
Lack of constructive work initiated for
either NYC’s or health students discour-
aged NYCs. ,
Some NYC’s feel that the students took
advantage of them as individuals.

NYC’s would like to have practical
health education, such as first aid, artifi-
cial respiration, what to do in emergency
situations like strokes, heart attacks, etc.
NYC’s feel they would appreciate tuto-
rial programs involving their needs and
interests, done on a constructive basis.
NYC’s would like to have representation
within meetings and have something
done to abolish their dislikes. They want
spokesmen to make project directors
aware of their gripes and take action.

Recommendations for Future Student
Health Organization Projects
1.

Summer SHP’s must be a direct continu-
ation of SHO activities that exist during
the year.

The main SHO objective should not be to
sensitize or educate students or commun-

- jty, but rather to basically change the

structure of health care and delivery.

8. Attack should be whatever is the most

 
Appendix A: LISTING OF PARTICIPANTS

CENTRAL OFFICE STAFF

Project Director:

Marylyn Gore—Albert Einstein College of Medicine.
Student Co-directors:

Nivia Nives—Bronx Community College School of Nursing.

Peter Bryson—Downstate Medical Center.
Educational Coordinator:

Simeon Grater—Albert Einstein College of Medicine.
Faculty Sponsor:

Martin Cherkasky, M.D.—Director, Montefiore Hospital and Chairman, Depart-

ment of Community Medicine—Albert Einstein College of Medicine.
SOUTH BRONX

Student Area Coordinator:

Bernice Baker—Bronx Community College School of Nursing.
Community Coordinator:

Marie Gallishaw
Faculty Advisor:

Harry Becker—Albert Einstein College of Medicine.
Medicine:

Nora J. Avins—Woman’s Medical College.

Karen E. Benker—University of Southern California.

Ingrid Buhler—Albert Einstein College of Medicine.

Robert Cohen—-Albert Einstein College of Medicine.

Peter Cummings—Case Western Reserve University.

Robert Ferrell—New York Medical College.

Christopher Frantz—Albert Einstein College of Medicine.

John Graves—Albert Einstein College of Medicine.

Michael Pawel—Albert Einstein College of Medicine.
Nursing:

Iris Arroyo—Bronx Community College.

Patricia Benson—Syracuse University.

Harriet Hair-—-Bronx Community College.

Madeline Jervis—Bronx Community College.

Anna Lopez—Bronx Community College.

Vicki Vernig—-San Jose State College.

Jean Whelan—Hunter College.
Law

Arthur Kaplan—Harvard University.
Dentistry

Victor Sternberg—Tufts University.
Community Workers

Miriam Feliciano

Elizabeth Frole

Mercedes Hunter

Carmello Rodriguez
Program Advisor

Fannie May

BROOKLYN

Student Area Coordinator

Warren Sweberg-——Downstate Medical Center.
Community Coordinator

 

189
140

GREATER NEW YORK

Marian Williams.
Faculty Advisors

June Finer, M.D.—Columbia University.

Jeff Weiner—Downstate Medical Center.
Medicine:

William Basta—Downstate Medical Center.

Richard Berkowitz—Downstate Medical Center.

Ernest Braasch—Downstate Medical Center.

Eric Cameron—Downstate Medical Center.

Benjamin Fass—-Downstate Medical Center.

Robert Johnson—Downstate Medical Center.

Daniel Koblentz—Downstate Medical Center.

Leslie Kriegman—Downstate Medical Center.

Margo Mazur—New York University.

Joseph Ryan—Downstate Medical Center.

Jules Tanenbaum—Downstate Medical Center.

Richardo Wilson—-Downstate Medical Center.

Daniel Yellon—Downstate Medical Center.
Nursing

Leslie Clarke—Boston University.

Ellen Pindus—Molloy College for Women.
Law

Roger Haines—University of California at Berkeley.
Dentistry

Jan Wade Gilbert—Meharry Medical College.

Steven Parnes—Meharry Medical College.
Sociology

Marian Hyler—Tufts University.

HARLEM

Student Area Coordinator

Richard Clapp—Columbia University.
Community Coordinator:

Mary Smalls.
Faculty Advisors:

Ezra Davidson, M.D.—Harlem Hospital.

Doris Wethers, M.D.—Knickerbocker Hospital.
Medicine:

Joan Adler—University of Cincinnati.

Louis Bartoshesky—Cornell University.

Ken Cousens—Columbia University.

James Cowan—Meharry Medical College.

Stephen Gluckman—Columbia University.

Barry Goozner—Columbia University.

John Hibbert—Howard University.

John Obedzinsky—Columbia University.

Colin Romero—Howard University.

William M. Smith—Columbia University.

Carter Willsey—Columbia University.
Nursing

Angela Gaetano—Hunter College.

Patricia Jones—Bronx Community College.

Barbara McFadden—Bronx Community College.
Law

Ellsworth Martin—Howard University.

Francis Vergata—University of Chicago.
Psychology

Marla Isaacs—Columbia University.

International Affairs:
Janet Barrett—Columbia University.

 
GREATER NEW YOUKK

Clinics Scheduled daye Time Ext.
*Endocrine & Obesity ------ Wednesday -.--------------- 1:00-8:00 p.m. --- 715, 117
*Hematology -------------- Wednesday ----------------- 9:00-11:00 a.m. .- 715, 117
*Neurology --------------- ist and 3rd Mondays __.- 2. -9100-11:00 a.m. -- 115, 717
*Pediatric Follow-up ------- Monday, Tuesday and
Thursday .--------------- 41:00-12:00 noon . 715, M7
*Pediatric General -------- Monday through Friday ----

8:00-4:00 p.m. --- 715,717

*Physical Handicapped -..-2nd Tuesday ---------------- 9:00-11:00 a.m. -- 716, 717

*Premature -.------------- Wednesday .-.-------------- 1:00-8:00 p.m. --. 715, 717 ‘
*Respiratory Follow-Up --.-Tuesday ----------------+"- 9:00-11:00 a.m. -- 715, TW7
*Seigure -..--------------- Thursday ------------------ 9:00-11:00 am. -- 715,717
*Surgical Follow-Up ------- Wednesday ----------------- 1:30-3:30 p.m. --- 715, 17
*Urology .---------------- Tuesday ------------------> 9:00-11:00 am, .. 715, 717
Surgery: . ,
*Breast _.----------------- Wednesday ----------------- 1:80-8:00 p.m. --- 414
Child _._-.----------- _--Monday, Wednesday and
Friday -.----------------- 9:00-11:00 a.m. -- 580
Diagnostic ..------------ Monday and Tuesday -------- 1:00-8:00 p.m. --- 580
Thursday ------------------

Female __..-------------- Thursday and Friday -------- 9:00-11:00 a.m. -- 490
Followup --------------- Thursday ------------------ 1:00-8:00 p.m. --- 580
Hand ..-------- tl eeeenee Wednesday ----------------- 9:00-11:00 a.m. -- 580.
Male ._..--------------- Monday, Tuesday, Thursday

and Friday .-------------- 9:00-11:00 a.m. -. 589

, *Plastie -.-.-------------- Monday .------------------- 1:00-3:00 p.m. --- 580
Thursday ------------------ 9:00-11:00 a.m. -- Ai4

*Podiatry -.--------------- Tuesday --.---------------- 9:00-11:00 a.m. -- 408
Wednesday -.-------- eeeenee 1:00-3:00 p.m. --- 408

*Proctology --------------- Monday and Friday --------- 9:00-11:00 a.m. -- 580
*Thoracic .----------------Monday and Thursday --.---1:00-3:00 p.m. --- 418
*Tumor, Head, & Neck _...Wednesday ----------------- 9:00-11:00 a.m. -- 490
*Urology-Adult -.----- leeeee Tuesday and Thursday ----- 9:00-11:00 a.m. -- 580
Infertility (Male) -------- Wednesday ------------- __.-5:00-8:00 p.m. --- 580
*Vascular ..--------------- Tuesday and Friday ---.----- 1:00-3:00 p.m. --- 418

Ear, Nose and Throat __.-Monday, Tuesday,

Thursday and Friday ----- 1:00-3:00 p.m. --- 490

Eye ....----------------- Monday, Tuesday, - oe

. Thursday, Friday --------- 1:00-8:00 p.m. .
Oral Surgery ----------- Monday through Friday ___. 8:00-4:00 pm. --- 657
Others:
Blood chemistry ‘--------- -Monday, Tuesday and ‘ a
Thursday ...------------- 7:00-9:00 a.m. .-- 408

Mental Hygiene— .

(Adult and Child) ---- Monday through Friday ----- 9:00-5:00 p.m. --- 567
Adult ._..--.--------- Tuesday, Wednesday and / .
. Thursday -.-------------- 5:30-9:00 p.m. ..-- 567

Rehabilitation Medicine ...Monday through Friday -.--- 8:00-11:80 a.m. -- - 584

Employees Health Service Monday through Friday ----- 8:00-4:00 pm. .-. 417

* Appointment clinics oe

Central, Harlem Destrict Health Center
2238 Fifth Avenue (197th Street) AU 3-1900 -
I. Dental clinic : Ce
1. The patient must come from 2 public school within the health district (Public.
School 189, 136, 175, 183, 197, 120), but they do riot have to be referred,
through the school—if a child attends one of the schools a parent ‘may
bring him to the clinic. Looe tate btr

 

 

146 |

 
SUMMER 1968

Community Workers:

Charlie Mae Jones.

Nettie Knox.

Maxine Livingston.

Altamese Maxwell.

LOWER EAST SIDE

Student Area Coordinator:

Steven Dubovsky—New York University.
Community Coordinator :

Helena King.
Faculty Advisor:

Alice Miller—New York University.
Medicine:

Jerome Aronowitz—University of Maryland.

Edward Charney—New York University.

Joseph Colletti—Howard University.

Kenneth Ducker—New York University.

Judith Pleasure—New York University.

Diana Post—New York University.

Sharon Ruskin—Marquette University.

Peter Sheckman—New York University.

David Sternberg—Tufts University.

Joseph Willner—New York University.
Nursing: —

Beryl Gifford—Hunter College.

Marilyn Levine—Hunter College.

Judith Levy-—Hunter College.

Joan Musaro—Hunter College.
Law:

Martha Halpin—Yale University.

Jonathan Marsh—New York University.

Bettina Plevan—Boston University.
Dentistry:

Gerald Low—New York University.
Psychology:

Linda Gunsberg—Yeshiva University.
Community Worker:

Sharon Diaz.

NEWARK

Student Area Coordinator

Daniel Tartaglia—New Jersey College of Medicine.
Community:

Reginald Peniston
Faculty Advisor

John Seebode, M.D.—New Jersey College of Medicine.

Medicine
Richard DeBlasi—New Jersey College of Medicine.
James Davis—Howard University.
Peter Dorsen—New Jersey College of Medicine.
Karen Filkins—New Jersey College of Medicine.
Andrew Hurayt—University of Rome.
Dennis Massler—New Jersey College of Medicine.
Bruce Wermuth—Stanford University.
Walter Wiechetek—University of Maryland
Nursing:
Andra Cross—-St. Mary’s College. .
Laura Doner—O’Connor School of Nursing.
Ann Maroney—Syracuse University. |
Joyce Quock—O’Connor School of Nursing.
Kathleen Sherdian—St. J oseph’s College.

141

 
142

Law:

Neal Wiener—Loyola University of Los Angeles.

Community Workers:
James David Branch

NA awe

Katherine Cunningham

George Acosta
Myrna Alvarez
Louis Aquino
Cathie Baker
Alan Benton
Shirley Beechem
Gail Bristol
Eugene Brown
Alfred Burt
James Canty
Joanne Challenger
Pat Carswell
Roscoe Carthen
Victor Castro
Nelson Cintron
Michael Colden
Earl Collins
Kevin Collins
Gregory Dabney
Gregory Darby
Bradley Davis
Vashti Davis
Alvin Duggins
Rafael Figuera
LaVell Finerson
Willard Finerson

Sociologist Evaluator:

NEIGHB

ORHOOD YOUT

Walter Fletcher
Nellie Garcia
Maria Gomez
Mirella Gomez
Jeffrey Goodson
Elaine Hale
Walter Hall
Nurseal Hill
Dwight Jackson
Agnes Jacobs
Alzrina Johnson
Gloria Jones

Lilly

Jones

Leonard Knox

Eric

Livsey

Michael McClamb
Frank Morales
Josephine Morales
Arthur Murphy
Mason Napir

Julio

Nieves

Elizabeth Norwick
Terry Ormand
Doris Ortiz
Martha Pacheco
Gladys Padilla

Ronald Miller—-New York University.
Administrative Assistant:

Jody Williams—Albert Einstein College of Medicine.

Project Secretary:
*Richard Perez.

H CORPS

Gwendolyn Page
Carlos Perez
Raymond Perez
David Ravenell
Tom Reynolds
David Rhabb
Jack Rivera
Naomi Robinson
Nilda Rodriquez
Leroy Rozus
Rodney Shepard
Laverne Singleton
Cassandra Smith
Joan Smith

Leon Terry
Randolph Tomlin
Mamie Towns
Gabriel Vasquez
Julio Vasquez
John Watson
Norm Whitlow
Phyllis Whittiker
Marilyn Whittfield
Marilyn Wilder
Denise Wills
Nina Yung
Appendix B: HEALTH RESOURCES IN THE HARLEM AREA

HARLEM HOSPITAL OUT PATIENT DEPARTMENT
Lenox Ave. and 137th St. AU 6-3300

People in charge Service
Dr. Wesley --------------- Director ambulatory care
Dr. Russell .------------- Director social services
Mr. Watkins ..-.---------- See for clinic problems
Mr. Giddings ------------- Surgery clinics
Miss Mebane .------------ TB clinic
Mrs. Johnson ------------- Emergency room coordinator
Mrs. Place _.-------------- Pediatric clinic coordinator
Dr. Kahn _..------------- Director Pediatrics
Miss Richardson -.-------- R.N. pediatric clinic
Mrs. Williams ------------ Clerk, pediatric clinic

Clinic procedure:
I. New patient (never been to HH. before)
1. Start at the initial screening desk
2. Screening area
a. examination for the type of medical problem
b. clinic card number is assigned
. medicaid application can be made
. blod and urine tests are ordered
. X-ray (required by state law)
_ sent to a specific clinic window for the medical problem
8. Specified clinic window
a, medical records are completed and sent to be kept in the file room
b. Now the patient may be:
(1) given an appointment for the correct clinic for his problem or
(2) sent directly to the correct clinic when immediate service is possible
or
(3) sent to the emergency room if immediate treatment is needed but
the clinic for his problem is closed
4, ‘When a patient goes to a specific clinic for his problem
a. drop the clinic card into the box or hand it to the clerk .
_b. clerk then either fills out medicaid form or makes out a bill for the patient
c. patient then sits and waits to be called for treatment
‘II, Old patient (been to H.H. for that problem before)
4. If the clinic that the patient goes to is an appointment clinic, the patient
goes straight there on the day of the appointment and drops the appointment
- eard in the box or hands it to the clerk. The patient’s records will already
be there. ,
III. Old patient with a new problem
1. Patient must first go to the screening desk for an examination for the type
of medical problem
2. Then the patient may
a. go directly to his specific clinic if it is a non-appointment clinic or
b. get an appointment for his specific clinic if that clinic requires appoint-
ments or :
c. go to the emergency room if immediate treatment is needed but the clinic.
for his problem is closed ,
IV. Obstetrical-Gynecological Clinic (Ob-Gyn)
1. Itis on the 8rd floor of the K building . ‘ ee
2. It requires a double registration—once on the ground floor at the clinic
registration desk, and then again on the Ob-Gyn floor (8rd).

ho ae

148
144

Vv.

VI.

VII.

VIII.

XI.

GREATERK NHW YURK

3. Ob-Gyn does its own screening and keeps its own records

Emergency Room

1. Ambulance service is by police call only

2. All patients must be registered and screened at the emergency room registra-
tion desk.

Pediatric Clinics - os

1. They are on the 8rd floor of the pediatric building—patient goes directly

there to register
2. These clinics see infants and children up to about 11-12 years of age.
8. Procedure

a. Patient goes directly to the pediatric clinic

b. New patients go to the clerk to register and to fill out a medicaid applica-
tion:

Old patients go to the clerk and give her the clinic card and the medicaid
card (if they get medicaid).

c. Now sit and wait to be called for treatment .

a. Note: to save time—if the child has a clinic card (any child who has been
to H.H. before or was born there has one) the parent.can call a day
ahead so then his child’s hospital records will already be at the clinic and
will not have to be sent for when he comes.

e. If there is any trouble ask for Mrs. Place. She is in charge of the clinic
and is there to take care of a patient’s problems

Oral Surgery Clinic
1. This is the only place in the Harlem area that one can go to get teeth pulled

(except to a private dentist). .

2. Must get there at 8:00 A.M. to have a general examination. This is required
before they will give a patient the general anesthetic (gas).

3. Parent must accompany child the first time to register him, then the child
can come with anyone the next time.

Opthamology Clinic

1. Very poor clinic at H.H. Go someplace else like to MIA.

Psychiatric Clinic

4. All of the psychiatric facilities available to the Harlem area are described
on pages 14-18. ,

Additional Remarks about Harlem Hospital:
1. The specialty clinics have anywhere from 3 weeks to 2 months waiting list.
2. A playroom will be opened in the pediatrics clinic at the end of the summer.

It will be staffed by a full time paid worker from the Domestic Peace Corps. It

is there for the children who come to the clinic so that the waiting will be more

bearable both for them and for the parents who bring them. ,

Paying: :

a. The fees at H.-H. are determined on a sliding scale; this means that a person
pays an amount that is based on the income of his family. ,

b. Patients do not have to pay when they get the treatment; they can ask that
the hospital send them a bill.

c. The bills usually do not come for many months.

d. If a person has medicaid, he only has to bring the bill back to the hospital
along with his medicaid card. That takes care of the bill. oo. .

e. A patient should not worry about any billing problems. Treatment must be
given for all, regardless of financial status.

. If a patient has any difficulty in one of the clinics, he. should ask to see Mr.

Watkins.

*Appointment clinics

Clinics Scheduled days =. sme: Ct

- Gynecology . :
*Cytology ....------------- Monday ....------------- --21:00-8:00 pm. -. 680
*Dysmenorrhea ..-.-------- Thursday -.---------------- 9:00-11:00 a.m. -- 630
“SUMMER 1968

Clinics Scheduled days Time Ext.
*Endocervicitis .----------- Wednesday ....------------- 9:00-11:00 am. -. . 680
*Endocrine ._.------------- Wednesday and Thursday _.-1:00-3:00 p.m. --- 630

: . Wednesday ..--------------- 9:00-11:00 a.m. -- 680
*Gynecology General ------ Tuesday ------------------- 42:30-3:00 p.m. - 630
Gynecology General ------ Monday, Tuesday
Thursday, Friday --------- 9:00-11:00 a.m. -- 630
*Infertility .---.---------- Wednesday, Thursday - ------ 1:00-3:00 p.m. --- 630
*Menopausal -------------- Thursday .----------------- 9:00-11:00 a.m. -- 680
*Tumor Follow Up -.------- Monday -..----------------- 1:00-3:00 p.m. --- 630
Maternal Health --------- Saturday .------------------ 9:00-12:00 noon - 628
*T.U.D. _...--------------- Tuesday and Wednesday - --- - 9:00-11:00 a.m. -- 628
*Oral Contraception --.----- Wednesday and Thursday -. - _12:30-4:00 p.m. -- 628
MEDICAL CLINICS:
*Allergy .----------------- Wednesday and Friday -.----- 9:00-11:00 a.m. .- 408
*Cardiac _...-------------- Monday, Wednesday ---------
Thursday and Friday -------- 9:00-11:00 a.m. -- 639
*Chest & T.B.C.— -.-------- Monday, Wednesday,
Adult _...--------- Thursday and Friday ----- 9:00-11:00 a.m. -- 418
Children -.--------- Tuesday -..----------------- 9:00-11:00 a.m. -- 418
Dermatology ------------- Monday through Friday --- -1:00-3:00 p.m. --- 689
*Pijabetes _..------------+- Tuesday and Friday --------- 1:00-3:00 p.m. --- 668
Diabetic Supply and .
Instruction _--.---------- Monday through Friday ----- 9:00-11:30 a.m. -- 408
*Gastroenterology --------- Consultations, Wednesday ---1:00-3:00 p.m. --- 687
Hematology -.------------ Wednesday --.--------------- 1:00-3:00 p.m. --- 580
*Medical _.__.------------- Monday through Friday ----- 9:00-4:00 p.m. -- 637, 668
Medical Reception -.------- Monday through Friday --- -- 9:00-4:00 p.m. 540
*Neurology. --:------------ Tuesday: -----------------+- 1:00-3:00 p.m. -- 580
*Thyroid .---------------- Tuesday oe eee cence eee e- 9100-1100 a.m. -- 639
Venereal Disease— ,
Male G.C. .---------- Monday through Friday ----- 9:00-11:00 a.m. -- 639
Syphillis -..---------- Monday through Friday ----- 4:00-3:00 p.m. --- 6389
OBSTETRICAL. :
Antepartum (new cases) .-Monday through Friday ----- 9:00-11:00 a.m. -- 631,
*Antepartum (revisits) __.-Monday through Friday - ---- 1:00-3:00 p.m. --- 631
*Antepartum Adolescent ___Priday ...------------------ 1:00-3:00 p.m. --- 631
Family Planning General _-Tuesday, Wednesday and 5:30-7:30 p.m. --- 631
Thursday .-------- aw eeee 1:00-3:00 p.m. --.- 6381
Post partum ------------- Tuesday ------------------- 1:00-3:00 p.m. --- 631
Orthopaedic and fracture:
*Fracture—
Adult ....----------- Tuesday and Friday -------- 1:00-3:00 p.m. --- 414
Child _.-------------- Friday ...------------------ 9:30—-11:30 a.m. -- 592
*Practure—End Results. . :
(Long term follow--up) - -Thursday .--------------- 1:00-3:00 p.m. --- 414
*Orthopaedic—Adult Monday ..------------------ 1:00-8:00 p.m. --- 592
Child ...-.------------- Friday ..------------------- 9:30-11:30 a.m. -- 414
Pediateric:
*Allergy -.---------------- Wednesday and Friday ------ 9:00-11:30. a.m. -- 715,717
*Cardiac _.-_-------------- Thursday. .----------------- 1:00-3:00 p.m. --- 721
*Dermatology ---.--------- Tuesday -.--------------- -9:00-11:00 a.m. ..° 715, 717
*Development ------- veces Monday -------------------- 1:00-3:00 p.m. --- 715,717
*Deabetes ..-.------------ ist Tuesday -..---------+- 715, 117

*Appointment clinics

_-9:00-11:00 a.m. --

145
GREATER NEW YORK

Clinics Scheduled days Time Ext.
*Endocrine & Obesity ------ Wednesday .---------------- 1:00-3:00 p.m. .-. 715,717
*Hematology -------------- Wednesday -.--------------- 9:00-11:00 a.m. .. 715,717
*Neurology --------------- ist and 3rd Mondays ----- -.9:00-11:00 a.m. -- 715, 717
*Pediatric Follow-up ------- Monday, Tuesday and
Thursday -.-------------- 11:00-12:00 noon . 715,717
*Pediatric General --.------ Monday through Friday ---.
8:00-4:00 pm. ..- 716, 717
*Physical Handicapped _.--2nd Tuesday ---------------- 9:00-11:00 a.m. -. 715, 717
*Premature _-------------- Wednesday .---------------- 1:00-3:00 p.m. -.- 715, 717
*Respiratory Follow-Up _...-Twesday ------------------- 9:00-11:00 am. .. 715, 717
*Seizure ._.--------------- Thursday ------------------ 9:00-11:00 a.m. -. 715, 717
*Surgical Follow-Up ------- Wednesday .---------------- 4:30-3:30 pm. ... 715, 717
*Urology ----------------- Tuesday -.----------------- 9:00-11:00 am. -. 715,717
Surgery: :
*Breast __-.--------------- Wednesday ----------------- 1:30-8:00 p.m. --- 414
Child _..-..------------ Monday, Wednesday and
Friday ..----------------- 9:00-11:00 a.m. -- 580
Diagnostic ...----------- Monday and Tuesday -------- 1:00-3:00 p.m. --- 580
Thursday .-----------------

Female ....-------------- Thursday and Friday -. - ----- 9:00-11:00 a.m. -- 490
Followup --------------- Thursday ------------------ 1:00-8:00 p.m. --- 580
Hand ..-------- eee ee Wednesday ----------------- 9:00-11:00 a.m. -- 580.
Male ___.---.----------- Monday, Tuesday, Thursday

and Friday .-------------- 9:00-11:00 a.m. -- 589

*Plastic ...--------------- Monday ..------------------ 1:00-3:00 p.m. -.- 580
Thursday ..---------------- 9:00-11:00 a.m. -- 414

*Podiatry ..--------------- Tuesday ..----------------- 9:00-11:00 a.m. -- 408
Wednesday ...-------------- 1:00-3:00 p.m. --- 408

*Proctology --------------- Monday and Friday --------- 9:00-11:00 a.m. -- 580
*Thoracic _..-------------- Monday and Thursday ------ 1:00-3:00 p.m. --- 418
*Tumor, Head, & Neck _... Wednesday ----------------- 9:00-11:00 a.m. -- 490
*Urology-Adult -_--.------- Tuesday and Thursday ----- 9:00-11:00 a.m. -- 580
Infertility (Male) --.----- Wednesday ---.------------- 5:00-8:00 p.m, --- 580
*Vascular _....------------ Tuesday and Friday - ------- 1:00-8:00 p.m. --- - 418

Ear, Nose and Throat _..-Monday, Tuesday,

Thursday and Friday -.---- 1:00-3:00 p.m... .- 490

Bye _..-.---------------- Monday, Tuesday,

Thursday, Friday -.- ------- 1:00-3:00 p.m.
Oral Surgery ----------- Monday through Friday _...8:00-4:00 p.m. -.- 657
Others:
Blood chemistry ‘---------- Monday, Tuesday and ©
Thursday -.-------------- 7:00-9:00 a.m. --- 408

Mental Hygiene—

(Adult and Child) -... Monday through Friday --.--- 9:00-5:00 p.m. -.- 567
Adult ..-...--.------- Tuesday, Wednesday and
. Thursday ...------------- 5:30-9:00 p.m. --. 567

Rehabilitation Medicine --.Monday through Friday ----- 8:00-11:30 a.m. -- 584

Employees Health Service Monday through Friday ----- 8:00-4:00 p.m. .-- 417

* Appointment clinics

Central, Harlem Destrict Health Center
2238 Fifth Avenue (137th Street) AU 3-1900
I. Dental clinic
1. The patient must come from a public school within the health district (Public
School 139, 136, 175, 133, 197, 120), but they do not have te be referred
through the school--if a child attends one of the schools a parent may
bring him to the clinic. + ,

146
SUMMER 1968

To be eligible the child must be between the fifth grade through junior high
school.

Parent must accompany child only on the first visit, when history and financial
information are given and a consent form is signed. No treatment is given
on the first visit; appointment will be made for a later date. Registration
times are 9-11 a.m., 1-4 p.m. Monday through Friday.

a. Treatment appointments can be for the morning or the afternoon;
parent need not be with the child on these visits.

Paying: Depends upon family income. If income is too high one is not eligible
for the services, if the patient is eligible the services are free.

The dental clinic does everything but tooth extractions (must go to Harlem
Hospital oral surgery or private dentist). ,

School dental chairs

a. A number of schools have dental chairs. These are merely extensions of the

dental clinic, and therefore function similarly and provide the same
services.

b. Locations: Public School 24—22 East 128th Street LE 4-2866.

Public School 68—127 West 127th Street MO 2-1410.
Public School 144-134 West 182 Street MO 2-8460.
Public School 156—-2960 Eighth Avenue AU 1-4347.
Public School 194—242 West 144 Street WA 6-0580.
Public School 188—2121 Fifth Avenue AU 3-3056.

II. Social hygiene clinic

1.
2.

3.

Dr. Bloom is in charge.
Person may receive free venereal disease examinations and treatment without
appointment.
Hours: Monday 9-11.
Tuesday 1-5
Wednesday 9-11.
Thursday 1-7
Friday 9-11.

III. Maternal and Child Health Station

1.

fe

Services:

a. This facility is for well babies; One should not take a sick child here.

b. Periodic physical examinations. ,

c. Immunizations for DPT, polio, smallpox, and measles. (Monday and Friday,
9-11 a.m. come early).

d. Parent can come ask a doctor or nurse advice, etc.

e. When child enters school the records that are kept here will be sent to the
school. ae

Children from birth to school age are eligible.

Walkin (with parent) will be accepted the first time, but afterwards must

have an appointment.
Hours: Monday and Thursday AM and PM.
Tuesday, Wednesday and Friday AM only.

. Additional Locations:

Morningside Health Center, 264 West 118th Street MO 38-8822, .
Upper Harlem Child Health Center, 231 West 151 Street TO 2-2640.
Mt. Morris Park Child Health Center, 122 Street and Madison Avenue
LE 4-4612. ;
St. Nicholas Child Health Center, 281 West 127th Street UN 5-1800.
Stephen Foster Child Health Center, 50 Lenox Avenue EN 9-4610.

IV. Chest clinic . .

1.

2.

3.

Only location is the Morningside Health Center, 264 West 118th Street MO
83-3822. rere

At this clinic chest X-rays and other tests are given to find out if person has
tuberculosis or other diseases of the chest. If disease is found, treatment is
given. : : no

Call for an appointment.

147
148

GREATER NEW YORK

V. Eye Clinic

1. Persons up to 21 years of age are eligible for the eye examinations and

prescriptions for glasses.

2. Patient is usually referred through a school nurse or through a child health

station, but parent may call for an appointment.

8. There is an additional location at the Morningside Health Center.

VI. Health Education Services

1. Dr. Monrose is the health education officer for the district. He is located in

room 212,

2. Consultation services are offered in the planning of health committee activities
and health programs for church groups, PTA’s and other clubs and settle-

ment houses,

3. Films and pamphlets on a wide variety of health topics are available. A
minimum of three weeks notice is essential in booking films, although by
special arrangement one may pick up the films at the NYC Department of
Education Film Library at 305 Fifth Avenue, room 11D, within 3-4 days

of ordering.

a. The order must be placed with the district officer. No more than 4

films may be ordered at once.
4, Speakers are also available with 4-5 weeks notice.

VII. Other Agencies in Central Harlem District Health Center building.

Visiting Nurse Service of New York, room 215 AU 6~-7210.
Family and Child Welfare Student Unit, room B36.
Pediatric Social Service, room 211.

Alcohol Unit, rooms 307, 308, 311.

Community organization for Social Service, room 318.
Rehabilitation Medicine, rooms 334, 335.

FOF Owe

Summary and Time Schedule of
SERVICE IN CENTRAL HARLEM HEALTH CENTER DISTRICT
(February 1968)

Legend: A=9-12 a.m. P=1-4 p.m. E=4-7 p.m. *= First and third Tues-

day of month
Central Harlem District Health Center Build- :
ing, 2238. Fifth Avenue, NYC. 10037 283-1900. M T Ww T
Dental ....____.....--.------------+-+---- AP -AP AP AP
Social Hygiene __-.--_-------------------- AP P A PE
Maternal and Child Health _____----------- AP A A AP
Bye ._..---_------------------+----+------ AP : P
Morningside Health Center, 264 West 118
Street, NYC. 10026 MO 38-3822.
Dental _.___........-+------------------- AP AP AP AP
Maternal and Child Health _.---_-.-.------- A A A AP
Bye ____..__.__.------------- ee eee P A A A
Chest _....-.---------------------------- AP A*PE* A AP
Prenathan and Family Planning --------.-- Pp P
Upper Harlem Child Health Center -.--------- A “A A A
231. West 151 Street, NYC. 10039 AU 3-1970. ,
Mt. Morris Park Child Health Station °.....-.-.- .
122 Street and Madison Avenue, NYC. 10035 A A
LE 4-4612. P
Prenatal and Family Planning ....-_.....-. A A A
St. Nicholas Child Health Station -......-.----
281 West 127 Street, NYC. 10027 UN 5-1300.. A
Stephen Foster Child Health Station .-...-----
50 Lenox Avenue, NYC. 10026 _.N 9-4610. A AP
Alexander. Hamilton Child Health Station ------ as
2690 Eighth Avenue, NYC. 10030 862-8002. : woes
Dental Clinics in the Schools (See page 3) ---- A A. A A>

> > > bP

>>> > a

>> > >

>
 

SUMMER 1968

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

Clinies: .
Monday ------------ Internal medicine --------------- 10-12 noon.
Dermatology ------------------- 1-2:30 p.m.
Tuesday ----------- Har, nose and throat ------------ 9 am.2 m.p.
Gynecology -.----------------777 2-4 p.m.
Allergy ---------------- ceeee eee 10 a.m.-12:30 p.m.
Wednesday --------- Ophthamology ------------------ 10 am—1 p.m.
Thursday ---------- Pediatrics .--------------------- 10:30 a.m.—1:30 p.m.
Friday ...---------- Internal medicine ------------- -- 10 a.m—1:30. p.m.
Saturday ----------- Ear, nose and throat -.---------- 9 am—1 p.m.
Optometrist -------------------- 1:30 p.m.—4 p.m.

1. MIA is a very pleasant place—it does not look like a clinic. The staff is courteous
and thorough, and the wait tends to be the shortest of any clinic in the Harlem
area.

2. Itis best to call and make an appointment for one of the clinics in advance.

8. Get there early—30-45 minutes before clinic starting time—for the shortest wait.

4, Paying: patient must pay from 8-10 dollars per visit. They accept medicaid.
They will not send a pill as Harlem Hospital Clinics do. ,

5. For eye problems, go to the optometrist first. He will refer patients to the
opthalmologist if it is necessary.

6.. If there are any difficulties see Dr. Farkas, the director.

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

Por P

aS

8.

Eye clinic—First floor.
Ear, nose, and throat clinie—Second floor.
Allergy clinic—Second floor.
Hearing and speech clinic.
Laboratories—Second floor.
Pharmacy—basement.
A modern, well-equipped facility.
Mrs. Benoit is the Outpatient Department Supervisor.
Mrs. Fernandez is the Registrar.

First visit is for registration and screening only; a parent must accompany @
child.

Second visit is for a speciality clinic for which the patient has been given an A.M.
or P.M. appointment (always on the same day of the same week as the first
clinic visit). -

For a foster child the BCW number and the case number are required.

Procedure for a new patient

No appointment—arrive by 8:30 a.m. on any weekday.

Patient gets number at the information desk and sits to wait for an interview.

At interview the patient receives a clinic card and a chart number. '

Patient then gets in line and pays in advance for treatment (see Paying be-

low). ‘

e. After paying the patient receives his chart and goes to the screening clinic
where he gives the chart to the nurse and waits to be called.

{. Doctor screens the patient and recommends either returning to the screening
clinic or to a speciality clinic at a later date.

g. Patient takes white slip to appointment window and there receives an ap-
pointment slip which he must not lose. :

Paying:

a, The first visit costs $5. .
b. All subsequent visits cost $4.50.

aess

149
GREATER NEW YORK

¢. X-rays, laboratory work, etc. all cost extra.

d. Special fees may be reduced at the discretion of the payment desk, but pa-
tient must always pay something unless Medicaid or insurance covers fees,

e. There is no billing procedure—patient must pay (or present Medicaid card)
on the spot.

KNICKERBOCKER HOSPITAL
70 Convent Avenue, AU 1-4100

1. Pediatric clinic only.
2. A.M. on Monday and Friday.
P.M. on Tuesday, Wednesday, and Thursday.
No screening is required; appointments can be made by phone.
4. Paying:
a. The first visit costs $3.
b. All subsequent visits cost $2.
c. Patient does not have to pay at the time of treatment; the clinic will send a
bill.
d. Medicaid is accepted in full.

ADDICT REHABILITATION CENTER
253 West 123d Street

1. A half-way house for individuals desiring to be cured of heroin addiction.

2. Persons desiring to enter must send a letter or call Mr. James Allen, the director.
A personal interview follows this letter.

8. Has both inpatient and outpatient services, As of now women are only seen on

an outpatient basis.
4, This is a realistically oriented facility which is run by a staff of ex-addicts.

5. Mr. Allen or one of his staff is also available to give illustrated talks on drug
addiction.

6.. One of their most important functions is the finding of jobs for the patients stay-
at the center. One of their most important goals for a patient is the achievement
of economic self-sufficiency and stability.

CHILD PSYCHIATRIC SERVICES AVAILABLE
IN THE HARLEM AREA
Because of the increasing awareness of the need for child psychiatric treatment in
the Harlem area and because of the difficulty in attaining such treatment, these facili-
ties have been compiled separately.

HARLEM HOSPITAL

2238 Fifth Avenue, District: 116th. Street to 155th. Street
Inpatient service: there is no inpatient service. Outpatient service: handles ap-
proximately 500 patients a year.

A.. Staff: 3 full-time psychiatrists

3 part-time psychiatrists
1 psychologist os .

B. Diagnosis: waiting period is from three days to a month; diagnosis is done in a
conference with a psychiatrist, a social worker, and a psychologist.

C. Treatment: children are referred to Bellevue, social agencies, special schools,
Rockland State Hosp., and the Bureau of Child Welfare for placement in
special homes.. Treatment at Harlem Hospital seldom exceeds one appoint-
ment a week with a psychiatrist; occasionally, children are treated by a
social worker. ;

D. Special facilities: . Harlem Hospital runs a special school for children aged 9 to
13. There are now 15 children in it and there are plans to expand it.

ST. LUKE’S HOSPITAL
421 West 113th, Street, District: 86th. Street, to 125th. Street,
Morningside to the river
Inpatient service: no inpatient service. Outpatient service: handles approximately
500 patients a year. :

a

150
SUMMER 1968

A. Staff: rotating staff of residents.

B. Diagnosis: waiting period is about a month; the child does see a psychiatrist
after he has gone through the pediatrics clinic. :

C. Treatment: waiting period is about 6 months;
ali treatment is by psychiatrists—appointments are seldom more frequent than
one per week per child.

PRESBYTERIAN HOSPITAL
West 168th. Street and Broadway, District: 155th. Street to 181st. Street
Inpatient service: there are 16 inpatient beds (in the New Psychiatric Hospital)
which are used for teaching and research as well as treatment. Outpatient service:
handles approximately 800 cases a year and accepts about 15-20 per cent for treatment.
A. Diagnosis: waiting period is one to 83 months and all children must go through
the pediatries clinic before child psychiatry.
B. Treatment: varies depending on the needs of the family—may be appointments
with psychiatrist, family conuseling, or group therapy; may be as often as
three times a week. Referrals are drawn from all sources.

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

MT. SINAI HOSPITAL
144 Madison Avenue, District: unlimited
Inpatient service: there are 15 inpatient beds which are used for teaching and
research as well as treatment; the service has 7 psychiatrists part-time and pa-
tients are usually not accepted for more than three months.
Outpatient service:
A. Staff: 8 psychiatrists—part-time
2 psychologists—full-time

B. Diagnosis: children are referred from al lsources and are screened in the sum-
mer; a doctor sees the child and a social worker sees the family. In September
25-30 cases are accepted for the year—no more are accepted.

C. Treatment: here again, patients are accepted who will be good teaching material;
children seldom see the therapist more than once a week.

PD. Special facilities: there is a NIFAST clinic (Non-intensive, Flexible, Adaptable,
Short-term clinic) for “crisis intervention”; this clinic meets once a week and
accepted 350 cases last year; it is staffed by 6 residents, 3 attending psychia-
trists, 1 social worker, one assitant, and one community worker; it accepted
all but neurological or brain-damage problems.

Other & hospitals outside the Harlem area:

. Hospital for Joint Diseases—1919 Madison Avenue, Psychiatric Clinic, TR 6-7000
Belluvue Hospital—ist. Avenue and 30th. Street Mental Hygiene Clinie, OR 9-5000
Roosevelt Hospital—428 West 59th Street Psychiatric Division, 544-7000
Jewish Memorial Hospital—Broadway & 196th. Street, LO 9-4700
New York Infirmary—321 East 15th. Street Psychiatry Clinic (No

district, but no emergency or inpatient facilities).
CA 8-8000
New York Medical College—106th. Street & Madison Avenue Dept.
of Psychiatry.
Clinics in the Harlem area:

NORTHSIDE CENTER FOR CHILD DEVELOPMENT
31 West 110th. Street EN 6-6464
waiting list for treatment is over a year.

151
152

GREATER NEW YORK

—the center does not take brain-damaged or handicapped children.
A. Staff: therapists, psychiatrists, psychologists, social workers.
B. Fees: sliding scale. ;
JAMES WELDON JOHNSON COMMUNITY CENTER
2089 38rd, Avenue TR 6-3533 District: 96th. Street to 125th. Street from 5th. to the
East River

James Weldon Johnson Community Center—2089 8rd, Ave. TR 6-3533

District: 96th. St. to 125th St. from 5th. to the East River

A. Staff: psychiatrists, psychologists, social workers.

B. Diagnosis: there is a waiting list of about six families for screening and the
clinic will not accept retarded or brain-damaged children.

C. Treatment: the waiting period for treatment is about 15 families or three
months; appointments can be made as often as twice a week; no fees.

KAREN HORNEY CLINIC
329 East 62nd. Street TE 8-4333
A. Staff: psychiatrists, psychiatric social workers.
B. Diagnosis: there is.no waiting period for diagnosis or treatment.
C. Treatment: usually “family-oriented” with appointments once a week with a
psychiatric social worker; fees are adjusted but are not Medicaid eligible.

Other clinics outside the Harlem area:

Payne Whitney Psychiatric Clinic—525 East 168th Street, TR 9-9000, District:
34th. Street to 96th. Street, east of 5th, Avenue. .

Postgraduate Center for Mental Health—124 E, 28th. Street, MU 9-7700 all types
of therapy; no Medicaid.

New York Clinic for Mental Health—1i50 5th. Avenue, CH 2-3778.

Catholic Charities Guidance Institute—122 East 22nd. Street open intake; 1 month
wait, Staff: 1 psychiatrist, 1 psychologist; 4 social workers.

Alfred Adler Mental Hygiene Clinic—333 Central Park West

American Foundation of Religious & Psychiatry—3 West 29th. Street, MU-6138,
Staff: ministers, priests, or rabbis in psychiatric training.

Girls & Boys Service League—138 East 19th. Street GR 3-4800.

Henry Street Settlement—265 Henry treet, OR 4-1100.

Hudson Guild Counselling—436 West 27th. Street, 255-1400.

Institute for Crippled & Disabled—400 First, Avenue, OR 9-0100. special groups
for obese and neurologically damaged; no geographic limit.

-MEDICAID

I. Centers:

1. Main Center: 830 West 34th Street.

2. Local Centers: 451 Lenox Avenue (183rd Street). Harlem Hospital (Women’s
Pavilion Rm 108). .

207 W. 151st Steret.

2384 7th Avenue (189th Street).

254 St. Nicholas Avenue, (128rd Street).

75 Lenox Avenue (114th Street).

II. To Apply You Need to Bring:

Social security number.

Last eight wage stubs or earning statement from employer.

Name of bank and amount of savings.

Amount of stocks and bonds. . :

Health insurance: name of company, policy number, amount of premiums.
Life insurance policies,

Veteran’s serial number, veteran’s administration claim number.
Medicare card (if over 65).

9. List of any medical expenses for current year.

SAF a Pw Dp

III. Medicaid Complaints:

1. Send letter to the mayor and_a copy to Mr. Hamp Coley, 380 West 84th Street,
New Work, N.Y. ‘ ,

2. For a complaint about a drug store:
a. Immediately call Elihu A. Gorelik, 790~3757.

(wempn nttnn ia
SUMMER 1968

b. Send letter to Mr. Alex Green, Room 367, senior pharmacist, Bureau of
Health Care Service 330 West 34th Street, New York, N.Y.
—the complaint should state:
(1) the name, address and phone number of the pharmacy.
(2) the name, address and phone number of the patient.
(8) the item (prescription) in question.
IV. List of Medicaid Drug Stores in the Harlem Area:

America Pharmacy, 1645 Lexington ----------------------0- 000779 876-9981
Ascione Pharmacy, 2268 Ist -.-----------------------0rrrr AT 9-0811
Asbell Pharmacy, 1600 St. Nicholas -------------------------e ctr WA 1-5994
Atwater Pharmacy, 1404 Madison __---------------------- ct AT 9-0400
Beta Pharmacy, 1960 7th --------------------------0rrrr MO 38-5567
Bishop Pharmacy, 273 W. 125th ._.----------- eee 864-0151
Black Rexall, 1882 8rd 5 ------------------------00crrrr EN 9-1350
Broadmoor Pharmacy, 2675 Broadway ----------------r--00c0rrrr AC 2-2914
Brown’s Pharmacy, 159-06 Harlem River Dr. ._..------- eee eee AU 1-7242
Callipo, J., 2146 Ond __.-- enn ee ee newer 534-9455
Cardinal Drug Store II, 2338 2nd ---------------------0-r rrr SA 2-0805
Cardinal Drug Store I, 935 Amsterdam -.-------------------770 77007 666-7039
Claremont Chemists, 3181 Broadway ----------------------77 7700007 MO 2-0220
Clunie Pharmacy, 21 Convent ----------------------70errrr eeeeeee RI 9-6970
Cohen’s Drug Store, 2101 Amsterdam ---------------------77r rrr LO 8-8763
Cohler’s Block Drug Store, 1988 3rd --.--------------------0 0 rrr EN 9-8538
Cohn, David, 1990 2nd --------------------- bone cece cece eee e eee reee TR. 6~2451
Cohn, Nathan, 1596 Madison ----------------------2r0crrrrr 9 LE 4-0151
Columbia Chemists, 1121 Amsterdam (oe eee cee ee eee nee eee enero UN 4-8773
Co-op Drug Co., 376 Manhattan ---..----------------00n rrr AC 2-0668
D&S Farmacia Central, 2040 2nd ----------------------0rr re 722-7100
Delane Pharmacy, 586 Lenox --.----------------------0 700 FO 8-3777
Deleina Pharmacy, 1741 Park -._.------------------rrrc rrr EN 9-6540
Dorris Pharmacy, 1450 Lexington -----------------------0r cer >E 289-8012
Drug Mart Pharmacy, 326 W. 125th ._._.-_---------------------- 0 ere RI 9-0318
Dumbar Drugs, 2802 8th -------------------------- errr 288-9055
Eighth Ave, Drugs, 2512 8th -.--------------------rerccoc re 288-9636
Eldorado Drugs, 2647 Broadway ----------------------07r rrr MO 2-6030
Embassy Pharmacy, 2457 7th ------------------------00cccrr AD 4-1800
Eureka Pharmacy, 2500 7th ....----------------------0 rrr WA 6-5546
Farmacia San Martin, 3340 Broadway -------------------77-70 007770" _-- 286-5358
Famous Pharmacy, 1887 7th .---------------------7 000 MO 2-2070
Fein’s Ethical, 3586 Broadway --------=---------------7r rrr 286-4344
Finklestein, L., 1863 2nd ---_-------------------------rrrr 722-9388
Forman Drugs, 2680 8th ----.----------------------0 rrr 281-1400
Friedlands Pharmacy, 574 Lenox --------------------7--00r ctr WA 6-4708
Globe Pharmacy, 3361 Broadway -----------------------r-c rrr WA 6-8900
George’s Gothic Pharmacy, 2180 Bth ___.-------------- eo eeert FO 8-0600
Ganbarg Drug, 2810 Broadway ------- bone eee eee eee eens UN 4-0700
Godettes Pharmacy, 2000 Amsterdam ---.------------------7rrr00007" WA 71-9571
Gubins, J., 100 E. 111th -....-------------------------r err 584-9876
Harlem Cut Rate Drugs, 68 W. 116th -.-.-.--------------------e0ctr - .869-9766
Hart Pharmacy, 1661 Amsterdam ------------------------700 errr FO 8-8867
Hartly Chemists, 1219 Amsterdam _.-----------------------0--0 rr RI 9-8480
Heights Pharmacy, 701 St. Nicholas _..-------------------------0 700000077 234-9803
Idell Pharmacy, 302 E. 100th -.------------------------00er 0 348-9880
Jaystone Drug Co., 104 Lenox --.---------------- renner EN 9-3636
Jomel Pharmacy, 2069 2nd .------------- pe eee ee cee eee nee eee ener TR 6-8071
Kenwood-Peters Pharmacy, 144 W. 125th -..--- eee ence cee ee eee cere 865-1052
Kirschemer Pharmacy, 1711 3rd --------------------7--r 000 831-3786
Langer Drug, 3399 Broadway wee cece beeen eee ce ce een n seer AU 1-0500
Lasalle Drug, 3143 Broadway ------------- ee eee nec ee eee e eee esses tec ee MO 2-6908

153

 
154

GADALEN iINDYY LVUOL

Lax Drug, 360 Lenox -..---------------------------------- eee eee eee EN 9--0365
Las Marias Pharmacy, 6188 Lexington --....-..------------------------ SA 2-4627
Lato Drug Co., 2248 2nd -...--..-------------------------------------- AT 9-0030
Lenox Terrace Drugs, 20 W. 185th .__.....------------------ 2-222 - eee AU 6-2120
Lenox Pharmacy, 145 E. 125th ._..__-.-------------------------------- SA 2-9305
Linchon Pharmacy, 2810 8th ____......---------------------- eee eee ee MO 2-6915
Litvin Pharmacy, 2423 2nd ...-_..-----------------------+------¢------ SA 2-2053
Majestic Pharmacy, 356 W. 145th ......---.---------------------------- AU 6-6780
Malach Pharmacy, 2185 8th _-___-.------.------------------------------- 864-8114
Mills Pharmacy, 2082 Madison -_-......--.---------------------------- SA 2-3128
Mishkin, 1961 Amsterdam ‘_.......------------------------------------ AU 6-0444
Morningside Hts. Pharmacy, 1802 Amsterdam --.------.------------------ MO 6-43387
Morton Pharmacy, 1698 Madison ..--..--------------------------------- 122-9527
Mt. Carmel Pharmacy, 2825 1st _.______.___--------------------------- TE 1-9876
Mt. Morris, 1981 Madison _._.---.-.----------------------------------- TR 6-4041
Pacific Pharmacy, 1821 Amsterdam ___._...---------------------------- AU 6-0960
Palmer Theresa, 2395 Broadway ---------.----------------------------- SC 4-4800
Pharmacraft, 3645 Broadway ----....------------------------- Meee eee AD 4-4528
Physicians Prescriptions Service, 2340 7th _....-.----------------------- AU8-4052
Pleasant Pharmacy, 363 Pleasant --..-...-.-----------------+----------- AT 9-5677
116 East Drug Corp., 116 BE. 125th .._-_____..----------------+-------- TE 1-1151
Raysol Pharmacy, 1870 Lexington _.......------------------------------- 848-2117
Rexall Drug Store, 1850 Madison -...-..---.--------------------------- TE 1-2354
Rio Pharmacy, 3889 Broadway -....---.------------------------------- LO 8-2880
Rico Pharmacy, 170 Manhattan -_--------.------------------------------- 149-8317
St. Nicholas Pharmacy, 840 St. Nicholas ....----------------- tewa------AU 1-1700
S-O Cutrate Drug Co., 1486 Lexington _..._...------------------+----- AT 9--4120
Santos Pharmacy, 3419 Broadway -.-----.-.-----------------------+------- 962-9298
Schaaf Pharmacy, 2149 8th .__--------.------------------------------- MO 2-6019
Schreier’s Pharmacy, 1878 Lexington -.------------------=------------- EN 9$-4760
Sharff Inc., 350 W. 125th _--_...----------------------------+-+------- UN 46300
Shirnat Rexall, 3559 Broadway ..------------------------------------- AU 6-5790
Siegel’s Drug Store, 111 BE. 115th -........--.----------------------+-- EN 9-4030
60 E. 125th Drug Corp., 60 B. 125th ...---...--------------------------+-- 427-6610
Snow & Yeoman’s Pharmacy, 3661 Broadway --.------------------------ AU 6-2940
Swan Pharmacy, 3645 Broadway -._---.----------------------------"----- 281-9990
Taft Pharmacy, 1080 Amsterdam ............-.------------------------ UN 4-8600
Terry Drugs, 3481 Broadway ---.--.--.----------------------------- --WA 6-6910
Theresa Pharmacy, 104 Lenox ._...._.---------------------------------- 869-9850
Theresa Pharmacy, 3901 Broadway _..-..------------------------------ WA 3-7617
Thomas, John, 2601 Broadway ....-----------------------------:------ UN 4-6600
Tosan Drug, 3419 Broadway .....------------------------------------- AU 3-6628
Trau Pharmacy, 2123 8rd _._..--..------------------- + 9-2-2 eee eee EN 9-4013
Unity Drug Co., 2621 Broadway ..--..---------------------------------- AC 2-4100
V&J Pharmacy, 2247 Ist .....--.--.-------------------- eect eeee 848-2548
Vim Drug, 3817 Broadway -.-...---.--------------------------------- WA 7-0220
Webster Drug, 2509 Broadway ____._.-.-------------------------------- RI 9-3063
West Side Drugs, 3524 Broadway ..----.----------------------+----++---- 926-5500
Whelan, 145th & Broadway ...---.-----------------------+----+------- WA 6-3250
Whelan, 2802 8th ..---.-------- We eee ee eee AU 6-3590
Whitehouse Pharmacy, Amsterdam & 122nd -__----...------------------- MO 6-7989
Williams Pharmacy, 2155 7th .-__-..-.--..---------------------------- MO 2-2876

ADDITIONAL IMPORTANT RESOURCES OF THE COMMUNITY
Department of Health:
Dr. Harris—Commissioner in charge of child and maternal health.
Dr. Pitkin—Director of School Health (566-7082)
Dr. Frederickson—Director of Harlem Health Center (AU 3-1900)
Miss Ambrose—Central Harlem Director of Nursing ..
SUMMER 1968

Harlem Consumer Education:
2325 7th Ave. (926-5300)
Harlem Self Help:
179 W. 187th St. Rm 12A :
J. Qualifications: 17-21 years of age fill out application.
2. Functions: 21 weeks of basic education in math, science, and english.

HARYOU ACT:

Local Boards:
No. 1 207 West 151st Street 868-7000.

No. 2 2886 7th Avenue 862-3500.
No. 3 451 Lenox Avenue 862-1166.
No. 4 254 Saint Nicholas Avenue 666-6920.
No. 5 Lenox Avenue 666-3935.
Legal Aid Society:
It is not used very much because results depend very much on the lawyer one gets,
and because they will not handle any controversial cases.

United Block Association:
68 East 131st Street (281-6000, 234-3822)

Mrs. Addie Patterson—Problem Broker
Mrs. Testamark—Schools (20 West 128th Street 281-6307)
Miss Brabham—Operator (6th floor)

Urban League:
204 West 186th Street (AU 6-8000)
Mr. Wingate—Director

Citywide Coordinating Committee For Welfare Rights:
514 West 126th Street (Amst. + Bdwy.) 3rd Floor
Local: 2825 7th Avenue (18ist St.) 926-5300
2430 7th Avenue (141-2nd) 286-9399

FOR EMERGENCY PHYSICIAN IN MANHATTAN CALL 879-1000

grU.S. GOVERNMENT PRINTING OFFICE: 1969 0-—355-232

185
U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE
Public Health Service :