I live in this neighborhood for about two years now and im used to the sound of the elevator train and up the streets the cars that are around. And where the kids play. Some people might think its colorful, you know . But when you live here you call it something else, because it doesnt look good or smell good or feel good. Especially not when youre sick. Not when your body hurts. 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 too. You know . All over the country. Here in the bronx, we call it the Montefiore Health center where people from my neighborhood can come and have their sickness treated and their hurt 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 helped services traditionally do, but in the philosophy its different in startling and significant ways. Here in the montefiore neighborhood center, and in the counterparts of cities and towns this concept of care has profoundly affected the Health Professional and patient. This man never had a doctor before, at least not one who knew his name or history. Have you had much swelling in your legs . Yes. I was hurting so bad. I turned around mrs. Skinner is getting on in years and it never entered her mind that shed be getting so much interested attention in a place devoted to medical care. What dont kill me, i wont cry. You know, something to do with your heart. Mrs. Hitchcock complains about a lot of things but never thought that complaining about her medical care would make a difference but it has. Every time i took the pill instead of the arm stopped hurting, it would hurt and then my chest would hurt. Just a few short months ago, it certainly never occurred to many of the people theyd be helping to shape the entire way that the health care is about to be offered but they are. And the medical people are listening. This is the story of a new kind of comprehensive health care 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 the consumers which goes where they are, listening when they talk and answers when they question and perhaps most important of all, accepts their advice on how it can best serve their needs. It is the story of a Health Care Philosophy which can well apply not just to the poor, but to everyone and affect the whole approach of medicine in the future. Right now, hundreds of thousands of americans are utilizing it every day through their neighborhood Health Center. Im dr. Roger eggerberg, dean of the university of Southern California school of medicine. This film describes new 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 been inadequate. For instance, hard to obtain impersonal, fragmented. In that kind of a setting, quality often suffered. At a day when there are probably 13 Million People who are not receiving 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 aware of. So lets take a closer look at some of the problems and what neighborhood Health Centers are doing about them. If youre poor, poverty poor, and you live if places like and these, sickness can be a life long blight. A kind of vicious circle described by the physician who said the sick get poorer and the poorer get sicker. If youre poor and sick there are some mighty discouraging barriers between you and good medical care. Barriers like transportation. Im standing out here for half an hour waiting for the bus to come along. If you miss one, no telling how long you have to wait and then you get to the hospital then you have to wait some more. Once i get to the hospital, when you have to get your kids all dressed and get yourself dressed and youre very, very sick. And then you have to walk several blocks to catch the bus. So i never go until im nearly dead before i go or even before i take the kids. Because its too difficult. At long distances, no predictable way to get there or get home later and only the most serious illness can drag you out. And once you are there, what then . Physicians and other medical people are under immense pressures in the Emergency Rooms and clinics, but as so many physicians know Emergency Rooms just werent designed for that job. Well, Emergency Rooms were designed to handle acute 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 function with supreme skill and are presented with the kind of emergencies for which this place was designed. But the role of the emergency room has changed over the years. And now people are bringing routine problems here. If you had to take three buses here or a 10 taxi ride, youre likely to wait until youre really sick or 10 sick as they used to say in watts. Unfortunately being 10 sick meant not getting well very fast. As the doctor knows so well. Underlying all of this is the inescapable fact that there are hardly enough doctors to go around as medicine is now practiced in this country. To add 30 million patients and 15 hours of extra work each week to every doctors work load would throw the whole medical system into chaos. The fact is, we need to explore new ways 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 the neighborhood Health Centers. The Health Problem that plagued the city ghettos the migrant camps, the poor wherever they were concerned physicians and Health Professionals all over the country. And expiration for Creative Solutions was top priority. And with the help of the office of economic opportunity, the search 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 oeo had begun to implement the idea of Community Medicine in action. The idea was to deliver high quality, accessible, comprehensive one door care where all the families needs could be met. They called it the neighborhood Health Center. And the neighborhood was so involved in it that in little towns like california they built it themselves. Theres just more hammer and saw participation here. This is community participation. Because this group voluntarily building its own center can address other problems too. As they break for lunch they may talk about housing and education and welfare. Community worker puts it this way. Through the experience of attacking a specific problem and working with one another, they have begun to see the relationship of such things as Health Problems to the lack of housing, lack of education, lack of response by the institution in this society that so dramatically affect their lives. And not only do they have at least some of them have for 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 Worker like tom, medically deprived people of communities were helping themselves. A Health Center in this neighborhood, thats right. And it wasnt even going to resemble a chilly, hospital emergency room. This was going to be accessible care. If they had anything to say about it, it would be in the best looking building in town. The centers didnt have to be magnificent or elab race to begin with. The first in california were drawn up around the attractive courtyard but they did have to be convenient and comfortable and easier access, with pleasant waiting rooms in which neighborhood people would feel welcome and at home. Poor people arent so outside of the main stream of medical care they dont want what other people want. Perhaps most significantly, they want what Health Professionals themselves want. They want private offices. All right, you tell me is this comfortable . Yeah. They want quiet examining rooms. Say ah. Open wide. They want comfortable conference areas, where a warm and lasting relationship can be established between Health Professionals and patients. I find that in the relationship we are able to establish more than just the ordinary doctor patient relationship. Rather that of a friendship in which were not interested only in the pregnancy, but on the whole family. And i feel that it shouldnt only be interested in providing health care, but also embracing the standard of living and giving hope for future generations to come. You see a fundamental and most important concept of the Health Center is to offer patients family care medical service through an approach with tremendous implications for the whole medical field. Its called team medicine. And its offered by a highly organized group who responds to both medical and social. The typical health team is made up of physicians, frequently including an obstetrician too, 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 which will be responsible for all of its health needs so its possible for an entire family to come in at once. And each member be seen by the appropriate person on their team. In order to protect oh, wow. Yeah. Extra tooth. While his father is getting attention just down the hall, young spanky is getting his pediatric workup. The pediatrician has the unique opportunity to use his pediatric training to best advantage. He doesnt wind up spending half of his time as a clerk or a record taker or social worker or as a nurse or receptionist. All of the members of the team contribute as coequals with their own specialized area of expertise. In my particular case, i found over the months that more and more i have learned to rely upon the other members of the team to do their part of the job and so i have had more time to concentrate on what i can do best. To help the entire family and the patient in their total medical care. Let me know and ill get the social worker to talk to you give you some help because hes at a pretty rough age without a diet and the may be too much for him to handle. I think as far as i can see from this picture that the left with teams physicians, many centers offer incenter specialist consultants. Specialists like this gynecologist who is available to consult on special patient problems. You can refer a patient if circumstances require. When have you had your last period . The 12th of last month. Have they always been regular, your periods . Yes. How long do they last . Five days. Psychiatric consultations are also possible in the New York Center and Team Physicians take full advantage to talk over a specific case problem. Reinforce this connection. Thats right, okay. One of the most Important Team members is the dentist whose facilities are almost always busy. Ill show you how we brush the teeth. Here at the Center Dental care is an important aspect of Family Health care. Our main consideration of course is clinical dentistry. However, we feel it very important to begin a program of Preventive Dentistry with instructions in diet and nutrition. We begin our Preventive Dentistry program with home hygiene and home care. Our assistants here are trained to continue the program by further instructing the families and the children especially upon each visit. Hold it yourself and put it, then down. For incentive, your own toothbrush with your own name on it. There you are. Now, take your toothbrush, jose, and take it home with you. While the Family Health team makes maximum use of physicians and dentists, each team also draws upon the nurse with Public Health skills who knows and is known by her patients in a very special way. This mother and i have built up a tremendous relationship. I know her family, i have been to her home. She knows the doctors and the Family Health workers. We are her team, hers alone. Its people saying youre that special to us, you know, were your special team. And were interested in you not only in terms of the medical aspects but how are your children doing in school . Well find out how to take an oral temperature. We said it was fundamental to center philosophy to involve people from the neighborhood in creative, new health roles and certainly one of the most creative is the idea of the Family Health worker. The Family Health worker is typically a woman, a though there are expanding opportunities for men in the hole and a person who lives in the neighborhood and understands its needs, its people and the community resources. If the patient is unconscious, you never take an oral temperature. Care of the bed fast, checking vital signs, first aid and elements of anatomy and passed some rigorous examinations, these Family Health workers are integrated into the functioning health care team. Come in sometimes within the next couple consulting closely with the Public Health nurse who serves as the team coordinator, is given the assignments which is visiting a patient to visiting city hall to get action on a housing violation. For Family Health workers like raquel martinez, patient care often begins by visiting in the home, apartment or tenement. There you can check the entire family in their home environment. Not just a mother who is pregnant. But also the children. For whom she may well suggest things like diet changes, or better oral hygiene. At periodic intervals the Family Health worker makes an appointment for the family at the center. Here in health unit number three, this patient and her children will be given all the medical attention they require. For the mother that means the obstetrician. I think its all right, the baby is in good position and well probably expect to deliver at the end of the month. Please ask her how shes feeling since the last time i saw her. [ speaking a Foreign Language ] and thats the way its working at centers all across the country. Team medicine, with the Family Health worker bringing the doctor what hes lost. The ability to see patients in the context of their home and family and what me never had a cultural bridge into the community. I understand youre walking now. Listen again as the Family Health worker responds to the needs of a patient who happens to be a neighbor and a friend. It catches me right in you know . Right in there. Yes. Then it goes on around. Up under my rib. Thats the part of the shoulder. I dont like going to the doctors. I have come to this clinic more than i ever went to a doctor in my life. So the patients come to their neighborhood Health Center. There arent any complicated eligibility requirements, no lengthy forms to fill out in cold, unfriendly environments. Always patients are seen as people whose health needs are bound up with the other circumstances of their lives. Young salvador there isnt just an injured wrist. His mother kept a dangerous washing machine and one of the first things that the center did was to send someone out to his house to share some safety techniques. This man isnt just a heart patient. But hes the head of a large family and its important for him to have an incomeproducing job. A factor which will be taken into account in his treatment. Yes even mrs. Hitchcock who complains a lot is seen as a tired wife and a mother of five who must be listened to and responded to with attention and respect. Not only because she needs to ventilate her feelings, but because it allows the center to see where they may not be meeting patient needs. I said, look, this is my body. So they listened to their patients, both in the center and on the job. If a man cant get off work to come to the center, the Center Worker will go to him. Even in the middle of a plowed tomato field. Can we help you with your familys Health Problems . Thats what they want to know. On the job or at home, Center Workers go out where the patients are. To tell them about the Health Services available and they tell it in the language of the people. [ speaking a Foreign Language ] if they live too far to make the trip themselves, the center bus will go get them. The idea that the center must be accessible was top priority from the beginning and nobody is ever denied care because he lacks transportation. Accessible medicine is as accessible as your backyard. Yes, they could come into the center for treatment, but this woman has always had a fear of hospitals. And injections under your own grape arbor arent as threatening. Bringing Academic Work to describe what goes on in the backyard and its sanctioned by tradition. This gift is given with sincerity and gratitude and received the same way. You know, good things from the outset, the Health Center idea was based on the concept of community participation. That residents in the centers neighborhood cared about the kind of service they would have. And that they must have an influential voice in determining the way in which care was delivered. For Center Directors like Rodney Powell an his staff in watts, Community Involvement means working with his health counsel, the Management Group made up of concerned family members. An opportunity to work on plans. Many know that. But i think one of the biggest problems is theyre lacking the understanding what the team really means. And the person whos who plays a key role hasnt had the kind of training that i think you proscribed him originally. And these are people who are serving in the interpretive, communicative advocacy role back to the teams and hes still not accepted. The doctors regard him as someone less than a professional and the people such as the social workers and the Public Health workers havent accepted his role. Hes dealing from the position of no power. Dealing from a powerless position. Thats why hes not recognized. Let me identify right hire the conflict in my experience the Community Health council serves our center. You cant get to the heart of things by using statistical surveys. You have got to get the community itself to identify its health needs and wants. The consumer input is absolutely essential and it must be in the context of full partnership. We get consumer participation from the patients themselves, employees at the center for our Community Residents and most significantly the Community Residents are members of the Community Health council. The board of directors who set Program Policy for the center. Are doctors supposed to be able to make contact with anybody regardless to the level of the person . At the same time the implications for the future of the new health care are complicated and intriguing. In all their activities whether medical, dental, pharmaceutical consultation or laboratory, the centers work with a medical institution in their own area. Usually a medical school, teaching hospital, Public Health department or established group practice. A new way to deliver health care, yes and a great many important ways it is. And here in these centers with their ties to the communities they serve, they are training neighborhood people to take their part in it. The Training Programs include not only dental assistants, Family Health workers, laboratory and other health speciali specialists, but key punch operators and records and other secretaries. They will be equipped to fill needs at the center itself or go out in the community and work in other facilities. By creating new wage earners the neighborhood Health Centers are helping to develop the Financial Health of the community as well as the physical health. Its new and its challenging and its frustrating too. Because the problems arent all solved yet by any means. There are still patients whose needs arent being entirely satisfied. Still Health Workers not entirely at home with the new concept of care. The system is evolutionary and its inevitably confronting tough and complicated issues such as recruitment and changing professional roles and others. But the neighborhood Health Center idea is well launched. And its implications are far reaching. As a flexible system which emphasizes full involvement of the consumer himself, the Health Center principal may well be useful not just as medicine for the poor. But for medicine as a whole. In king city, california, in the southern Monterey County group, the doctors and colleagues have successfully proved that they can work closely with Government Agencies to slow gaps in health care with new services and man power. We i hope represent a real working partnership between private physicians and government working towards the same goal. And so far, we have had excellent relations with washington and we have had real experience at bringing better medical care to people who never before had adequate medical care in their lives. The development of our program here, the oeo encourages us to develop any innovations that we were capable of through our own initiative and imagination. I feel that if this grant ended tomorrow that we would never go back to practicing medicine exactly the same as we did prior to the grant even with our private patients because we learned techniques and used techniques of delivering medical care that have changed our entire pattern of practice. For the better, im convinced. Its a beginning and while its far from perfect its light years away from what was there before. This Family Health worker is an expert on that. You have to live in this neighborhood. You have to really be here to know what it was like before and what a wonderful thing has now happened for the peoples health. The center has not solved all of the problems of schools and houses and sidewalks, but for my friends and my neighbors and all of the people who live here, to them, this center is a great thing. Im talking for me. It is a great thing too. The center as they did on opening day you come with special prayer and thanksgiving. Opening day, the beginning of something important. From this day, the people will have a Health Center of their own. And it is their own in the special way that anything you build yourself belongs to you. Community action, this is evidence that there is such a thing. And that it can work. Perhaps whats more visible here, where the ideal may be more difficult to obtain but it can be done because they did it. So in future days, when they come here to have their sickness treated and their hurts made well, you can understand it that they feel very much at home. Thats what it means to have a center. Youre watching a special edition of American History tv airing during the week while members of congress are in their districts due to the coronavirus pandemic. Tonight at 8 00 eastern, sarah mileoff discusses her book,
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