Layers of history dating back 19,000 years in a rural Pennsylvania Rock shelter. He explains why this and other locations have led to revise theories about revised theories about when humans arrived in the americas. And at 5 00 pacific on the presidency, discussions on james madison. The first looks at americas founding documents and the second and the partnership he had with his wife. That is what is coming up here on American History tv. [indiscernible]. Wo years now im used to the sound of the elevators elevated train. The kids play. People might think [indiscernible] but when you live here, you call it Something Else [indiscernible] body hurts. R good [indiscernible] it is part of a new idea what is going on in other cities, all over the country. Ite in the bronx, we call [indiscernible] canle from my neighborhood come and have their sickness treated and their hurts 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 startling and significant ways. Concept of care has profoundly affected both the Health Professional and the patient. Sky ever had this man never had a medical doctor before, at least one who knew his name and medical history. I was hurting so bad. Inmrs. Skinner is getting on years and it never entered her mind she would get so much interaction and attention in a place devoted to medical care. If the place does not kill me, if the place does not kill me, it is so quiet. 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. I took the pills but every time i took the pills, every time, instead of my arm hurting, it would hurt and then my chest would hurt. And just a few months ago, it certainly never occurred to many of these people they would be helping shape the entire way in which their neighborhoods healthcare was to be offered. But they are. And the medical people are listening. This is the story of a new kind ,f comprehensive health care and the way it is being offered in 36 American Cities and towns. It is a story of an approach that goes where they are, listens 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 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 using it every day, through their Neighborhood Health center. I am dr. Roger egbert, 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. Hard to obtain, impersonal, fragmented. In that kind of a setting, quality suffers. And today there are probably 13 Million People not receiving the kind of care we all deserve. Now with people working in their neighborhoods with professionals in the planning and operation of the centers, there are new ideas and new directions 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 you are poor, poverty poor, and you live in places like these, sickness can be a lifelong fight. Blight. It kind of vicious circle, described by the physician who said, the sick get poorer, and the poor get sicker. If you are poor and sick, the re are some mighty discouraging barriers between you and good medical care. Barriers like transportation. I have been standing around here for half an hour waiting for the bus to come along. If you need one, you dont care how long you have to wait. Then you get to the hospital, you got to wait some more. It is hard. You get to the hospital and you have to get your kids dressed and get yourself dressed and you are very, very sick. And you have to walk several blocks to get the bus. So i never go until i am nearly dead before i go or even before i take the kids. Because it is too difficult. Add long distances, no particular way to get there or get home later, and only the most serious illness could drag you out. And once you are there, what then . [paging system] [baby crying] physicians and other medical people do a supremely difficult job. Emergency rooms just were not designed for that job. They were designed to handle acute catastrophes of all kinds. And when the medical or surgical need of top urgency they and , their staff function smoothly and efficiently. The team in Emergency Rooms all over the country function was supreme skills and presented with the kinds 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 are very likely to wait until you are really sick. Or 10 sick as they used to say in watts. Unfortunately, being 10 sick often meant not getting well very fast. As dr. Egbert 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 now in this country. To add 13 million patients and 15 hours of extra work each week to every doctors workload 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 Problems that plague the city ghettos, migrant camps, the poor wherever they are concern physicians and , Health Professionals all over the country. Exploration for creating solutions was a top priority. 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, one door care, where the whole family of health needs could be met. They called it the Neighborhood Health center. And the neighborhood was so involved in it that a little town like this in california, they built it themselves. [power tools] there is more than ] there is more than hammer and saw participation here. This Community Building its own center as a unity of strength that can address other problems as well. As they break for lunch they may talk about other things like housing and education and welfare. One 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 as such things as Health Problems to the lack of housing, lack of education, a lack of response by the institution in the society that so dramatically affects their lives. And not only do they have, some of them have, 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, medically deprived people in communities like this are helping themselves. A Health Center in this neighborhood, thats right. And it was not 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 the best looking building in town. The centers did not have to be a magnificent or even elaborate to begin with. San franciscos first ones were inhouse trailers drawn up around an attractive courtyard. But they did have to be convenient and comfortable and easy to access, with pleasant waiting rooms in which people would feel welcome and at home. Most people are not so far out the mainstream of medical care that they dont want what other people want. Perhaps most significantly, they want what Health Professionals themselves want. They want private offices. You tell me, is this comfortable . They want quiet examining rooms. It wide. H, open they want comfortable conference areas, where a warm and lasting relationship can be established between Health Professionals and patients. [speaking spanish] i find that in this doctorpatient relationship, we are able to establish more than just the ordinary factor of patient relationships, rather that of a friendship. In which we are not interested only in the the whole family. This should not only be interested in providing health care but also in raising the standard of living and giving hope for future generations to come. A fundamental and most important concept of a Health Center is to offer patients family care medical service. Filled with implications for the whole medical field. It is called pain medicine, and it is 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 a sign to a health it is assigned to a health team which will be responsible for all of its health needs. It is possible for an entire family to come in at once. And each member be seen by the appropriate person on their team. Oh boy. Put your tongue back, honey. And while his father is getting attention just down the hall, young spanky is getting his pediatric workup. As a member of your team, the pediatrician has the unique opportunity to use his pediatric training to best advantage. He doesnt wind up spending half his time as a clerk 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, ive 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 i will get the social worker to talk to you and maybe give you some help, because he is at a pretty rough age right now without a diet, in the diet may be a little too much for him to handle. As far as i can see from this picture many centers offer the convenient advantage of in Center Specialist consultants, specialists like this gynecologist at the montefiore center, who is able to concert to consult on specific patient problems. Refer a patient to [indiscernible] i have when have you had your last period . About the 12th of last month. The 12th of last month. Have they been always regular, your periods . Yes. How long do they last . About five days. Psychiatric consultations are also possible in the new york center. Physicians take the opportunity to talk over specific case problems. Reinforce this connection. Swallow. That is right, honey. One of the most Important Team members at any center is a dentist whose facilities are almost always busy. We will show you how we brush the teeth. Dental care is an important aspect of Family Health care. Our main consideration is clinical dentistry, but we feel it 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. Floss and do it yourself, ok . Put it up, then down. Up, then down. For incentive, your own toothbrush with your own name on it. Ok. 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. She 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. I mean it is people saying you , are that special to us. You know, we are your special team, and we are interested in you not only in terms of the medical aspects, but how are your children doing in school . Today they are going to tell us how to take an oral temperature. While you are doing it important to was bring people from the neighborhood to create new health rules. 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. To learn such health skills, such as care of the bedpans, checking vital signs and pass examinations to demonstrate their knowledge, these Family Health workers are integrated into the functioning health care team. In the next couple weeks. Consulting closely with a 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 coronary patient to visiting city hall to get action on a housing violation. The Family Health worker is like patient care often begins by visiting in the home, apartment, or a tenement. There, she 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. This patient and her children will be given all the medical attention they require. For the mother, that means the obstetrician. It is all right. The baby is in good position, and we probably expect her to deliver towards the end of the month. [speaking spanish] how have you been feeling since the last time i saw her . [speaking spanish] [speaking spanish] and that is the way it is working at Centers Across the country. Team medicine with the family , Health Worker bringing the doctor what he has 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. I understand that you are walking now. Know listen again as the Family Health worker response to the needs of the patient who happens also to be a neighbor and a friend. It catches me right in, you know, right in there. Right on up under my ribs and this part of my shoulder. I dont like to go to doctors too much. I have never been sickly no sickly person in my life. I have been to this clinic more than i ever went to a doctor in my life. So, the patients come to their Neighborhood Health center. There are not any complicated eligibility requirements for the patients, no lengthy forms to fill out in cold or unfriendly environments. Top priority goes to serving people. And all these patients are seen as people who felt bound up with the other circumstances of their lives. Young salvador there is not just an injured wrist. He is a little boy whose mother kept a dangerous washing machine. One of the first things the center did was send someone out to share safety techniques. That man is not just a heart patient. His doctor knows he is the head of a large family and it is important to have an income producing job, a factor that will be taken into account in his treatment. Who mrs. Hitchcock 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 patients needs. I said look this is my body. , so they listen to their patients, both in the center and on the job. If a man cannot come into the center, a Center Worker will come to him. Even in the middle of a plowed tomato field. Can we help you with your familys Health Problems . That is what they want to know. [barking] 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 spanish] 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 own backyard to this elderly couple in king city california. , yes, they could come into the center for treatment, but the old woman as always had a fear of hospitals. The injections here are not anywhere near as threatening. Outreach, bringing medicine to the consumer community, academic words to describe what really goes on in their backyard. And their appreciation takes a form sanctioned by tradition. This gift is given with sincerity and gratitude and is received the same way. You know, good thing that 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 dr. Rodney powell and his staff in , community watts involvement means working with his health council, a Management Group made up of concerned Community Members selected by their neighbors. We have an opportunity to work. We know that. I think one of the biggest problems is the lack of understanding of what the team really means. The person who plays the key has not had the kind of training that i think you prescribed for them initially. That is never healthy. These are people who are serving in the interpreting, communicative advocacy roles. The doctors regard him as someone less than professional and the people such as the social workers still have not accepted his role. That is because he is dealing with a position of no power. I think that he is dealing from a powerless position and that is why he is not recognized. That is the conflict. Let me identify right here. The conflict is we can get people who can do this. In my experience, a Community Health council is one of the vital channels of communication that serves our center. You just cannot 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 a full partnership. They get consumer participation from the patients themselves. The employees at the center, who are Community Residents and members of the Community Health council. The board of directors who set Program Policy for the center. The doctor is supposed to be able to make contact with anybody with regard to the level of the person. The implications for the future of this new kind of 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 area, usually medical school, teaching hospital, 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 , technicians, xray technologists and other Health Specialists, but also switchboard operators, records specialists, and secretaries. When the training is complete, these people will be equipped to fulfill needs of the center itself, or go in the community and work at other facilities. By creating new wage earners, Neighborhood Health centers are helping develop the Financial Health of the community as well as its physical health. It is new and it is challenging and it is frustrating, too. Because the problems are not all solved yet by any means. There are still patients whose needs are not 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 off. And its implications are farreaching. As a flexible system which emphasizes full involvement with the consumer himself, the Health Center principal may well be useful not just as medicine for the poor, but for medicine as a whole. Doctor california, the southern Monterey Group operates the center, the doctor and his colleagues have successfully proved private Group Practice can work closely with Government Agencies to fill gaps in health care with new services and manpower. I hope we represent a real working partnership between private physicians and government working towards the same goal. And so far we have had an experience of bringing better medical care to people whove never before had adequate medical care in their lives. The development of our program here encourages to develop any innovations that we are capable of through our own initiative and imagination. And i feel if this grant ended tomorrow, that we would never go back to practicing medicine exactly the same we did prior to the grant, even with private patients. Because we have learned techniques and used techniques medical care that have changed our entire pattern of practice, for the better im convinced. Since the beginning, and while it is far from perfect, it is light years 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 happened for the peoples health. The center has not solved all the problems of schools and housing and trashy sidewalks, but for my friends and my neighbors and all the people who live here, to them the center is a very great thing. And talking for me, it is a great thing, too. [singing in spanish] you build the center yourself, but it didnt help on opening day you come with special prayer and thanks giving. [singing in spanish] 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 anything you build yourself belongs to you. Community action. This entire Health Center is evidence that there is such a thing and it can work. Perhaps it is more visible here than in some other areas, but the ideal may be more difficult to obtain, but it can be done because they did it. So, in the 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 is part of what it means to have a center. [captions Copyright National cable satellite corp. 2020] [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. Visit ncicap. Org] announcer 1 you can watch archival films on Public Affairs in their entirety on our weekly series reel america saturday at 10 00 p. M. And sunday at 4 00 p. M. Eastern here on American History tv. Announcer 1 this sunday on american artifacts, sifting through the years of Human History dating back 19,000 years inside april Pennsylvania Rock shelter. Here is a preview a rural Pennsylvania Rock shelter. Here is a preview. An hour southwest of pittsburgh, meadow craft rock shelter has been the site of extensive archaeology work since 1973 after university of pittsburgh students removed layer after layer of sediment, evidence of human activity as early as 19,000 years ago. We visited this craft to learn the story from the archaeologist leading the research. In thisgot here columbus got here in 1492, he encountered aboriginals on symantec a or wherever he landed. And they were the taino. And he or members of his entourage presented questions we have been asking ever since. Who are they, what did they come from, when did they arrive . It a question they did not ask but will be have addressed is what were they doing . What were the lifestyles like . He thought he knew the answers because he thought he was in the east, not the west indies. He called them indios, or supposition was at least within 100 years that they had arrived here 2500 years before he did. That benchmark arrival date has been pushed further and further and further back through the years but will take a series of intellectual developments in western europe before we can actually answer any of those questions appropriately. Excavationhe initial started here in 1973, we thought we understood everything there was to know about the first people in the new world. There was a prevalent model about how that event took place, when that event took place, what their lifestyles may have been like that literally everybody believed. And the excavations here and have a series of other locations have altered our perceptions of the past in such a way that literally everything we thought we knew, we dont know anymore. It is clear the earliest people who came to this site were in fact what we call broadspectrum subsistence folk. Like college guys they would eat anything in the refrigerator. They were eating elk to mouse sized animals, and incredible assortment of plants. Remains. 4 million plant , 956,000 animal bones representing 105 different species. Announcer 1 learn more sunday 3 00 eastern here on American History tv. It is easy to follow the federal response to the coronavirus outbreak at cspan. Org virus. Track the spread throughout the u. S. And the world with interactive maps and charts to watch briefings and hearings with Public Health specialists anytime, unfiltered. Tour concludes a look at san antonio with a look at one of the earliest structures in the city, the spanish governors palace
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