Beyond The Wall (1969)

The American hospital came about as an answer, a response to the need of the people, a need for an institution where all could go for the benefits of up-to-date medical care. For more than 200 years, our hospitals have been fulfilling this role admirably. But times change. America is in the midst of strong social evolution with all the stress and turmoil that accompany it. As these changes come about, new needs of new people are brought to public light. For example, we must recognize that adequate health care is not a privilege of the elite. It is a right of everyone. Our hospitals are facing up to that responsibility. They are responding to the needs of the people. They are moving out into the community, taking the full benefit of their medical knowledge and services to those who need it most. They are extending beyond the institutional wall that separates hospital from community. They are making themselves sensitive to the needs of the people they listen, study, and respond. The nature of that response may be one of the most important concepts ever to come about in healthcare. That's what this film is about. [Music] [Applause] [Music] the affluent and the not so affluent. The halves, the have nots. Two types of people, two ways of life, separated by walls. Walls of many kinds, social, economic, racial, political. Even our hospitals have erected walls. The wall of the institution, which forms a barrier more difficult to crack than a brick or concrete wall. Because the institution by its very nature places many people beyond the wall. >> You would have to wait four and 5 hours before you can get waited on. And the waiting I couldn't stand it. Being a negro, a lot of places you have to go when you're someplace and you get hurt or something. Uh, it's sort of a himhaw. They don't want to just actually tell you, but you can get the feeling of it. So, you make up your mind you're just not going anymore. >> I stayed there 18 hours and >> well, the community comes here. They don't have [Music] [Applause] This is Pennsylvania Hospital, the nation's first. It was founded in 1751 with the influence of Benjamin Franklin, who saw the need for such an institution in the city. Even the poor inhabitants of the city, though they had homes, yet were therein but badly accommodated in sickness, and could not be so well and so easily taken care of in their separate habitations, as they might be in one convenient house, under one inspection, and in the hands of skillful practitioners. Thus, this hospital was founded because of the need of the community, the need for a centralized institution to take in the ill. But it's been a long time since Benjamin Franklin's day, and the needs of a community change. >> Most Americans take their health care for granted. They have blue cross plans, company health protection policies. Health care is a right for them, not a privilege. Such a feeling often is an alien thing to society's lower echelons. The land of the living sick, it's sometimes called. Outdoor toilets, shabby homes, many with no running water or no heat to fight the cold of winter, and little education to fight the worst chill of poverty. Some have never had a family doctor. Some have never been to a hospital or they are afraid to go. Some are too old to go alone. They are all beyond the wall. [Music] 200 years ago, there was a need for the institutional hospital. From Pennsylvania hospital to the newest, they have responded well to that need. But the institution cannot make its health care available to people who do not go to it to those who are beyond the wall. Therefore, the institution must penetrate those walls, move out beyond them, and take their services to the people. >> St. John's Mercy Hospital in St. Louis County is one hospital actively responding to community needs. Sister Mary Isidor, the administrator. Michechum Park, a community with a need. About a thousand people live in this one square mile suburban poverty pocket in western St. Louis County. came into existence as at the suggestion of Father Flanigan of the Catholic Hospital Association who challenged me at a meeting of our sisters to open a storefront clinic in a deprived area. Well, we were looking around for the area and uh my our mayor from Kirkwood came to see me and he told us that in his particular locality there was a very poor neighborhood called Meechum Park. Mechum Park. Only half the homes have indoor plumbing. Most of the area looks like a junkyard. Open sewage runs exposed in the gutters. Public assistance cases are numerous and health problems abound. St. Louis County Hospital is because of the distance inaccessible to most residents. So we arranged a meeting with the people of Michum Park and to our surprise we discovered that they were not in a very receptive frame of mind. They had been exploited evidently by groups going in there to make studies who had never returned to help them. And when they discovered that we were sincere about going over there and doing something, they agreed to remodel the old firehouse and to let us have the use of that if we would conduct it into a clinic to take care of them. An old firehouse, hardly the usual setting for a hospital to perform its functions. But then when a man is ill, what of his concern with architecture? >> Do you have any insurance of any kind? Do you have insurance with the city for health? No. No blue cross. >> No blue cross. >> No blue shields. >> No insurance or health protection. >> What would you think? The bare business of living takes all the money most of Meechum Park's residents have. There's little left to use for medical bills. The high cost of drugs would make proper medication for these people almost impossible. But in neighboring Kirkwood, a pharmacy owner cooperates with the clinic by selling the drugs at whatever cost the clinic's coordinator marks on the prescription. Most of the prescriptions are given C ratings, meaning the patient pays only 50 cents for the drug. >> You'll have it within the next hour or two. >> Oh, well, all right. There's two of them on there. I really Yes. I feel like I gave it a C because I feel like he really can't afford anything else. >> They's delivery van takes prescriptions free of charge to patients who have no way to pick them up. [Music] Because Mechum Park is not in the inner city area, transportation is a major problem in securing adequate healthcare. St. John's Hospital has solved a part of that problem by taking its services directly to the people where they live. >> And I think that it won't be very long till many of the hospitals could be engaged in this type of work. We have found it to be very satisfying to say the least of it. And we feel that we are doing a real community service by bringing the health services to the people. The health care needs of a community can be fulfilled from an abandoned firehouse in Nichum Park or just as effectively from an old convent. In Philadelphia, Hanaman Medical College and Hospital has its community medicine service operating from what once was a Dominican convent. How do we get a into a building like this? Because uh obviously the relationship between a building with an altar here and a and a health service is uh it's sort of remote. But really what happened was that in 1916 the Dominican sisters had bought this building for really a sort of an identical purpose. It has 105 rooms in it. And what they wanted to do was to make it possible for young women to make the transition from a troubled background to a place in society. That's not all that different from what we're trying to do right now and not all that different from what community medicine is all about. It has to do really with how successfully people can live as an expression of health rather than just that we take care of the cut of nails and the and the appendices and all of that kind of uh ordinary medical stuff. Well, to me, this clinic is it's a great help to especially the kids and the mothers in this community because we can walk here and walking distance and if we have any problem, we can come over here and sit down and talk to the doctors about it and they are very patient with you. They don't try to rush you off or give you no advice whatsoever. And I think it's one of the best things that could be done to have a clinic right here in the community. And I think it's very important in this regard to realize that it starts with the community. And with the community, however, in at least two senses of the word community. One is the area in which we live and work here. It's a 40 square block area with 13,000 people in it. And these are people who live here under particular conditions and who work in and outside of the community and who depend upon uh the community to provide the things that they need for their everyday living. But the community also has to be able to provide other kinds of services to them. Educational services, employment opportunity, training for employment, and medical care. And it's the medical care part of it that we of course are particularly interested in. Is this kind of a thing that a a institution like Honaman, which is a big hospital, a particularly one that has a medical school attached to it, has to be concerned with. How does it make its resources available in the most efficient way to the people of any given community? Also in Philadelphia, Temple University and Hospital began to extend its resources by first meeting with community representatives. This center, as is most other centers in this country, plan from day one with the community. Many of us began in ' 66 to have a number of conversations with various community leaders to find out what they really wanted in healthcare. This is one of two centers we are operating. This center is known locally as the comprehensive group health services center is operated jointly with St. Christopher's Hospital for Children and Temple University. It provides comprehensive health care services including medical services, dental services, X-ray and other kinds of ambulatory type care. That's it. I'm doing quite well. Excellent. >> Very fine. Patient. You see there? Okay. And there it is on the other eye. Because of extensive pre-planning with the community, Temple University and Hospital is able to respond directly and effectively to a wide range of specific needs in its area. >> One example of how we may be responsive to the community is uh found in the hours of operation of this center. This center has just gone into evening hours. We're aware that clinics which follow the traditional middle class hours do not reach the kinds of people that we're trying to reach in terms of their working or their operating or living hours. Our community uh formed an advisory board known here as the advisory board to the comprehensive root health services center. The board itself elected a chairman and at this center Mr. Oscar Shamburgger, a local taxi driver, is chairman of our board. >> Well, our our board of directors consist of 30 people, which is 10 professional people. Five of them appointed by Temple and five of them appointed by St. Christopher Hospital and uh 10 neighborhood people that were elected and we also have 10 people from our area of DAC that's anti-poverty and then 30 people consist of our boards and all of these to try to help run things smooth. It was very hard getting off the ground, believe me. Uh, not being used to these things. And then a lot of people, so many government things have come into our neighborhood that we're skeptical of every one of them. So, we said we give it a chance and see how it act. Here at Cathedral School in Philadelphia, Hanaman Medical College and Hospital, already with a clinic in the old convent, is participating in a school lunch program. The program's purpose is to give the children a balanced meal every day, but it has an educational function, too. Local mothers help prepare the food, and they also learn something about good nutrition. >> It also has taught the children to eat many foods, vegetables, and meats that they had never been used to eating. As you can see, our sisters eat uh the uh lunch with the children and eat the very same food that they are eating. And this lends for a great deal of rapport between the the teacher and her pupils. >> Being involved with the community doesn't mean that a hospital has to be large or affluent. Bethany Brethren Hospital, a 57 bed institution on Chicago's west side, financed the cost of its clinic and created a community council to administer it. >> The clinic actually is uh operated on the decisions made within this group. the uh the way it is funded. Uh the board of directors at Bethany Hospital decided that uh this community should have an outpatient clinic and we had no government funds. So we decided that we would go it alone and finance the U center out of hospital funds. We did appeal to some foundations uh well several and got not much response uh from foundations. We did uh contact Sears Robuck Foundation and they uh have furnished all the equipment you see here, the furniture and all the medical equipment as well. Um the actually the money that operates the uh center has been sort of borrowed from our plant fund at the hospital and we will if conditions are ever right return this uh money. >> The work of the center seems to be expanding and uh Dr. Watts has indicated recently in a recent conversation that uh fairly soon we will have to extend our operation and services to the community. >> This community health center uh grew out of a great need for medical care here uh in this area. Uh we are very proud of this uh clinic which is in uh direct association with the hospital. Uh it was created with the aid of the community organizations. uh these organizations um uh began by telling us exactly what they would like to have in this community and we responded uh uh by attempting to create this type of care here in the area here at the center. Now we are able to uh uh virtually take care of the total care of the patients uh uh that is in association with the hospital. Uh currently here we we see patients in pediatrics uh uh in general medicine in obstetrical uh uh cases with gynecology and we are able to follow the patient into the hospital uh take care of his needs and then refer him back to the center. uh in the future along with the general care of the people in this area we also uh will attempt an immunization program which we hope will cover this entire area of the city. Uh uh we hope to be able to do this uh mainly in conjunction with uh the people who work here who circulate in the community and attempt to make sure that patients uh come back for their follow-up care. [Music] This is the age of mobility and St. Mary's Hospital in a suburb of St. Louis has found that a clinic on wheels best satisfies a specific need. >> The clinic was uh initially conceived in order to cut down the uh perinatal mortality that St. Louis unfortunately has. And when the idea was suggested uh that possibly better perinatal mortality statistics uh could be achieved by going out in the neighborhoods where the unit was more accessible. The sisters uh very promptly seized upon the idea. The St. Mary's mobile clinic visits two St. Louis locations every Wednesday. First, it parks in an elementary school parking lot. The school furnishes a waiting area and besides their professional duties, the sisters act as babysitters for patients who bring their children. >> Is he eating well? >> Yes. >> The adapted house trailer has been converted into a reception area, two examination rooms, dressing areas, and a restroom. >> Have you been taking your vitamins an hour? >> Yes. >> Feel the baby kicking a lot? >> Yeah. Mostly at night. going to bed. It kicks a lot. Very big kicks. >> Are your ribs sore? >> Yeah. >> How you doing? >> We have found in going into the neighborhoods >> I doubt very much that uh it's possible for people to attend the mobile clinic where otherwise uh they would not because of the fact that u they have no transportation problem. In addition to our prenatal care that we provide, the uh sisters provide a multid-disciplinary uh service to these patients in the form of uh dietetics care uh the proper preparation of uh nutritious and uh inexpensive foods. >> Could you tell me what you had to eat yesterday? >> Uh for breakfast yesterday, I had a hot dog sandwich and a can of soda. And for dinner, I had two pieces of chicken and two slices of bread and a glass of milk. >> Did they also tell you what types of foods are naturally high in sodium? >> No, they didn't they didn't explain that to >> didn't explain that to you. >> Okay. Well, things like potato chips >> and pickles, ham, wieners, your lunchon meats are all very high in sodium. And these are foods that we'd have to >> um not have in the type of diet. >> Big cities are not the only places where special needs exist. Distance too can keep even those who can afford proper care from getting it. This is Hawky out on the western plains of Kansas. Great Plains Lutheran Hospitals at Philipsburg operates 13 small rural hospitals in the state. Sheridan County Hospital in Hawky is one of them and it is extending its services out into the homes of people for whom trips to the hospital would be impossible. >> Hy is a community in northwestern Kansas. We have a population of around 1,200. The county is Sheridan County and has a population of about 4,500. The idea of a home health care service originated as a result of a need of patients who had been cared for in the hospital but no longer needed the acute care that was given in the hospital. Yet they hadn't really recovered to the point that they were completely self-sufficient. Many of them needed supervision with taking their medications, help with their personal care and hygiene. >> A registered nurse, a home health aid, and a physical therapist routinely visit the shutins. >> Physical therapy and rehabilitation exercises make up a large portion of the home care program. >> Okay, that's fine. Now, let's go sit in the chair over here and work out with the baton exercises. >> One of the services of our home health care is the food preparation where we serve meals on wheels. Taking warm, well-balanced meals to some of the patients in their homes. >> Can you fix your teeth? >> Mhm. I can't pour this. Okay. Pour it over. >> All right. That's for you. This one don't work very good. >> Care for the elderly always has been a concern for those engaged in medicine. And it is fitting that Pennsylvania Hospital, the nation's first, is involved in extending its services in the direction of the aged in its community. Many of the elderly are afraid of hospitals. they just will not go. Some could not afford it and for others it would be physically impossible to get to a hospital. So the hospital took its services to where the people are, a lowcost apartment complex that houses many senior citizens. The building in which uh we are now sitting is a uh lowcost high-rise apartment house for senior citizens in South Philadelphia. When this building was planned, a number of civic groups in the area requested that clinic space be set aside for these older adults. Uh so that the building was built with this clinic uh uh laid out as you have seen it. Now, uh, Pennsylvania hospital, which is not far from this, uh, high-rise building, was asked to set up the medical facility in the clinic. Uh, Pennsylvania hospital organized uh, the clinic. There is a uh, clerk registar, a social service worker, a registered nurse, and there are doctors who volunteer their time to work in the clinics. Uh the purpose of the clinic primarily is to provide a place near these older people where they can come for treatment instead of traveling to the hospital. Most of these old people are infirm and especially in inclement weather find it very difficult to get to the hospital and in addition uh many of them are frightened at the prospect of going to the hospital. Now the long range program down here is this uh this clinic actually is only one part of a very large program which will include recreational facilities and social welfare uh services for these older adults. So that any senior citizen uh coming here uh can have a recreational program can receive advice in any way for any problems that he may have either at home or uh relating to his own social welfare and at the same time can receive medical treatment. So it is a comprehensive program designed for these older adults. Uh Pennsylvania Hospital, we are very happy to say, uh is very much aware of the community needs and is very happy to participate in a program such as this because it is the feeling at Pennsylvania Hospital that uh we must move out of our walls into the community, moving beyond the wall of the institution, making an active effort to develop a real partnership. between hospital and community. That's what it's all about. Not abandoning the traditional place of the hospital, but building upon it, expanding it, and extending it out to serve the needs of man in his community. This is the challenge. [Music] [Applause] [Music]