[train sound] i have lived in this neighborhood for two years now. Im used to the sound of the elevated train. The kids play. Some people might think. Colorful. But when you live here, you call it something else. It does not look good, or feelgood, or smell good. Not when your body hurts. It is part of a new idea what is going on in other cities, all over the country. Here in the bronx, we call it the Neighborhood Health center. People from my neighborhood can 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 some startling and significant ways. , and itsew york counterparts in other American Cities and towns, this concept of care has profoundly affected both the Health Professional and the patient. Senior golardo never had a medical doctor before, at least one who knew his name and medical history. Do you have swelling in your legs . I was hurting so bad. I came back to her three times. Or three times. Mrs. Skinner is getting on in 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, it is so quiet. It has 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. 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 of comprehensive health care, and the way it is being offered in 36 American Cities and towns. It is the 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 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 suffers. And today there are probably 13 30 Million People not receiving the kind of care we all deserve. Now with people in their neighborhoods working together 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 blight. A 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, there 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 there is no telling how long you have to wait. Then you get to the hospital, you got to wait some more. It is very hard to get to the hospital when you have to get your kids all dressed very, very , 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 predictable 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 in the Emergency Rooms and clinics. So many physicians know that Emergency Rooms just were not designed for that job. Emergency rooms were designed to handle acute catastrophes of all kinds. When the medical or surgical need is up top urgency, they and their staff function smoothly and efficiently. The team in Emergency Rooms all over the country function was with 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. Egberg 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 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 were, 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 familys health needs could be met. They called it the Neighborhood Health center. And the neighborhood was so involved in it that in little so, california, they built it themselves. [power tools] there is more than just hammer and saw participation here. This Community Building its own center has 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 of such things as Health Problems to the lack of housing, lack of education, a lack of response by the institutions 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 like tom medically , deprived people in communities like alviso 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 magnificent or even elaborate to begin with. San franciscos first quarters were inhouse trailers drawn up around an attractive courtyard. But they did have to be convenient and comfortable and easy of 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. Say ahh, open it wide. They want comfortable Conference Areas where a warm and lasting relationship can be established between Health Professionals and patients. [speaking spanish] [speaking spanish] i find that in this doctorpatient relationship, we are able to establish more than just the ordinary dr. Patient relationshipt rather that of a friendship. , in which we are not interested care,n providing health but 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. Through an approach with tremendous 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 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. In order to protect your 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 consult on specific patient problems. Refer a patient to certain circumstances required. 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. Team 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 we felt it was important to involve people from the neighborhood to create new health rules. 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. To learn such health skills, such as care of the bedpans, checking vital signs and pass rigorous examinations to demonstrate their knowledge, these Family Health workers are integrated into the functioning health care team. Come in some time 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. For Family Health workers like raquel martinez, 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. 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. 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] please ask how she has 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. 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 no sickly person in my life. 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 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. Senior golardo 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. 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 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 go 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] [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 lady has always had a fear of hospitals. The injections here are not anywhere near as threatening. Outreach, bringing medicine to the consumer, to the community, academic words to describe what really goes on in their 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 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, and 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 watts, Community 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. Many of them 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 the Neighborhood Health agent. These are people who are serving in the interpreting, communicative advocacy roles. No one pays any attention to him. 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 from 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 it 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. We 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, regardless of 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 a 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 keypunch operators switchboard , operators, records specialists, and secretaries. When the training is complete, these people will be equipped to fill 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. In king city, 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 ofellent relationship bringing better medical care to people whove never before had adequate medical care in their lives. The development of our program here at the oeo encourages to develop any innovations that we are 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 private patients. Because we have learned techniques and used techniques of delivering 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 lightyears 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] if you build the center yourself on opening day you come , with special prayer and thanksgiving. [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 with the ideal may be more 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 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 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 Harriet Tubman is celebrated for her work as an abolitionist, underground railroad conductor, and union army scout during the civil war. Next, karen hill of the Harriet Tubman house talks about Harriet Tubmans lesserknown role as an activist in the womens suffrage movement. The president Woodrow Wilson house in washington, d. C. Hosts this conversation as part of a series commemorating the 100th anniversary of women gaining the right to vote. Elizabeth welcome, good evening. My name is elizabeth carter, and i am the executive director at the Woodrow Wilson house. It is truly my pleasure to welcome you to the first of a series of speaking events that we are going to have on a suffrage series. So the wilson house, if you have , not been here bere