Some people i think, its colorful. It doesnt look good or smell good or feel good and the neighborhood. Especially not for the sick, or when your body hurts. But we have a good answer to sickness in this part of new york. It is part of a new idea. All over the country here in the bronx week we call it the Neighborhood Health center. Yuck people from my neighborhood can come and have their sickness treated. You are entering the new world of health care. We use the same science and instrument equipment, it is different than some startling ensign significant ways. This concept of care is profoundly affecting both the Health Professional and the patient. This man has never had a doctor before. Have you got much swelling in your legs . I was hurting so bad. It had never entered her mind that she would be in a place so devoted to medical care. Im so proud. Mrs. Hitchcock complains about a lot of things, but you never thought complaining about her medical care would make a difference. But it is. I took the pills, but every time i take the pill, instead of my arm start hurting, then my chest would hurt. Just a few short months ago, it certainly never occurred to none of these people that they were helping shape the entire way in which their Neighborhoods Health care was being offered. But they. Our and the medical people are listening. This is the kind of new comprehensive health care and the way it is being offered 36 cities and towns. It is a story of a an approach that goes where they are, listens when they talk and answers when they question. Except their advice on how it can best serve their needs. music 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. music right now, hundreds of thousands of americans are using it every day, through their Neighborhood Health center. music i am dr. Roger egbert, dean of the university of universe e of Southern California school of medicine. This film describes new ways of providing health care for the poor, whether they live in the country of 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. Today there probably 30 Million People not receiving the kind of care we all deserve. Now with people working the neighborhoods with professionals in the planning and operation of the centers, there are new ideas and new directions we should all be aware of. Lets take a closer look at some of the problems, and what Neighborhood Health centers are doing about them. music if you are poor, poverty poor, and you live in places like these, sickness can be a lifelong fight. 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 mighty discouraging barriers between you and good medical care. Barriers like transportation. Standing around here for half an hour waiting for the bus. If you miss one, you dont turn home, you have to wait. In any given hospital you have to wait some more. Is hard to get to the hospital when you have to get your kids dressed and get yourself dressed and youre 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 their or get home later. And only the most serious illness could drag you out. Once you are there, what then . Dr. , to the emergency room. [paging system] [baby crying] physicians and others do its supremely difficult job in the countrys Emergency Rooms and clinics. But as many physicians know, Emergency Rooms were not only designed for that job. They were designed to handle acute catastrophes of all kinds when the medical need is of top urgency, they and their staff function smoothly and efficiently. The teams in Emergency Rooms function was supreme skills and presented with emergencies which this place was designed. music but the role of the emergency room has changed over the years. Now people bring routine problems here. If you had to take three buses to get here, or 10 taxi ride, youre 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 well, underlying all of this is the inescapable fact that there are hardly enough doctors to go around as medicine is practiced now in this country. Two at 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. 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 city ghettos, migrant camps and poor, concern physicians and Health Professionals all over the country. Explorations 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. music so it began. In the city ghettos and 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, that little town in california, built it themselves. [dog barking] [power tools] there is more than hammer and saw participation here. This is community participation. This Community Building its own center has a unity of strength that can address other problems as well. As a break for lunch they may talk about 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 and the society that so dramatically affect their lives. Not only do they have, some of them have, 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. music with a vigorous and necessary help of Community Workers, medically deprived people in communities like this are helping themselves. Health center in this neighborhood, thats right. And it was not even going to resemble a cold, in personal, hospital emergency room. This was going to be accessible care. And if they had anything to say about it, it would be given in the best looking building in town. music the centers did not have to be magnificent or elaborate, san franciscos first ones were inhouse trailers drawn up around an attractive courtyard. They had to be convenient and comfortable and easy to access. With pleasant waiting rooms in which people would feel welcome and at home. People are not so far out the medical care that they dont want what other people want. Perhaps most significantly, they want what Health Professionals themselves want. You tell me, is this comfortable . They want quiet examining rooms. Open wide. They want comfortable conference areas, where a warm and lasting relationship can be established between Health Professionals and patients. Spanish] i find that this doctorpatient relationship, we are able to establish more than just the ordinary factor of patient relationships, rather that of a friendship. Were not only interested in the pregnancy, but the whole family, i think this emphasize is this. Should not be only provided interested in providing health care but to give hope to future generations. A fundamental and most important concept of a Health Center is to offer patients family care medical surface. This implies many things in the medical field. It is called Team Medicine and it is offered by a highly organized group whose members respond to patient needs, both medical and social. A typical health team is made up of physicians, usually including an obstetrician and pediatrician. 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 team which will be responsible for all of its health needs. It is possible for an entire family to come in at once. Each member will be seen by the appropriate person on their team. Put your tongue back, honey. While his father is getting attention just down the hall, young spanky is getting his pediatric workout. As a member of your team, the pediatrician has the unique opportunity to use his pediatric training to his advantage as a clerk or social worker or as a nurse or receptionist. All members of the team contribute as coequals with their own specialized area of expertise. In my particular case, i found over the months that more and more i have learned to rely upon the other members of the team to do their part of the job. 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 and the diet may be too much for him to handle. As far as i can see from this picture many centers offered 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. When have you had your last period . Last month. Have you been regular on your period . 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. One of the most Important Team members and any center is a dentist whose facilities are almost always busy. We will show you how they brush the teeth. Dental care is an important aspect the Family Health care our main consideration is medical dentistry. We feel its important to give a program of preventative dentistry with programs of dietician. We begin our program with the basics and that is instruction in home hygiene and home care. Our assistants are trained to continue the program by further instructing the families and the children, especially upon each visit. Do it yourself, ok . Put it up, then down. For incentive, your own toothbrush with your own name on it. There you are. Now take your toothbrush, jose, and take it home with you. The Family Health team makes maximum use of physicians. Each team also draws upon a nurse with Public Health skills. 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. It is people saying you are that special to us. 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 . They are going to tell us how to take an oral temperature. The idea of the Family Health worker. Vital to involve them in neighborhoods. The Family Health worker is typically a woman, though there are expanding opportunities for men. And always a person who lives in the neighborhood and understands its needs, its people, and its community resources. Health skills such as check of the bed cast. Passed some rigorous examinations. These Family Health care workers are integrated into the functioning alpha carotene. Consulting closely with a Public Health nurse, who often serves as team coordinator, the Family Health worker has been her days assignments, which can include everything from visiting a coronary patient to visiting city hall to get action on a housing violation. Patient care often begins by visiting in the home, apartment, or tenement. There, she can check the entire family in their home environment. s. At periodic intervals, the family has an appointment at the center. They will be given all the medical attention they require. For the mother, that means the obstetrician. The baby is in good position, and we expect her to deliver towards the end of the month. Spanish] ask her how she has been feeling since i last saw her . Spanish] and that is the way it is working at Centers Across the country. 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 a cultural bridge into the community. I understand you are walking now. Listen again as the Family Health worker responds to the needs of the patient who happens to be a neighbor and a friend. It touches me right in there. Then into my ribs and this part of my shoulder. I dont like to go to doctors too much. I have never been a sick 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 a cold or unfriendly environment. 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. This is a little boy whose mother kept a dangerous washing machine. He is not just a health patient. His 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. This is a mother of five who must be listened to and responded to with respect, not just because she needs to ventilate her feelings, but because she allows the center to see where they may not be meeting patients needs. This is my body. So they listen to their patients, both in center and out of the job. If a man cannot come into the center, a Center Worker will come to him. 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 on a patients farm to tell them about the Health Services available, and they tell it in the language of the spanish] music if it is 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 california. Yes, they could come into the center for treatment, but she has always had a fear of hospitals. The injections here are not nearly as threatening. Outreach, bringing medicine to the community, academic words to describe what really goes on in the backyard. Their appreciation, this gift has given with sincerity and gratitude and is received the same way. From the outset, the Health Center idea was based on the concept of community participation, that residents in the 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. Powell, 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. We know that. One of the biggest problems is the lack of understanding of what the team really means. The person who plays the key role does not have the kind of training that i think you prescribed for them. That is never healthy. These are people who are serving in communicative roles. The doctors regard him as someone professional. That is because he is dealing with a position of no power. I think he is dealing from a powerless position and that is why he is not recognized. Let me identify right here. The conflict is we can get people in. 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 in the context of a full partnership. We get participation from the patients themselves. The employees at the center, and the Community Residents who are 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 in. 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 works with a medical school, or established group practice. A new way to deliver health care, yes, and a great many important ways it is. 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, laboratory technicians, xray technologists and other Health Specialists, but also switchboard operators, records specialists, and secretaries. When the training is complete, they fulfill the needs of the center itself, or go in the community and work at other facilities. By creating new wage earners, 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 it is evolving. It is confronting tough and complicated issues such as recruitment and changing professional roles and others. The Neighborhood Health center idea is well launched. Its implications are farreaching. Five civil system which emphasizes full involvement with the consumer, the Health Center principal may well be useful not just as medicine for the poor, but for medicine as a whole. We represent a real working partnership in private positions and government working towards a single goal. So far we have excellent relations. We want to bring that a minute better medical care to people. The development of our program here encourages to develop many innovations that we were not capable of our own initiative. I feel that if this grant and tomorrow, we would never go back to practicing medicine the same we did prior to that, even with our private patients. Because we wouldnt learn new techniques that have changed our entire pattern of practice for the better. Im convinced. It is a beginning. While it is far from perfect, it is light years from what it was before. This Family Health workers an expert on that. You do not have to live in this neighborhood. You have to really be here to know what it was like before and what a wonderful thing now has happened for the people. The center has not solved all the problems of schools and housing, but for my fronts and my neighbors and all the people who live here, to them, the center is a very great thing. It is a great thing for me as well. On opening day you come with a special prayer. 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 a reminder there is such a thing and it can work. Perhaps it is more visible here than in some other areas, but the idea where the idea may be more difficult to maintain, 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 if they feel very much at home. That is part of what it means to have a center. Each week, American History tvs reel america brings youn archival films that provide context for todays public