It took a while. But we have a good answer to sickness in this part of new york. It is part of a new idea that is going on in other states. You are entering a new world of health care. It draws upon the same science and uses the same instruments and Equipment Health services traditionally do. But in its philosophy and practice, it is different and startling and sing cant ways. Ways insignificant in startling and sing it ways. In new yorks montefiores way, this concept has affected the professional and the patient. Kai ardo never had a doctor before, at least one new his name and medical history. Your . Your legs . I was hurting so bad. I turned around and came back to her three times. Getting on in years and it never entered her mind that she would be getting so much intense and in a place devoted to medical care. If the place does not kill me, it is so quiet. Misses 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 the my chest would hurt. Itjust a few months ago, never occurred to many of these people they would be helping shape the entire way in which their neighbor Hood Health Care was to be offered. But they are. And the medical people are listening. This is the kind of new currents of health care and the weight is being offered and 36 cities and towns. The way it is been offered. An approachy of a that goes where they are, listens when they talk and answers when they question. And it excepts 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 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. Impersonal,in, fragmented. In that kind of a setting, quality suffers. 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. 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. Theou are poor and sick, art 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 need one, you dont care how and you have to wait. Then you get to the hospital you have to eight. Some are. [horns] 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. 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. Once you are there, what then . Dr. , to the emergency room. System] [baby crying] physicians and others do was job a supremely occult job. Emergency rooms a supremely difficult job. 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. But the role of the emergency room has changed over the years. Now people bring routine problems here. 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. Well, egbert knows 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. Andat 30 million patients 15 hours of extra work each week to every doctors workload, would throw the whole medical system into chaos. Explore is, we need to 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. Trieding that is being and then Everett Health centers. In that Neighborhood Health centers. The Health Problems that plague city ghettos, migrant camps and poor, concern physicians and Health Professionals all over the country. Exploration for crating solutions was a top priority. With the help of the office of economic opportunity, the search became known as the health right programs. So it began. And towns, ghettos something was happening. Members of the Health Professions working closely with the lbo 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 petitioner patient here. This is community participation. More than hammer and saw 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 expense of attacking a specific problem and working with one another, they beat 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. , some ofdo they have 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. 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 chili, impersonal 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. 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 wait. Far out theot so 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 . Want quiet examining rooms. Open wide. Want comfortable conference areas, where a warm and lasting relationship can be established between Health Professionals and patients. [speaking 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. Also embracing a fundamental in most important concept of a Health Center is too often patients family care medical service. It is called pain medicine, and is offered by a the typical health team is made up of physicians, usually including an obstetrician. Health nurse and one or more Health Specialists called Family Health workers. 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. Back, honey. Ongue while his father is getting attention just down the hall, young spanky is getting his pediatric workout. Team, thember of your pediatrician has the unique pediatricy to use his as aing to his advantage clerk or social worker or as a nurse or receptionist. 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 their totalent in 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 theany centers offered convenient advantage of in Center Specialist consultants. Specialists like this gynecologist at the montefiore center, who is able to concert consult on specific patient problems. When have you had your last period . Last month. Have you been regular on your period . How long do they last . About five days. Psychiatric consultations are also possible in the new york center. Opportunityake the 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. Then took care is an important aspect of Family Health care. Withain consideration the instructions in diet and nutrition. We begin our Preventive Dentistry program with the basics. 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. Upon publicso draws health skills. Builts mother and i have 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 . Are going to tell us how to take an oral temperature. The idea of the Family Health worker. 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. If the patient is unconscious, you never take an oral temperature. Skills, such health such as checking vital signs. They pass examinations to demonstrate their knowledge, these Health Workers are integrated into the functioning health care team. 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. 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. [speaking spanish] ask her how she has been feeling since i last saw her . [speaking 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 contact us of their homeland 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 response to the needs of the patient who happens to be a neighbor and a friend. It touches me right in there. And this partibs 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. Toso, the patients come their Neighborhood Health center. There are not in a 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 people who felt bound up with the other circumstances of their lives. This is a little boy whose mother kept a dangerous washington 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 outents, both in center and 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] 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 people. [speaking spanish] 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. Medicine is as accessible as your own backyard couple inderly 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. , this giftciation 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. 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. Regard him as someone professional. Is dealingbecause he with a position of no power. Athink he is dealing from 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. Andemployees at the center, the Community Residents who are members of the Community Health council. The board of directors who set Program Policy for the center. Supposed to bes able to make contact with anybody i. The implications for the future of this new kind of health care are complicated and intriguing. In all their activities, whether pharmaceutical, consultation, or laboratory, the 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 op