I know i lived in this neighborhood for about two years now and im used to the sound of the elevator train and of the streets. Well, cars sit around in the gutter. I think the waking life, the kids. Some people, i think and its colorful. You know. But when you live here you call it Something Else because its born of doesnt look good or smell good or being especially not youre sick and not your body hurt and you want to make it. Well, it took a while, but weve got a good answer to sickness in this part of new york. Its part of a new idea thats going on in other cities. Do you know all over the country here in the bronx, we call it the montefiore Neighborhood Health center, where people from my neighborhood come to have their sickness treated and made well, you are entering a new world of health care. It draws upon the same science and uses the same instruments and equipment that Health Services traditionally do. But yet in its philosophy and its practice, it is different in some startling and significant ways. Here in new yorks Montefiore Health center and in its counterparts in other American Cities and towns, this concept of care has profoundly affected both the Health Professional and the patient. In york, a lot, though they never had a doctor before, at least not one who knew his name and, his medical history. He had much swelling in your legs. Yeah, its just adaptations in a way, to keep cool. That is so sad. Would hope so. Be that i dont run from it because my dad, mrs. Skinner, is getting on in years and it never entered her mind that shed getting so much interest attention in a place devoted to medical care. So saying, dont kill me and dont. I thought, you know, have something to do with your heart. Mrs. Hitchcock complains about a lot of things, but she never thought complaining her medical care would make a difference. But it is if i took the pills. But every time i the pill instead of my arm and stop hurting it hurt. And then my chest would hurt up about. And just a few short months ago, it certainly occurred to many of these people that theyd be helping shape the entire in which their Neighborhoods Health care was to be offered. But they are and the medical people are listening. This is the story of, a new kind of comprehensive health and the way it is being offered in 36 American Cities. And towns. It is the story of a unique and creative approach to the health of its consumers, which where they are, listens when they talk answers, when they question and perhaps important of all, accepts their advice on how it can best serve needs. It is the story of a Health Care Philosophy which could well apply not just to the poor, but to everyone and the whole approach of medicine in the future. Right now, hundreds, thousands of americans are utilizing it every day through their Neighborhood Health center. Im dr. Roger achterberg dean of the university of southern californias school of medicine. This film describes a ways of providing health care for the poor, whether they live in the country or the city by means of Neighborhood Health centers. In the past and in many places today, health care for the poor has inadequate, for instance, hard to in personal fragmented in that kind of a setting quality, often suffered. And today are probably 30 Million People who are not receive the kind of care we all deserve. Now with people in their neighborhoods working together with professionals and, the planning and operation of these centers, there are some new ideas and new directions that we should all be of. So lets a closer look at some of the problems and what Neighborhood Health centers doing about them. If youre poor, poverty poor and you live in places, these sickness can be a life long blanket, a kind of vicious circle described by physician who said the sick get poorer and the poor get sicker. If youre poor and sick there are some mighty discouraging barriers between you good medical care. Barriers like transport. And standing out here for a half an hour waiting for the bus come along. If you one. No telling. How long you have to wait. And then you get to a hospital. Youve got to wait for more. Very hard. You get to hospital when you have to get your kids all dressed that. Get yourself dressed and you very very sick. Then you have to. So to bus. So i never go until im nearly dead before i go. Even before i the kids because its difficult at long distances no predictable way to get there or get home later only the most serious illness can drag you out. About 2 hours. And once you are there what theyre very. Sure you have to be to go. Physicians and other medical people have got a supremely difficult job under immense pressures in their countries. Emergency rooms and clinics. But as so many physicians, Emergency Rooms just werent for that job. Well, Emergency Rooms were designed to handle catastrophes of all kinds. And when the medical or surgical need is of top urgency, they and their highly trained staff function smoothly and efficiently. The team in Emergency Rooms all over the country functioned with supreme. And theyre presented with the kind of emergencies for which this place was designed designed. But the role of the emergency room has changed over the years. And now people bring routine problems. If you had to take three busses to get here for a ten hour taxi ride, youre very likely to wait until youre really sick or 10 sick, as they used to say in one unfortunate they are being 10 sick, often not getting well very fast. As dr. Achterberg knows, so. Underlying all this is the inescapable fact that there are hardly enough doctors to go around as medicine now practiced in this country to add 30 million patients and 15 hours of extra work each to every doctors workload would throw the whole medical into chaos. The fact is, we need to explore new of delivering health care, health care to everybody, not just the poor. And this means using as many people as we can to extend the hands of the doctors. Something that is being tried in Neighborhood Health centers. The Health Problems that plague the city ghettos, the migrant camps, the wherever they were concerned, physicians and Health Professionals, all over the country and exploration Creative Solutions was top. And with the of the office of economic opportunity. The surge became known as the health right programs. And so it began in the city ghettos and country towns. Something was happening. Members of the Health Professions working closely with the ohio had begun to implement the idea of Community Medicine and action. The idea was to high quality, accessible. One door care where the whole family has health needs could be met. They called it the Neighborhood Health center. And the neighborhood was so involved in it that a little towns like lbc or california, they built it themselves. Theres more just hammer and saw participation. This is a community because this group voluntarily building its own center has a unity of that can address other problems. And as they break for lunch, they may well talk about things like housing and education, welfare, Community Worker tom youre adel puts it this way. Through the experience of attacking a specific problem and with one another theyve begun to the relationship of such things as Health Problems. The lack of housing lack of education and a lack of response by the institutions and the society that so dramatically affects their lives. And not only do they have, at least some of them, for the first time, a positive image of themselves, but theyre beginning to see ways that they can move possibly to change some of the other areas of their life. So with the vigorous and necessary help of Community Workers like tom here are now dramatically deprived people of communities like l. B. So were themselves. A health in this neighborhood . Thats right. And it wasnt even, frankly, to resemble a chilly, impersonal emergency room. This was going to be accessible. And if they had anything to say it, it was going to be given in the best looking building in town. The centers didnt have to be magnificent or even elaborate begin with. Seven. Franciscos first orders were in hospital growing up around this attractive courtyard. But they did have be convenient and comfortable and easy of access with pleasant waiting rooms, which neighborhood people would feel welcome and at home. I suppose people arent so far outside the mainstream of medical that they dont want what other people want perhaps most dignified leave. They want what Health Professionals themselves want and i like my picture on it. They want private offices. Now you tell me, is this comfortable . Yeah. I should go and call. They want quiet examining room. They are open at. Why. They want a comfortable conference where a warm and lasting can be established between. Health professionals and patients. When i sat a, they just say, look, dont go anywhere obstetrics. And without putting though, i find that in this doctor patient relationship we are able to establish is more than just the ordinary back to a patient relationship but rather that of a friendship in which were not interested only in the pregnancy but on the whole. And i feel that centers as this should be only interested in providing health care, but also in raising the standard of living and giving hope for future generations to. You see. A fundamental and most important concept, the Health Center, is to offer patients, family care, medical service through an approach with tremendous for the whole medical field. Its called Team Medicine, and its offered by a highly group whose members respond to patient needs, both medical and social. The typical health team is made up of physicians, usually internist and pediatrician. Though, including an obstetrician to a dentist, a Public Health nurse and, one or more new Health Specialists called Family Health workers. When a family registers at the center, it is assigned to a health team, which will be responsible for all of its health needs. So its possible for an entire to come in at once and each member be seen the appropriate person on their team in order to protect your voice, you retain back on the table. Guy and the extra right. And while his father is getting attention down the hall, young, spunky, getting his pediatric workup as a member of. The team. The pediatric man has the unique opportunity to use his pediatric training. The best advantage he wind up spending half of his as a clerk or a record taker social worker as a nurse or receptionist. All of the members of the team can attribute as coach with their own specialized area of expertise. Well, why dont we see in my particular case ive found over months that more and more i have to rely upon the other members of the team to do their part of the job. And so ive had time to concentrate what i can do best and how i want to help entire family and the patient in their total medical care. Then let me know and ill get the social worker to talk to you and maybe give you some help because hes at a pretty rough age right now without a diet and, the diet may be a little bit too much for him to handle. I think as far as i can see from this picture, thats left for the teams position. Not many centers offer that convenient advantage of in Center Specialist specialists. This gynecologist at the Montefiore Center who is available to consult specific patient problems. I wanted to refer a patient to a circumstance that requires that of your tummy. Now, have you when have you had your last period. Right. The 12th of last month. 12th of last month. Have they been always regular your periods . Yes. And how long do they last. You have five days to. From what . Psychiatric consultations are also possible in the New York Center and Team Physicians take advantage of the opportunity to talk over a specific case problem, reinforce connection, and by following. Thats right. Okay. One of the most Important Team members at center is the dentist whose facilities are almost always busy and ensure we practice. Well show you how. We brush our teeth. Here at the center, care is an important aspect of Family Health care. Our main consideration, of course, is clinical. However, feel it very important to begin a program of Preventive Dentistry with instructions and diet and nutrition. Feel. We begin our Preventive Dentistry program with the basics and that instruction in home hygiene, home care. Our assistants here are trained to continue the program by further instructing the families and the children especially upon each visit already to for us and doing through self care and put it off. Then don asked f j for instead of your own toothbrush, with your own name on it, or say, there you are, not take your toothbrush, jose, and take it home with you. And the family helped make the maximum use of physicians, dentists. Each team also upon the nurse with Public Health skills who knows and is known by her in a very special way. This mother and i have built a tremendous relationship. I know our family. Ive been to her home. She knows the doctors and the Family Health work where team hers alone. I mean its people saying youre that special to us you know were your special team and were interested in you not only terms of the medical aspects, but how are your children doing in school this time . Sun today is going to tell us how take an oral temperature while youre it. We said that it was fundamental to center philosophy to involve people. The neighborhood in creative new health and certainly one of the most creative is the idea of the Family Health worker and the Family Health worker is typically a woman. So there are expanding opportunities, women in the role and always a person who lives in the neighborhood and understands it needs its people and its community resources. If the patient is unconscious, you never take an oral temperature. In the such Health Skills or care of the bed fasd. Checking vital signs, first aid and elements of anatomy and passed some rigorous examinations to demonstrate their knowledge. These Family Health workers are integrated into the functioning Health Care Team and come in sometime within the next couple of weeks consulting closely with the Public Health nurse who often serves as team coordinator. The Family Health worker has given her days assignments, which can include everything from visiting a bed past coronary patient to visiting city hall to get action on a housing violation. I want to bill for Family Health workers like martinez in new yorks bronx patient care often begins visiting in the home apartment tenement. There can check the entire family in home environment, not just mother who is pregnant, but also the children for whom she may well suggest things like diet changes or better oral hygiene. Have have periodic get around the family worker, make an appointment for the family. The center here in Health Number three. This patient, her children, will be given all of the medical attention they require for the mother. That means the obstetrician who think its all right. The babys in good and well probably expect her deliver towards the end of the month. And you need to get those baby to win. But also you pay. Iraq a better place as ms. Santana health has been feeling since the last time i saw her in the turkey. This american, the simplest physical, only thing i could give my name and billing. Im going. To give my home and one brother here im how one and thats the way its working it centers all across the country Team Medicine with the family worker bringing the doctor what hes lost the ability to see patients in the context of their home and family and what he never had a cultural bridge into the community and mr. Beltran. And as youre walking now know listen in again the Family Health responds to the needs of a patient who happens also to be a neighbor and a friend so it catches me right in you know right in there and then you go around i dont if one of my real owner of my the rest of this sick part of my shoulder. Oh i dont want to go back to mike so i have never been no leave person in my life and ive come to this clinic and i ever went to a doctor in my life you dont gain from. It some of the patients come to their Neighborhood Health center. There arent complicated eligibility requirements for the patients. No lengthy forms to fill out in cold and friendly environs once top priority goes, serving people and always patients are seen as people whose health needs are bound up with the other circumstances their lives. Young salvadoran isnt just an injured wrist. Hes a little boy whose mother kept dangerous washing machine. And one of the first things the center did was to send someone out to his house to share some safety techniques. And he had went to a call senor gall