A Right to Health - Neighborhood Health Centers in Profile (1969)

[Music] I oh I lived in this neighborhood for uh about 2 years now and I'm used to the sound of the uh elevated train and off the streets where all cars sit around and the gutters and in the vacant Lots they the kids play some people might think it's colorful you know but when you live here you call it something else because poorness doesn't look good or smell good or feel good especially not when you're sick not when your body hurt and you want to make it well it took a while but we've got a good answer to sickness in this part of New York it's part of a new idea that's going on in other cities too you know all over the country here in the Bronx we call it the Monte fiori Neighborhood Health Center where people from my neighborhood can come to have their sickness treated and the earth 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 York's Monty theori Neighborhood 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 seor Gallardo there never had a doctor before at least not one who knew his name and his medical history have you had much swelling in your legs yeah just you SW out my leg on anyway to church before I got to the church I was hurting so bad I like turn around and come back two times Mrs Skinner is getting on in years and it never entered her mind that she'd be getting so much interested attention in a place devoted to Medical Care saying don't kill me don't I don't cry you know have something to do with your heart Mrs Hitchcock complains about a lot of things but she never thought complaining about her medical care would make a difference but it is so I took the pills but every time I'd take the pills instead of my arm stop hurting it would hurt and then my chest would hurt talk about and just a few short months ago it certainly never occurred to many of these people that they'd be helping shape the entire way in which their neighborhood's Health Care was to be offered but they are and the medical people are listening [Music] this is the story of a new kind of comprehensive Healthcare 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 needs of its consumers which goes where they are listens when they talk 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 could 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 [Music] I'm Dr Roger egberg 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 and today there are probably 30 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 let's take a closer look at some of the problems and what neighborhood health centers are doing about them if you're poor poverty poor and you live in places like these sickness can be a lifelong blight a kind of vicious circle describ by The Physician who said the sick get poorer and the poor get sicker if you're poor and sick there are some mighty discouraging barriers between you and good Medical Care barriers like Transportation well I've been standing out here for a half an hour waiting for the bus to come along if you miss one no telling how long you have have to wait and then you get to the hospital you got to wait some more well it's very hard to get to the hospital when you have to get your kids all dressed to get yourself dressed and you're very very sick then you have to walk several blocks to bus so I never go until I'm nearly dead before I go or even before I take the kids because it's too difficult add long distances no predictable way to get there or get home later and only the most serious illness could drag you out and once you were there what [Music] then Sheriff Physicians and other medical people have done a supremely difficult job under immense pressure in the country's emergency rooms and Clinics but as so many Physicians know emergency rooms just weren't designed for that job while 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 staffs function smoothly and efficiently the team in emergency rooms all over the country function with Supreme skill and they're 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 bring routine problems here if you had to take three buses to get here or a $10 taxi ride you're very likely to wait until you're really sick or $10 sick as they used to say in once unfortunately being $10 sick often meant not getting well very fast as Dr Egert knows so [Music] 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 doctor's workload would throw the whole medical system into chaos the fact is we need to EXP 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 problems that plague the city ghettos the migrant camps the poor wherever they were concerned Physicians and health professionals all over the country and exploration 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 highquality accessible comprehensive Ono care where the whole family's health needs could be met they called it the Neighborhood Health [Music] Center and the neighborhood was so involved in it that in little towns like Alviso California they built it themselves [Music] there's more than just hammer and saw participation here this is community participation because this group voluntarily building its own Center has a Unity of strength that can address other problems too and as they break for lunch they may well talk about things like housing and education and Welfare community worker Tom urell puts it this way through the experience of attacking a specific problem and working with one another they've begun to see the relationship of such things as health problems to the lack of housing lack of Education lack of response by the institutions in this society that so dramatically affect their lives and not only do they have at least some of them have for the first time a positive image of themselves but they're 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 urel the medically deprived people of communities like eliso were helping themselves a health center in this neighborhood that's right and it wasn't even faintly going to resemble a chilly impersonal Hospital emergency room this was going to be accessible care and if they had anything to say about it it was going to be given in the best looking building in town [Music] the centers didn't have to be magnificent or even elaborate to begin with San Francisco's first quarters were in house Traders drawn up around this attractive Courtyard but they did have to be convenient and comfortable and easy of access with Pleasant waiting rooms in which neighborhood people would feel welcome and at home poor people aren't so far outside the mainstream of Medical Care that they don't want what other people want perhaps most significantly they want what health professionals themselves want they want private offices all right now you tell me is this comfortable yeah better than has you got any calls they want quiet examining rooms they are open it War okay they want comfortable conference areas where a warm and Lasting relationship ship can be established between health professionals and [Music] patients I find that in this doctor patient relationship we are able to uh establish uh more than just the ordinary doctor patient relationship but rather that of a friendship in which we're not interested only in the pregnancy but on the whole family and I feel that centers such as this uh should not be only interested in providing health care but also in raising 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 [Music] field it's called team medicine and it's offered by a highly organized group whose members respond to patient needs both medical and social the typical Health team is made up of Physicians usually an internist and pediatrician though 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 will be responsible for all of its Health needs so it's 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 your yeah put your tongue back honey growing and an extra two and while his father is getting attention just down the hall young Spanky is getting his pediatric workup as a member of the team uh the pediatrician has the unique opportunity to use his pediatric training to best Advantage he doesn't wind up spending half of his time as a uh Clerk or record taker or social worker or as a nurse or receptionist all of the members of the team contribute uh as co-equals with their own specialized area of expertise why don't see uh in my particular case I found over months that uh 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've had more time to concentrate on what I can do best to help the entire family and the patient in their Total Medical Care then let me know and I'll get the social worker to talk to you and maybe give you some help because he's at a pretty rough age right now without a diet and the diet may be a little bit too much for him to handle yes I think as far as I can see from this picture that the left for the team's Physicians many centers offer the convenient advantage of in Center specialist Consultants Specialists like this gynecologist at the monif fiori center who is available to consult on specific patient problems I or to refer a patient to if circumstances required of your tummy now have you hand when you had your last period how about the 12th of last month 12th of last month have they been always regular your period yes and how long do they last usually 5 days from what psychiatric consultations are also possible in the New York Center and team Physicians take full advantage of the opportunity to talk over specific case problem reinforce this connection bite and swallow that's right honey okay one of the most important team members at any Center is the dentist whose facilities are almost always busy okay honey shall we practice and we'll 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 the basics and that is instruction in 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 the toothbrush and do it yourself okay put it off then down off down yay for incentive your own toothbrush with your own name on it Jose there you are now take your toothbrush Jose and take it home with you and she got a little sick 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've been to her home she knows the doctors and the family health workers we're her team hers alone I mean it's people saying you're that that special to us you know we're your special team and we're interested in you not only in terms of the medical aspects but how are your children doing in school Miss Thompson today is going to tell us how to take an oral temperature while you're doing it we said that 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 though there are expanding opportunities for men in the role and always a person who lives in the neighborhood and understands its needs its people and its Community Resources if the patient is unconscious you never take an oral temperature when they ruin such Health skills as care of the bed fast 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 healthc care team come in sometime within the next couple of weeks Consulting closely with a public health nurse who often serves as team coordinator the family health worker has given her day's assignments which can include everything from visiting a bedfast coronary patient to visiting City Hall to get action on a housing violation for family health workers like Raquel Martinez in New York's Bronx patient care often begins by visiting in the home apartment or tenament there she can check the entire family in their home environment not just the mother who was pregnant but also the children for whom she may well suggest things like Diet changes or better oral [Music] 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 of the medical attention they require for the mother that means the obstetrician it's all right the baby's in good position and we'll probably expect her to deliver towards the end of the month please ask Miss Santana how she's been feeling since the last time I saw [Music] [Music] her and that's the way it's working at centers all across the country team medicine with a family health worker bringing the doctor what he's 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 Mr B fine stand that you're walking now and listen again as the family health worker responds to the needs of a patient who happens also to be a neighbor and a friend time it it catches me right in you know right in there then it go right on round right on the under my rib come right on up my it right through the sick part of my shoulder I don't like to go to doctors too much so I've never been no sickly person in my life mhm and I've come to this Clinic more and I've ever went to a doctor in my life you done gain and some of the patients come to their Neighborhood Health Center there aren't any complicated eligibility requirements for the patients no lengthy forms to fill out in cold unfriendly environments top priority goes to serving people and always patients are seen as people whose Health needs are bound up with the other circumstances of their lives young Salvador there isn't just an injured wrist he's a little boy whose mother kept a 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 had much seor Gallardo there isn't just a heart patient his doctor knows that he's the head of a large family and it's important for him to have an incom producing job a factor which will be taken into account in his treatment sometime not all the time just sometime yes I've 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 doesn't hurt I said look this is my body so they listen to their patience both in the center and on the job if a man can't get off work to come to the center a center worker will go to him even in the middle of a plowed tomato field can we help you with your family's health problems that's what they want to know [Music] 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 [Music] people go ahead and tell [Music] 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 has ever denied care because he lacks transportation accessible medicine it's as accessible as your own backyard to this elderly couple in King City California yes they could come into the center for treatment but old Mrs bonady has always had a fear of hospitals and injections under your own grape arbor aren't anywhere near as threatening Outreach bringing medicine to the consumer to the community academic words to describe what really goes on in the bonatti backyard and their appreciation takes a form sanctioned by tradition call it corny at your peril this gift is given with sincerity and gratitude and it's received the same [Music] way you know things that's good and work from the outset the health center idea was based on the concept of community participation that residents in the center's 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 deliver for Center directors like Dr Rodney Powell and his staff in Watts Community involvement means working with his health Council a Management Group made up of concerned community members selected by their neighbors had an opportunity to work in clinic and many of them we know that Mrs I think one of the biggest problems is the lack of understanding what the team really means and the person who's the plays a key role has not had the kind training that I think you've prescribed for him initially and that's the neighborhood health agent these are people who are serving in that interpretive communicative uh advocacy role back to the teams and no one pays any attention to him he's still not accepted the doctors regard him uh as someone less than a professional and the people such as the social workers and the public health nurses still haven't accepted his role that's because he's dealing from a position of no power I you mean by that that dealing from a powerless position and that's why he's not recognized well that's the conflict let me identify it right here the conflict is that we can get people in who can do their in my experience the community health council is one of the vital channels of communication that serves our Center you just can't get to the heart of things by using statistical surveys you've 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 the employees at the center for our community residents and most significantly the community residents were members of the community health Council the board of directors who set program policy for the center a doctor is supposed to be able to make contact with anybody regardless to the level of the person at the same time the implication for the future of this new kind of Health Care are complicated and intriguing and all their activities whether Medical Dental pharmaceutical consultation or laboratory the centers work with a Medical Institution in their area usually a medical school teaching Hospital Public Health Department or established group practice a new way to deliver Health Care yes in 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 technicians X-ray technologists and other health specialists but also key punch operators switchboard operators record Specialists and secretaries when their training is complete these people will be equipped to fill needs at the center itself or go out into their community and work in other facilities by creating new wage earners the neighborhood health centers are helping develop the financial health of the community as well as its physical health it's new and it's challenging and it's frustrating too because the problems aren't all solved yet by any means there are still patients whose needs aren't being entirely satisfied still health workers not entirely at home with this new concept of care the system is evolutionary and in its evolving it is 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 Dr Dr in King City California where the southern Moder County Medical Group operates the center Dr Len Hughes Andress and his colleagues have successfully proved that private group practice can work closely with government agencies to fill gaps in health care with new services and [Music] Manpower we I hope represent um a real working partnership between private physicians and government working towards the same goal and so far we've had excellent relations with Washington and we've had a real thrilling experience of bringing better Medical Care to people who never before have had adequate Medical Care in their lives in the development of our program here the oeo encouraged us to develop any innovations that we were capable of through our own initiative and Imagination and 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've learn learned Lear techniques and used techniques of delivering medical care that that have changed our our entire pattern of practice for the better I'm [Music] convinced it's a beginning and while it's far from perfect it's 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 was like before and what a wonderful thing now has happened for the People's Health the center has not soled all the problems of schools and houses and trashy sidewalks but for my friends and my neighbors and all the people who live here to them this Center is a very great thing and talking for me it is a great thing too [Music] when you built your Center yourself as they did in alisol on opening day you come with special prayer and Thanksgiving [Music] opening day the beginning of something important from this day the people of Aliso 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 entire Health Center is evidence that there is such a thing and that it can work perhaps it's more visible here in Aliso than in some other areas 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 if they feel very much at home that's part of what it means to have a center [Music] speech speech speech