PN - Reiff, Michael///// CN - Colorado Student Health Project//// CN - University of Colorado Medical Center//// CN - Student Health Organization of Colorado//// CN - United States. Division of Regional Medical Programs//// Ti Colorado Student Health Project, summer 1968/ TC . Editor: Michael Reiff. IM [Bethesda, Md.,/Health Services and Mental Health Administration,/19701 CO - V, 101 p.:illus. CA -WA 546 AC6 C8c 1970:02NLM,Ol SSY EL FULL LEVEL IT - MONOGRAPH MT CORPORATE NAME MAIN ENTRY DA 710316 Ul - 1255244 COLORADO STUDENT HEALTH PROJECT summer 1968 COLORADO STUDENT HEALTH PROJECT SUMMER 1968 Sponsored by STUDENT HEALTH ORGANIZATION OF COLORADO in conjunction with THE UNIVERSITY OF COLORADO MEDICAL CENTER Student Coordinator ---------------------------- Michael Reiff Associate Student Coordinator ------------------- Randall Lortscher Area Coordinators ------------------------------- Vemon Bry Lisa Wilson Faculty Sponsors ------------------------------ C. Henry Kernpe, M.D. Prof. Howard Higman Research Fellms --------------------------I---- Alfred Claassen John Quicker Executive Secretary ---------------------------- Sharon Kabella Editor --------------------------------------- Michael Reiff U.S. Department of Health, Education, and Welfare Public Health Ser@e Heala Servz'ces and Mental Health Administration This prcVed was supported in full by The Division of Regional Medical Programs (Contract No. 43-68-1528) This report does not necessarily represent the t*ws of the Pub@ Health Se@e Table of Contents ACKNOWLEDGMENTS ------------- I--------------------------- v PREFACE ----------------------------------------------------- 2 Action and Reaction by Michael Reiff -------------------------------------------- 2 The Project Sponsors' Preface by C. Henry Kempe, M.D. and Professor Howard Higman ------- 5 CHAPTER I-THE SITES ------------------------------------- 7 The Grand Valley ------------------------------------------- 8 A. The Project by Vernon Bry ---------------------------------------- 8 B. The Health Care System ------------------------------- 10 The San Luis Valley ----------------------------------------- 12 A. The Project by Randall Lortscher ---------------------------------- 12 B. The Health Care System ------------------------------- 13 C. A Study of Folk Medicine in the San Luis Valley by John Quicker and Alfred Claassen -------------------- 14 D. Folk Medicine Questionnaire ---------------------------- 18 Denver ---------------------------------------------------- 18 A. The Project by Lisa Wilson ---------------------------------------- 18 B. The Health Care System ------------------------------- 20 East Denver ------------------------------ - ---------- 20 West Denver ------------------------------------------ 23 CHAPTER II-THE STUDENT REPORTS --------------------- 25 CHAPTER III-THE INTERNS ------------------------------- 51 59 CHAPTER IV-PERSPECTIVES ------------------------------- New Perspectives by Peter Bonavitch ----------------------------------------- 60 community Presence-A Justification by Bonnie Camp, M.D --------------------------------------- 63 Discussion ------------------------------------------------- 64 CHAPTER V-THE EVALUATION -by Affred Cl n and John Quicker ------------------------------ 73 in APPENDIX --------------------------------------------------- 85 partio_ipants and Preceptors ---------------------------------- 86 Conference Schedules ----------------------------------------- 89 Demographic Data ------------------------------------------ 91 Student Attitude Scales -------------------------------------- 93 Individual Evaluations -------------------------------------- 100 Student Questionnaire --------------------------------- ----- 101 iv ACKNOWLEDGMENTS We wish to thank the following people for their efforts and support during the 1968 Colorado Student Health Project: Dr. Robert Q. Marston, Dr. Richard Manegold, and Dr. Herbert Mathewson of the Division of Regional Medical Programs for their guidance throughout the project; Dr. Howard Doan and the staff of the Colorado-Wyoming Regional Medical Program for their interest and involvement; Mr. George Knox and Mr. Donald Brennan for their administrative assistance; Dr. Bonnie Camp and Miss Marcia Looney for their many hours spent in reviewing this report, and Mrs. Louinda Benson and Mrs. Martha Hodgkinson for preparation of the manuscript itself. This report is dedicated to our fond memories of Suzanne Campbell. v Pref ace COLORADO STUDENT HEALTH PROJECT ACTION AND REACTION As students in health professional schools we ence: the country's first interdisciplinary group find large gaps among ourselves, our patients, of health science students. This group initiated our institutions, and the allied health pro- several action oriented community projects fessions. Our curricula emphasize the basic which ranged from a concentration on the sciences and their clinical correlations-rarely health problems in the San Joaquin Valley of are we introduced to community health. Our California to work with the Medical Committee learning material is the medically indigent pa- for Human Rights in Mississippi. tient. We are taught the skills of viewing him In Autumn of 1965 these students felt the as a pathological specimen, seldom as a human need to share their experiences on a national being. Health care delivery is often seen as level. Sixty-five students from 25 health pro- medical crisis solving rather than an obligation fessicinal schools met at the University of Chi- to deal with a total life style inseparable from cago for the First Assembly of the Student environmental and socioeconomic conditions. To Health Organizations (SHO). The decision to the ghetto dweller health care is considered a establish a summer fellowship in community low priority. These health care consumers are health for 1966 grew out 'of these meetings. often alienated from a health care system in Funding was approved by OEO and this first which they lack franchise. Hospitals are too Student Health Project (SHP) was formally often viewed as institutions where one comes sponsored by the University of Southern Cali- prepared to die, deteriorate, or, at best, wait fornia School of Medicine and the Student for hours to be seen. A manifestation of this Medical Conference of Los Angeles. Ninety health care crisis is the lack of representation fellowships were secured for students from 40 of minority groups in our own schools. health schools across the country. The students The Student Health Organization has evolved formed interdisciplinary teams aided by pre- in reaction to these situations. Its history has ceptors familiar with community health prob- been well documented.1-4 It has now witnessed lems, community workers and local agencies. four national assemblies and 3 -years of Stu- The objectives of the program were to aid in dent Health Projects. Its numbers are now esti- the procurement of health services, a role which mated at over 2,000. This involvement arose later became known as "patient advocacy," to from a small but committed nucleus of medical catalyze community action around health- students at the University of Southern Cali- related issues, and to educate the students con- fornia. The first formal activity of this group cerning the problems of health care delivery was to sponsor a student forum on controversial to ghetto areas. health and social issues deleted from the classi- The movement has since grown. In the sum- cal medical curriculum. This led to the publica- mer of 1967 three health projects based on the tion of a journal, Borborygmi, and eventually to model of the previous year were launched irf the formation of the Student Medical Confer- New York, Chicago, and California. These in- volved 260 students of medicine, medical tech- McGa@ey, et. at., A Study in Medical Action-The Student nology, dentistry, dental technology, osteopathy, Health Organizations. NEJM, 279:74-80, 1968. 1 Gordon, L. J., Ed., Chicago Student Health Project, Summer nursing, social work, and law. The new projects 1967, Chicago, Ill., 1968, Chicago Student Health Project. added ghetto-area high school students, "high 3 Brod, T. M., Ed., 1967 California Student Health Project, Los Angeles, California, 1968, California Student Health Project. school interns," to the teams in an attempt to 4 Fisch, S., Williams. J., Ed., The Student Health Project of the interest them in medical and paramedical South Bronx, New York, N.Y., 1968, South Bronx Stttdent Health Project. careers. 9. z5umMER 1968 These projects again stimulated more student for whom continuity of care is often an insur- involvement during the.academic year and have mountable obstacle; the seasonal worker who led to concern not only in the Area of ghetto is often unaware of existing programs and, health, but also in school curriculum reform, stu- many times, lives in areas where no such pro- dent involvement in planning school policy, grams have been instituted; and the urban and programs demanding the incorporation of more rural ghetto dweller who is becoming progres- minority students into our health schools, and a sively more alienated from a health care system 'thin our in which he has no voice and is used as a concentration on internal changes wi own institutions. "teaching case." The 1968 Colorado Student Health Project The summer was one of education, some con- derives from our own student participation in crete achievements and numerous frustrations. these former activities. It reflects the same joint An initial frustration was the delay in funding student-faculty-community sponsorship, and which made it impossible to plan programs in shares many common goals with past programs. advance with community agencies. This lack As stated in the grant proposal, our particular of structure has been criticized by many of the objectives encompassed the areas of commun- fellows, interns, community groups, and the ity service, self-education and biomedical ca- sociology students in their evaluation of the reers.5 The community service aspect involved project. The -philosophy of unstructured objec- defining community health needs as perceived tives has been an integral part of many former by the residents and ourselves, sensitizing the SHP'S. In this type of situation the student existing health care institutions to these needs; learns to base his priorities on the needs of the promoting the full utilization of existing facil- community rather than his preconceived no- ities and the evolution of new health services; tions. This has been described by MeGarvey and attempting to make active participants out et al: I of largely passive health care recipients. We ... the student was given a large de- attempted to augment our own education by gree of autonomy, and was supported living and working in the environment of our by extensive consultative resources. gipatients"; learning to understand the inequal- With minimum structure, the student ities of the health care system for the poor, and was forced to identify problems. and in turn to plan health programs as they relate discover solutions, drawing upon his., to community needs; experimenting with an own resourcefulne ss. Pressed to begin interdisciplinary approach to health problems; defining his identity as a member of and considering ways which these types of ex- the health professions, the student be- periences might be incorporated into our uni- gan a process of self-discovery and re- versity curricula. The objectives of the high direction of professional commitment. school "intern" program included augmenting The argument for more structure is that it our effectiveness in their conununities and stim- leads to more achievement. Yet the following ulating these students in the directions of in- pages document many successes of the students. creased community involvement and biomedical Why, then, did they feel that the project was careers. only moderately successful with regard to its. The project sites included five rural and two service aspect? As a group concerned with con- urban settings." This variety of placements tributing to alterations in the'present methods afforded the students the opportunities for con- of health care delivery, we cannot be satisfied trasti,ng health care facilities and delivery with therapy analogous to treating -the dying among a number of unique groups: the migrant patient with aspirin., To organize projects of worker who qualifies for few health care and greater import would necessitate intense, long- welfare benefits because of his transience, and range involvement. T question, then, may not be one of structure versus nonstructure but $(;rant Pro@, Colorado Student Health ProJect. -Rummer rather deep commitment as opposed to a sum- See ChaPters 1, 2 Rnd 5. See footnote 1, P. 2. SUMMER 1968 mer of exposure. If this 10 week period has led future projects should be organized on a more to the realization of such commitments, we have sustained basis; and should involve a closer fulfilled the prerequisite toward a more ger- look at our own communities, the institutions in mane level of function. which we work, and the schools which we What have we learned? We have seen many attend .7 of the problems and barriers to the delivery of The ultimate success of this project can health care to the "medically indigent." We have only be determined when we become the health begun to , develop realistic methods of dealing care system rather than its observers. It is with these problems. These insights have stimu- hoped that the following report will reflect on lated the growth of new ideas and -Derspectives. our prognosis. As one student noted: "We have been observing the end stage of a- disease process-we have been MICHAEL REIFF, working in communities where you see the re- Student Coordinator, sults of the present health care system ... We Colorado Student Health Project. have been patching up this end:,' but ignoring the process itseIL" The implications are that IA discussion of these new perspectives is included in Chapter 4. 4 COLORADO STUDENT HEALTH PROJECT THE PROJECT SPONSORS' PREFACE The two faculty sponsors chosen by the Orga- facilities and resources. The following reports nizing Committee of Colorado students faced fail to show, as clearly as we would have liked, the SHO Colorado summer project with a good the kind of admiration that developed for some deal of optimism and only a few concerns. Our of the rural physicians in private practice optimism related to the firm feeling that we among many of our students, almost all of were being asked to advise a group of idealistic whom on arrival saw private physicians in a young health professionals who wanted to get stereotyped and hostile @ way. The material de- involved in the rural and urban health needs of scribes well, on the other hand, the red tape our State and in the knowledge that out of their handicapping many programs designed to help experience would come models for us 'as the poor to achieve health care. teachers, for research and services, relevant to During the welcoming session, we insisted the education of health professionals both at that the University of Colorado Medical Center the student and faculty level. Our concern re- sponsorship brought with it the acceptance of lated to the fact that the students represented a certain arbitrary rules set by the University. great spectrum of motivations and attitudes. We were concerned that a number of students Some were likely to expect a good learning ex- would leave the proj6ct when we insisted that perience with the firm expectation that they during working hours no buttons, whether for would initiate some meaningful change which political candidates or for the cause of peace, could be carried on by others when they return could be worn. We were told that in other proj- to their respective schools. Some students were ects many students would have walked out right emotionally deeply involved in the innnediate then but nobody did. concerns over the war in Vietnam, the political The relationship between the coordinating election, the shortcoming of their current edu- con"mittee and the faculty sponsors remained cational experiences, et cetera.IAmong the lat- cordial. We learned a good deal from each other. ter, we expected to find and did find a few Because we managed to stay in the background, who saw no hope in gradual change in the medi- such rebellious attitudes which developed from cal care delivery system, in attitudes of physi- time to time were directed at the student leaders cians currently in practice and in government rather than against ourselves. programs designed for the improvement of We believe that the ultimate assessment of a health care for all. project such as this requires some time. Aside We faced a difficult task in assigning students from the effect on health care in the immediate to projects where they could make a contribu- project area which will be influenced by local tion and at the same time not cause such an and Federal support in the years to come, the enormous upheaval in the local community and effect on the participating students is not easily in our relationship to local physicians and io foreseen. Not all students who express interest governmental programs as to leave behind a in health care of the poor will end up delivering medical care situation worse than when they such care when their time comes. Some have came. For this reason we justified our involve- found the poor to be unmotivated, unattractive, ment in placement by pointing out that this and unrewarding to a degree that they will be summer project would not leave behind a single unwilling to limit their professional life to the viable health care system and that,'therefore, most needy. all efforts had to go towards improving existing We think, in any case, thai this may be too 5 COLORADO STUDENT HEALTH PROJECT much to ask and that a single system of medi- C. HENRY KEMPE, M.D., cal involvement of all professionals with all Professor and Chairman, levels of population would be greater justice to Department of Pediat7ics, University of Colorado Medical patients and health professionals alike. Center. We feel admiration and affection for the students who came to Colorado in the summer HowARD HIGMAN, of 1968 and are grateful for, the opportunity Professor of Sociology, to have been chosen as faculty sponsors. University of Colorado. 6 Chapter 1 The Sites COLORADO STUDENT HEALTH PROJECT The summer projects were based in three with our local high school student, who would major areas of the State. The rural placements give us-an introduction to the com unity from were situated in the Grand Valley on the west- her point of view. After this, further contacts ern slo'pe and the San Luis Valley in south- were made with local physicians and officials, central Colorado. The urban aspects of the pro- and we were told that there were few, if any, gram centered around two areas in Denver problems present in the area of health care in itself. The areas are discussed separately in Grand Junction. Consequently, we drew back this chapter. Each section contains a description and through the process of elimination decided of the individual projects as well as a sununary that if anyone knew the problem,,i of the region, of the students' impressions of the health care the local Vista volunteers would@ They were system in their respective locations. quite eager to give us an overall picture of the area, and from this, three realms of inquiry THE GRAND VALLEY were launched. One consisted of looking into the local teen- A. The Project age problem, and what to do about it during the The Grand Valley was chosen as one of the summer. One member of our team tackled this two project sites which would serve as a model problem and over a 1 month period found that for the rural aspect of health care in the United there were two main activities in which the, States. Grand Junction was made the coordina- teenager of the area participated-local dances ting center for the three other areas on the at "The Barn," and nightly excursions through western slope of the Rocky Mountains due to its the local shopping center parking lot. Although it was r strategic central location with respect to the ecognized that neither of these activities other placements: Palisade, Fruita, and Delta, led to self-improvement, little Iiupport could be Colo. Although Grand Ju-n gained for such things as opening the high ction is surrounded by agriculture on three sides, the town itself school or college gymnasiums or starting a teen is one of small businesses and prides itself for center. Consequently, this aspect of the problem .its selection as an All-American City in 1962. was dropped and a new area explored; that of It abounds with civic and social activities, such the mental health needs of the community. as the local TACT chapter, which is striving Through association with, and assistance from to maintain the All-American status. Its heter- sympathetic members of the Grand Junction area, a program was started for patients re- ogeneous population of 25,000 consists of 85- 90 percent Anglo-Saxon, 10-15 percent Mex' cently released from the State mental insti- ican- American and less than 1 percent black, but tution to help in their readjustments back- into during the harvest and hoeing seasons, the city the community. This proved to be quite gratify- comes alive with an influx of representatives ing from all points of view, and the result was of many different Indian tribes and southern the establishment of a Precedent for following programs designed to allow the stigmatized ex- Negroes. mental patient,a fair cha,.ice to come back to a Three students were placed in each of the four areas. Their charge was to grapple with community and embark upon another attack the objectives of the summer project reviewed cn reality. in the preface. To achieve these goals, 12 hearty The two students pursued the goals of the summer project in a different vein. They students embarked upon the task with great decided to look into the overall health care re- vigor. Their entrance into the Grand Valley sources available to those ;An the Grand Junction was unobtrusive, but contacts with local physi- cians and officials were made immediately, and area. To accomplish this, numerous meetings anci conferences were attendee] to determine avenues of exploration were mapped off. Re- gional headquarters were established and the just how the health care system in the area project was set to march forward. operated. It was found, to the surprise of no But,. where to march? In Grand Junction, the one, that those with money had little difficulty first order of business was to become acquainted in attaining what healtb- care they n(4ded, a 8 SUMMER 1968 situation not uncommon throughout the United make the problems potentially amenable to States. But what about those -without enough solutions. The three students in Palisade and money to buy health? To our amazement, @t another three in Fruita worked more in the was found that even those without money had area of approaches to meeting the health needs almost the same services available to them with of the migrant population. Both of these groups regard to health. All they had to do was to take aided the students in Grand Junction with the advantage of them, and if they needed other problems concerning the resident Mexican- health services that were not available, all they American minority, and the Indians working had to do was ask for them and they could be in the uranium mines. set up. Thus, we wondered if any health care The first step for all areas was to see just problems really did exist in these rural areas. what kinds of respective health services were We then went to those people unable to pay and needed by the three groups. This was ineffi- asked them if they had any needs for health ciently done by talking with people in the vari- care that were not met. Some said no, but from ous areas, but some feeling for the needs was our point of view, many had clearly visible obtained. Next, the services offered were made health problems such as poor nutrition and san- clear, and then the approaches to the two basic itation facilities. Very few utilized any of the problems were outlined. existing preventive care programs. Why didn't The Food Stamp Program was emphasized they take advantage of these free services? The for the migrant workers and information re- answers to this question were phrased in many garding available health services was outlined ways, but they boiled down to two basic ob- and distributed. The means to use these services stacles over and above that of not having were provided by the students. Transportation enough money. One problem was the lack of was arranged, and preventive screening meas- knowledge as to what "health" consisted of, ures such as throat cultures were performed. and what services were available to them to This screening provided highly revealing in- help attain "health." Another problem, was formation about the previously ignored pool of what could be called an alienation from the streptococcal infections. Also, the idea of a existing sources of potential benefits. Although centralized mobile migrant clinic sponsored by those in the financial and ethnic minorities the local hospital and staffed by local volunteer may have known of the programs and services, physicians was discussed with some hope that they felt that they were not intended to be in- it will materialize in the harvest season to cluded in them, and therefore, participated in- come. frequently. These two problems apparently were The Indians working in the uranium mines not recognized or were overlooked by those who were living in indescribable squalor with no provided the possible services, and consequently, sewage systems and runoff drinking water, the remaining two students embarked on a proj- without purification. Although they earned elct to try and make services which were osten- union wages, the area was so isolated that they sibly available, actually available. Three major were unable to do much on their own to im- minority groups were found to be in a similar prove conditions. When the knowledge of this situation in the Grand Junction area: Most of group was brought to their attention, the local the Spanish or Mexican-American population health authorities began to act and the problem in the city itself,. a group of 100 to 300 Indians was finally approached on a level where results working in various mines in the mountains to could be accomplished. Through our visits to the the southwest of Grand Junction and the In- mining camp, we were able to introduce the dians and Mexican workers who came to work miners and their families to the available health in the fields of the outlying areas. services, and the Public Health Department be- It took 1 month to come to the above con- came aware of how it could expand its services clusions, which left little time to develop solu- in meaningful ways. Such minor expansions as tions to many of the problems, but it was de- immunizations and health counselling were pro- .Cided to see what types of approaches would vided by the students, but the impact was mainly 9 COLORADO STUDENT HEALTH PROJECT an enlargement of the scope of ideas and under- to expedite the process of allowing greater standing about how to approach the two basic fulfillment for all individuals of this Nation. problems mentioned earlier. In the Grand Junction area itself, the students SKip BRY, served to expand the programs and outreach of Area Coordinator, the established agencies, and to make the agen- Grand Valley Project. cies aware that there were other approaches to the existing problems. B. The Health Care System This was done by such concrete methods as bringing 50 to 60 children to the immunization 1. The Present System of Health Care for the clinics. Classes that could be formally called Poor health education were expanded and where The town of Delta has one "semi-active" and previously four to 15 children had attended, 30 to 50 children were now able to be expos!d three active doctors, and a county-supported hos- to various aspects of health. In addition to i)ital with a capacity of 30 to 40. Palisade has allowing the established institutions to see va two doctors; and Cedaredge, Hotchkiss, and Peoria, towns of 1,000, have one doctor each. ious applications of their programs, the people According to one student, "the poor may receive who should have been able to use their pro- identical medical treatment to the middle class grams were able to have some positive exposure ... provided they take the initiative to come to to them, and hopefully, they will begin to utilize the doctor." the services more in the future. The students In Delta, the physicians make allowances for in Delta manned similar programs and in addi- the poor's medical expenses. They will "charge tion aided in a study of school dropouts which less, distribute advertising samples, prescribe is proving most valuable to the school system generically according to their understanding of of that area. the families' financial situation." Others allow At the end of 2 months, the SHP students in patients to pay what they feel they can afford. the Grand Valley did not have much in the way The hospital and one doctor bill patients with- of concrete edifices to show their accomplish- out expecting payment. The physicians do not ments or failings, but the experiences during go out after the patients but expect them to come to them the summer served to point out some of the Two organizations, the Colorado Migrant sources of the basic problems preventing the Council and Holly Sugar Corp. are set up to provision of-health care on a level compatible provide health care for eligibles: Migrants iii with the resources available. The small accom- the former, and employees in the latter. The plishments were quite gratifying but the.over- Colorado State Health Department provides all immensity of the basic problem often was free medical Care and drugs to migrants, but overwhelming and made the summer a frustrat- it is not a very well known program. Public ing one for all involved. However, it was seen health nurses seem to be doing an adequate task that the basic problems regarding health in the of getting children of school age proper medical rural settings are qualitatively'the same as and dental care, but these 'programs are under- those in the urban areas, but that the quantita- staffed. . tive aspect is quite different. The impetus to The Welfare Department can provide ade- attack and resolve the problems is sometimes quate medical assistance for its eligibles, while in striking contrast between the two settings. the Mesa County Health Department in Grand In spite of this, through understanding of racial, Junction offers a mental health clinic, a TB clinic that includes X-rays and medicine, and ethnic, cultural and fina,.icial minorities, and a handicapped child:ten's program, including the reasons for the current predicaments, Ob- a diagnostic epilepsy clinic. The Health Depart- tained through programs such as the SHP, the ment also provides a complete orthopedic clinic providers of health for the future will be able paying for almost everything and Li plastic 10 SUMMER 1968 clinic which pays for hospitalization, surgery, E. Dental facilities are needed for the Fruita, orthodontia, speech therapy, and hearing aids - Loma, Mack, and New Liberty areas, which for those who are ineligible. "Most of the medi- now rely on the "terribly overcrowded" dental cal clinics, however, offered by the Health De- clinic in Grand Junction. partment are on a referral basis by a doctor or osteopath .... and if an individual cannot 3. Bureaucratic Problems Which Hinder the afford to make it to a primary physician in- Usefulness of the Present Facilities to the itially, he has no chance of getting into any of Poor these clinics except mental, dental, and im- A. Lack of coordination among com- munization clinics, which need no referral." munity service agencies, due to personality Indians are cared for by governmental agen- clashes and segmentation of aims." Better com- cies on their reservations, or by the Bureau of munication and cooperation could increase the Indian Affairs if outside hospitalization is nee- effectiveness of local agencies, all of whom are essary. striving for similar goals through different In Palisade, health care is adequate. Public means. health nurses follow up cases when and where 1. Public health payment for migrant health possible. They are limited by the rather mobile care is not being made now to doctors and mi- life many of the migrants live. Lack of preven- grants. . tive measures, such as vaccination, is seen to be 2. The public health nurse can only visit a problem here. Two doctors in this area extend families to whom she has been referred by a their office hours during the peach harvest to local agency and, therefore, misses persons who care for the additional burdens more people add. have not come into contact with any agency. 3. People on welfare, old age pensions, and 2. The Most Pressing Health Care Needs for the social security hesitate to seek needed medical Poor help because they are not sure they can afford A. A more effective outreach program. This it and do not know whether their assistance would have to involve an increase of public programs will cover it. Finding out what the health nurses to reach more of the population agency will pay involves bureaucratic channels more often, and salary increases to make the which a poor person finds overwhelming. area competitive. 4. The public health nurse in Fruita for 1 B. A better transportation system to St. hour per week cannot prescribe medication or Mary's Hospital, which is often inaccessible for make diagnoses. This causes a reluctance on the persons without a car. Since the hospital is cen- part of the people to come and see her. B. The 9 to 5 hours of the welfare agency trally located in Grand Junction, more people are often impractical, especially to people who could utilize its facilities if they could get there. need assistance at an hour when the agency is C. Health stations in some of the outlying not open. Also, the whole idea of "appoint- districts could be useful, as they would be more ments" is often foreign to a person who needs personal and more accessible. For" example, a help "now" and not in 2 weeks. clinic at Fruita would be easily reached by C. The notion of filling out forms and appli- people from Loma ' Mack, and New Liberty, and cations is another latent bureaucratic dysfune- could include checkups and immunization. The t problem could be solved also by a mobile clinic tion that limits the welfare and other agencies success. serving all of Mesa County, and feeding into St. Mary's Hospital. 4. Concrete Proposals for Better Health Car@ .D. The "invisible poor," people who are just Programs missed by welfare and assistance programs - cause their income is above the maximum'pov- A. Assistance for the poor in getting to the erty income, but not enough for them to afford doctor, rather than a health clinic for the poor, adequate care, would benefit nicely from a low which would accentuate the fact that they are cost, comprehensive medical insurance plan. poor and should, therefore, be segregated. COLORADO STUDENT HEALTH PROJECT B. A low cost medical insurance plan for low who often use it as the only way to exist in income families, which would include financial the world. assistance for buying drugs. C. Clinics and doctors' hours which could be THE SAN LUIS VALLEY at night for persons who work all day and are only able to attend in the evening. A. The Project D. Increase the amount and use of informa:- San Luis is the capital of Costilla County tion on family planning, health care, et cetera, 'Oca d in South Central Colorado. The county so that more people could take advantage of I these things. is a valley bounded by the Sangre de Cristo E. Development of vocational training pro- mountains. Agriculture is the main source of grams, like nurse's aid training program or a income and all farming is done under irrigation. laboratory technician program, so the people There are no industries in the county; 62.8 per- could learn to be independent and help them- '2ent of the people have incomes under $3,000. selves. Spanish-Americans comprise 72.6 percent of F. Need for more public health nurses, at the population. Many of t-hese are descendants least four or five, to take the burden off those of the original Spanish settlers. who are there now and increase the quality and This area was the smallest project site as quantity of the care available. well as the most unique in that the students and G. Some sort of training in the Spanish- the SHO project doctors were actually in charge American culture and language for the "pro- of health care delivery. One of the primary goals in setting up the project in San Luis was fessionals" working with these people. This to allow the students to work in a public health would open communication lines and assist the education-community development role. This professionals in helping the people help them- concept remained a theory as the students con- selves. Understanding should be a task of the sumed most of their short summer stay aiding professionals as well as the poor. in this delivery of medical care and of greater import re-e@blishing the community's knowl- 5. Culture Problem& of the Poor as Problems for edge that the Sangre de Cristo Clinic, the major Medical Care public health facility in San Luis did have a p A. The transitory life of a migrant com- full time doctor with plans for year round med- pounds his other health problems. Their way of ical service. life leads to a lack of medical records on them The support from the local medical society and no personal relatio n with any one doctor. through the direct sponsorship of Dr. Dale Also, each time they arrive in a new area, they Thomas of La Jara, Colo., was greatly appreci- must begin all over again finding out what is ated. The students learned a great deal about available for them, where to go, who to see, how the private practice of medicine by spending much it will cost, etc., and even if they have 1 day a week with Dr. Thomas, as well as the been in the area before this is still a problem problems encountered in delivering health care due to the changes in what was there and what in this community. In addition, the health is now there. science students and the high school interns B. Mistrust of "Anglo medicine" seems to be had many learning opportunities under the a problem too, and reliance on folk practitioners supervision of the two SHO project doctors. is not uncommon. The "system" seems to per- In assessing the program orientation and petuate and encourage this mistrust with its planning, two aspects should be discussed. The red tape and uncooperativeness. first aspect is the short length of time the C. A value for preventive medicine should be project had in. San Luis. If one has never lived encouraged, not just seeing the doctor or worry- in a rural area, there are the problems in under- ing about an illness when it becomes severe. standing the power structure, the problems of D. Alcoholism, and all the social ramifica- an agricultural economy, the social behavior of tions thereof, is a serious problem for the poor the local residents, and flnplly the local Spanish- 12 SUMMER 1968 American culture. Given the array of unfamil- First, the Presbyterian Medical Service oper- iar factors, the students were somewhat con- ated the Sangre de Cristo Medical Unit, or fused as to what they could do to aid the com- Clinic, just outside of San Luis. This unit is munity in dealing with its health requirements. quite'a comprehensive outpatient clinic, which The "Con la familia" or living with a local has facilities for dental and medical care as family on arriving in the community was con- well as emergency child birth and minor sur- sidered an excellent introduction. However, this gery. Due to the students' presence and their was a brief 3 day stay and what the students procurement of a full time physician, the pres- really needed was someone who could guide them ent medical staff of the clinic includes: one full- in learning about the community's problems for time physician, one LPN, two part-time SHO the length of the project. In future projects in RN's and two part-time medical students. In the San Luis Valley a past SHP member could addition to the full-time physician mentioned, render valuable guidance as an area-coordina- doctors from Alamosa and Lajara come to the tor. With this method of leadership the students clinic Tuesday through Thursday for.one-half could widen their learning experiences about day. the rural area. The State public health nurse for Costilla With every evaluation, the question is raised County operates several different clinic sessions regarding the success of the project. There are throughout the year which provide free medical many persons who can give opinions; however, care to county residents. On a monthly basis, the most important person is the student who the nurse with the aid of volunteer doctors, actually worked and invested his summer in the conducts a "well baby" clinic and a school age project. In my opinion, some of the successful clinic at the Sangre de Cristo Medical Unit. On features of the project were: a yearly basis, she offers clinics for Head Start 1. A constructive interchange of ideas children, orthopedic problems, epileptic, and between persons who would not otherwise cleft lip and palate cases. In addition to these have direct lines of communication@x- and her normal duties, she is involved in follow- amples, high school students and medical up work on cases referred to her from C.G.H. students, RMP administrators and project and Colorado State Hospital ' members. The CAP agency in San Luis has an "emer- 2. A number of tasks or services that gency medical aid grant" from OEO which en- benefited someone which otherwise would ables them to pay for any medical treatment have gone undon xamples, getting a boy rendered at the clinic to a "poverty family." into school, getting a man a job. The welfare department also pays for medical care to various eligible groups; specifically, old RANDALL H. LoRTsCHER, age pensioners, and Aid to Dependent Children, Asso@te Student Coordimtor, Needy and Disabled and general assistance. Colorado Student Health Project. Costilla County provides a public health nurse for the schools in San Luis, who seems to be B. The Health Care System primarily concerned with the general health of the children. 1. The Pre.-.ent System of Health Care for the Two hospitals in L@Jara and Alamosa pro- Poor vide an extensive amount of care to the people I- of the Valley. Both have adequate operating, There are five different types of health care delivery, and emergency rooms, plus facilities systems for the poor near the town of San Luis. to deal with most surgical and medical cases. First, the Presbyterian Medical Service Clinic; second, a State public health nurse; third, finan- cial aid from the Community Action Program 2. The Most Pressing Health Care Needs of the Poor agency and. welfare office; fourth, a public school health nurse; and fifth, the Alamosa and First, there is a lack of qualified professional La-Tara Hospitals. people to staff the medical unit. What staff has COLORADO STUDENT HEALTH PROJECT been available seem to be there only on a tem- 4. Concrete Proposals for Better Health Car( porary basis.. A full-time physician, a dentist Programs and assistant, a lab and X-ray technician, and A. A comprehensive outreach program that two nurses are needed to enable the clinic to would involve a "total cure," rather than "band- function adequately. Next, the people'need to aid" approach to the population. be informed of the clinic's facilities and their B. Health re-education of the people for such eligibility to utilize them. things as dental hygiene and nutrition. A latent A second quite pressing need is an effective function of this program would be to increase ambulance service. At least a station wagon, and improve the communication between the and preferably a 4-wheel drive vehicle for the community and the agencies. out-of-way places, is needed. Many persons fail C. The need for full time clinic physicians. to use the clinic because of their lack of trans- The implementation of a new grant for hiring portation to and from it; and patients and accident victims often require movement to the permanent staff members will be beneficial to this goal. more comprehensive hospitals in LaJara and D. Creation of an adequate drug store, that Alamosa. can fill the doctor's prescriptions. Alcoholism seems to be a pressing problem E An effective, full-time ambulance service. of the area, which requires an effective treat- ment and education program. Psychiatric and 5. Cultural Problems of the Poor as Problems social type counseling, in addition to a fbllowup for Medical Care on patients who have been on the alcohol ward The pride and self-reliance of the Spanish- at the State Hospitai, is also necessary. American is seen as a problem when it limits A final need is for a more adequately sup- their effective participation in the clinic. plied drug store. Mpl,,- Prescriptions cannot be A. Many will not co'me to the clinic because filled because of an inzutficient amount of drugs, they cannot afford it. and often these people ai-e forced to go to Ala- B. They are often resentful of government mosa, when they can afford it, for their pre- "give away" programs. They do not want some- scriptions. one giving them money, but want jobs where they can earn the money. 3. Bureaucratic Problems Which Hinder the C. There is little or no conception of the no- Usefulness of the Present Facilities to the tion of preventive medicine, and most people Poor wait until they are quite ill before they will come to the clinic. This is especially true of the Like many poverty areas, the age-old diffi- fathers of the households. culties with the welfare department and the D. The notion of "the clinic" is still new to CAP agency seem to exist here. Specifically, many of the people. Technical innovations are the welfare department is often "slow" in dis- less readily accepted. in their society than in pensiiig inforriiation as to who is available for most, and many are not ready, to accept the what. They are often resentful of "outsiders" clinic yet. meddling in their business. E. The use of folk m6diciiie in place of scien- The CAP agency often seems reluctant to tific medicine is seen as a problem due to the make available information on what programs often improper care it provides. The psycholog- are available and to whom. The reluctance to ical effect is to cause the people to feel that a disclose information on emergency food stamps, doctor is unnecessary. medical care assistance, and the medical unit has been noted. C. A Study of Folk Medicine in the San A full time clinic-director, whose interest is Luis Valley in the effective operation of clinic and the max- Introduction: !mum distribution of services to the poor, would This study is concerned with the use of med- be most desirable. ical practices, other than "scientific" medicine, 14 SUMMER 1968 as used by a sample of people in and around the We constructed a questionnaire which con- San Luis Valley medical clinic. According to sisted of 10 of the more common illnesses based Saunders, "Folk'Medicine," like scientific med- on the 25 illnesses Saunders mentioned. The icine, undoubtedly derives much of its prestige commonness of the illness was decided upon and authority from the fact that the majority by the four SHO students on the basis of their of sick persons get well regardless of what is experiences in the clinic with illnesses.4 We done.' Although most persons in society prac- wanted to know what the person would do if he tice folk medicine to some extent, there is a contracted any of these, and if this would wealth of evidence indicating that it is a very change any when the illness became more se- important part of the Spanish-American cul- vere. We asked what he would do if he con- ture .2 tracted the illness, rather than what he had Saunders lists some 25 different illnesses for done when he had it, to eliminate anyone from which the "village folk" had remedies.3 One saying "nothin g" since he had never had it. of the goals of this study was to take some of This, it was hoped would add to a greater com- the more common illnesses he mentioned and pletion ratio of the schedules, even though the discover what forms of cure were utilized. This illnesses were common enough so that it was is in no way an empirical test of his theory, but unlikely that one had never contracted them. rather a study designed to discover some trends At least one would probably know someone who in the medical practices of the Spanish-Ameri- had one of these illnesses so, at the very least, cans in an attempt to implement changes toward would know what would be done. modern medical practices. The severity factor to discover change was MethodoZogy: included to help better define phases of the illness and to see during what phase of each The SHO students in the Valley had the particular illness the folk remedy was used, and unique position of close medical type contact when the doctor was used, and whether or not with a fairly large number of Spanish-American these were dependent on severity. We also were people. They treated the people in the clinic for interested in certain demographic facts as par- various ailments as well as making home visits tialling factors with severity and folk practices, for followup and additional care. These students but the small size of the sample restricted their reported several different instances of healing use. practices which appeared rather odd to them. A word must be included here about the na- For example, Miss Campbell noticed that a ture of the sample. The sample was collected on woman had placed a necklace of a string and an interview basis over a 6-week period by the dime around her child's neck to enable the four SHO students and one health intern in child's teeth to grow straight. She also reported conjunction with the rest of their duties. Inter- several instances of strips of sheet that were viewing was conducted as a supplementary task dipped in potato juices being wrapped around to their normal duties, and the interviewing a person's head to help cure headaches. She was done when they had time and with persons became curious about the extent and prevalence who were cooperative. I believe the main limita- of these practices as well as the.use of other tion of this was the size of the sample we were ones. We decided that one of the best ways to able to get and not a serious form of sample accomplish this was the construction of a bias. However, it should be noted that the questionnaire to be administered to certain pa- sample did consist of persons who were med- tients of the clinic and in their homes. ically oriented by nature of their participa- S---d,,@., Lle, "Healing ways in the Spanish Southwest." in tion in the clinic. We could assume that these E. Gartly Jaco, Patietzts. Physt'cians and Illness, The Free Press, persons are less folk medicine oriented than 1958, P. 191. 'See George Foster, "Relationship between Spanish and Spanish- those who do not come to the clinic, but oii the Anierican Folk Ikedicine," Journal of Am@can Folklore, vol. 66, other hand, it might be fallacious to assume that July-September, 1953, p. 201-217; and Lyle Saunders and Gordon He.@. "Folk Medicine and Medical Practice," Joumd of Modic(a Educa;ion, vol. 28. September, 1933, p. 4@S. 4A copy of the questionnaire is to I>e found at the end of this 'Saunders. op. cit.. v. 196. 'Itudy. 15 COLORADO STUDENT HEALTH PROJECT those who do not come to the clinic are neces- and are more reluctant to admit to being ill sarily more folk medicine oriented. It could be than women. Women riot only admit being ill that those who do not come to the clinic are more, but are more ready to talk about it, too. just less medicine oriented than those who do When men do come to the clinic, however, they come, and the clinic users would, therefore, be are usually in a "hurry" and do not have as more concerned with folk as well as scientific much time to spend there as women. medicine. This is perhaps an academic point, Table 11 is a depiction of incidents of folk but one which should not be overlooked. With medical practices for each specific ailment. these things in mind, we can now consider the These practices are utilized most often for findings: toothaches, and stomach aches and least often for colds and constipation. This could indicate Findings: that the former two ailments are the ones that @ip Table /.-Sample Description the people least trust medical science to help, A. Demographic: and the ones which they feel best able to deal 1. Size: 23 with. Their remedies are probably most suc- 2. Where person interviewed: cessful here and most accepted and trusted by the people. a. Clinic- b. Home - 52.'-' To accept this notion, it is assumed that all 9 39.1 -ra - ailments have an equal chance of occurring and C. Total 91.4 would, therfore, have an equal probability of -,Iac 3. Age: being treated by folk medicine. In the course of a. Range 16 through 92 b. Mean: 32.1 treatment, some remedies lose esteem as they th 4. Sex: All females fail repeatedly in their effects. This causes a -iia B. Folk medical practices: loss of faith in the old remedies and a willing- @iac ,rh 1. Total number of incidences of folk medical prac- ness to try new ones. The repeated success of tices: 97 2. Total number of incidences of nonfolk medical the new over the old will eventually cause the old to be abandoned for the new. Reluctance to practices: 384 3. Percent of the total number of practices that are try the new is due to the efficacy of old as well the r cl folk: 21.5 percent as the availability of the old and new and the Discussion: faith in each. It is much easier to maintain Ta One of the more interesting findings of table faith in an old belief, even with numerous fail- I was that the entire sample was female. This ures, than it is to develop faith in something -OPI f is empirical support for the student's report new, even with numerous successes; and this is ,Iild on the Medical Survey Questionnaire that for especially true of the more tradition oriented -,-ces the most part, men do not attend the clinics, societies. i..es @,-e a -.@ ta Table //.-Incidents of Folk Medicine for Each Specific Ailment 'Cien Number of times Number of tim@ Total number of PerFent of total Ailment folk medicine used nonfolk medical times a medical medic,l practi es practices used practice used that are folk medicine -@iat i)eopl General or specific aches and pains 9 56 65 13. 8 Skin conditions- 3 15 18 16. 6 Colds- 1 58 59 1 . 7 Headache 8 58 66 12.1 )lk c Earache- 16 42 58 27.6 !He i Sore throat 5 32 37 12.2 Sta Toothache ---- 18 22 40 45.0 Stomach ache 22 33 55 40.0 Diarrhea-- --- --- 12 37 49 24.5 .@@-ste Constipation --- --- --- 3 53 56 5.4 iess 16 SUMMER 1968 rable Il/.-Trends of Folk Medicine Practice Usage from Mild to Severe Cases of Ailments MILD SEVERE Ailment Folk Nonfolk Total Percent folk Folk Nonfolk Total Percent folk medicine medicine medicine medicine medicine medicine General aches and pains ---- 3 19 22 13.6 2 19 21 9.5 Cold ---------------------- I 31 32 3.1 0 27 27 -------- Headache ----------------- 4 22 26 15.4 2 18 20 10.0 Earache ------------------- 6 16 22 20.7 4 16 20 20.0 Sore throat ---------------- 3 18 21 14.3 2 18 20 10.0 Toothache ---------------- 11 9 20 61.2 7 12 19 36.8 Stomach ache -------------- 7 11 18 38.9 6 10 16 37.5 Diarrhea ------------------ 6 11 17 35.3 3 15 18 16.7 Constipation -------------- 1 17 18 19 20 5.0 Table /V.-Trends in the Use of Doctors and/or Clinics from Mild to Severe Cases of Ailments Ailment Doctors Other2 Total 3Percent Doctor Other Total Percent doctors 4 doctor General aches and pains ---- 1 21 22 4.5 9 15 24 37.5 Cold ---------------------- 2 30 32 6.2 10 17 27 37.0 Headache ----------------- 1 25 26 3.8 8 12 20 40.0 Earache ------------------- 3 19 22 13.6 9 11 20 45.0 Sore throat ---------------- 2 19 21 9.5 11 9 20 55.0 Toothache ---------------- 1 19 20 5.0 8 11 19 42.1 Stomach ache -------------- 2 16 18 11.1 7 9 15 43.7 Diarrhea ------------------ 1 16 17 5.9 8 10 18 44.5 Constipation -------------- 2 16 18 ii. i 7 13 20 34.9 1 Doctor indicates the number of times the doctor and/or clinic was used 3 Total includes the number of times the doctor and/or clinic and all for the spee c ailment. other sources were used. e other than a doctor Percent doctor i is the percent of the total that used the doctor and/or I Other indicates the number of times a soure and/or clinic was used for a specific ailment. theclinic for the ailment. Table III shows that, without exception, when seriousness and/or ambiguity of the dis- whenever an ailment becomes more seveIre, the ease becomes high, the person will turn to the people have a tendency to rely less often on dominent belief system of his culture for cure. the folk medical practice. When an ailment is From this our study would indicate that the mild and the cost of a mistake is low, folk prac- dominant belief system of the Spanish-Ameri- tices are utilized, but as the risk increases so cans in and around the San Luis clinic is not does the belief that folk medicine might not be folk medicine but scientific medicine. the answer for cure. This findinLy led directly While this might seem'surprising at first, a to table IV, which concerns the trends toward little reflection will show it to be quite plaus- scientific medicine as the severity of the disease ible. First of all, due to the nature of the study, increases. We find, again without exception, we are unable to make a statement about the that as the severity of the ailment increases relative power of influence of each of these people go to the doctor and/or the medical beliefs. We know from observation that folk clinic more. As the threat of danger from the medical practices are common and fairly ex- ailment gets greater, the belief in the efficacy of tensive in this culture, and that there is a fear folk cures go down, and the reliance on scientific of anglo medical doctors. However, these Span- medical practices increases. ish-Americans are quite exposed to modern Stanley H. King has, shown that there are medical practices via the clinics, public. health two important variables which determine which nurses and friends and children, and have, system of medical beliefs will be used, -serious- therefore, experienced many of the "wonders" iiess and ambiguity. Their contention is that of medical science. Secondly, the average age of 17 COLORADO STUDENT HEALTH PROJECT the sample, 32.1 years, is relatively young. C. What would you do if you had: (Their interpretation) Younger groups show a tendency to be more 1. Aches and pains 7. Sore throat aware of 'change and more ready to accept it a. mild a. hurts than older groups. Third, the sample was all b. moderate b. cannot swallow c. severe without women and, as the students have shown, women 2. Skin condition difficulty tend to go to the doctor more often t@ian men, 3. Cold 8. Stomach ache and seem less reluctant to accept modern medi- a. mild a. mild re eine. The infe' nee of this study is that modern b. severe b. moderate 4. Diarrhea c. severe medicine is replacing folk medicine as the prime a. 1 day 9. Constipation medical value although the former is still very b. 2 to 3 days a. 2 days_ significant for the Spanish-American. We are c. 4 days b. 3 to 4 days 5. Earache c. over 4 days also suggesting that the degree of severity and a. mild 10. Toothache ambiguity of an ailment, the sex of the sample b. moderate a. mild and the age of the sample are very important c. severe b. severe factors in determining what type of medical 6. Headache 11. Fever practice will be used. It seems further that if a. mild a. warm a greater and a more rapid change toward mod- b. moderate b. hot ern medicine is desired, the young women are C. severe the group to work with. Time and space prevent an adequate explanation of this last hypothesis; DENVER however, let it suffice to say that young women A. The Project ' do seem to be the carriers of modern medicine The Denver Project gave me a unique oppor- and probably exert enough familial influence to tunity to view the city in which I had grown assist in implementing the change. up-its people and its policies. It was also a In retrospect, I regret that many of the find- revealing experience to view the hospitals from ings must remain undiscussed. As in any re- I search, many questions have been raised that the outside, as a helpless, confused patient, rather than from the inside (as a helpless, con- must go unanswered and until a more compre- fused student). This contributed to the profes- hensive study can be designed and a larger and sional experience and perspective of all the more complete sample taken, many of the in- 'OHP's. teresting cross-tabulations will remain undone. The summer was a period of adjustment for The goal of this study has been to discover the medical school, the students, the community trends. of medical care with respect to certain leaders, and the people of the neighborhood. speci-fic illnesses for which it was claimed folk Rapport had to be established between each, practices were used. The manifest practical use of this is better medical care, the latent'uses and for the students, was met with immediate of this are still open to speculation and discus- failure. The first day, eager to spread their sion, and will continue to be. altruism, many were discriminated against for probably the first time in their life by finding no place to settle. Suddenly, all the "To Rent" JOHN C. QUICKER, vacancies had been filled in the Mexican-Amer- ALFRED J. CLAASSEN. ican neighborhoods. Unfortunately, more of this was to follow-those who were most idealistic at first were hit the hardest, defeated by the D. Folk Medicine Questionnaire system, bolted over by the immense need that A. Where'was the person interviewed: every.day became more apparent, and contin- 1. Home Clinic ually aware that time was all too short. The end 2. Age of the summer was greeted with despair-we 3. Sex had changed, but the areas remained largely 4. Education B. Discussion about present illness: the same. The feeling that remains beyond all SUMMER 1968 this, and is the basis for all SHO projects, is the 1. East Side quiet (or not so) determination that "I will A. East Side Neighborhood Center. As'pro- return when I am more able to help." gressive and open as this was set up to be, the Despite the individual frustration, as a group three students placed here felt that their ideas an invaluable amount was accomplished in were often suppressed by a @ff hesitant about terms of laying the groundwork for further our involvement. Our preceptor, a staff pedia- projects, for SHO, RMP, and C. U. Medical trician, was filled with good ideas and enthusi- School. asm, but implementation was close to impossible For SHO it was an experiments stop, look, without upsetting people or getting involved in and listen to what's happening in Denver. It red tape. confirmed our question about certain inade- The center is well looked upon by the com- quacies of the health care program and strength- munity; patients are treated in a friendly man- ened our desire to become involved in its change. ner and with respect in the course of getting For RMP there are countless projects to be- truly comprehensive care. One drawback is the come involved in, but the basic approach must long wait, a complaint so often launched at Den- be altered in any case. Plans cannot be drawn ver General and one of the reasons for the exist- up within the confines of a medical school and ence of the center. The medical students and be expected to coincide with the life of a -pov- high school interns followed patients in their erty neighborhood. The glowing example this course through the center and discovered that summer was a medical organization with much a 2 hour wait at the pharmacy was customary. money and good intentions, that decided to Often patients would leave, never to pick up prove these intentions by carrying out a project their medication and thus negating all the work for the good of the "low income" community. and lab studies that had been done. When the However, implementation according to the life .+ dents presented this to the preceptor, he re- style of the doctors made it not only impossible Lu but a mockery of those whose plan it was. sponded with "yes," it was already known, but For the medical school it will h would have to be proven and written up in red opefully open -tape before anything could be done. the eyes of the faculty that the present cur- Next year's project could use two students riculum offers -nothing to acquaint the student here if at least one has worked in the center with the relationship between disease and en- during the school year and established the nec- . vironment, between disease and the bearer of essary knowledge of the people and the setup. the disease. A medical school must teach more .B. East Side Action Center is indeed a site than the study of diseased organs in the con- of action; programs there encompass every- trolled conditions of the hospital; it must pre- thing from guitar lessons to shopping trips for pare its students to meet the request of society welfare mothers. It was so well organized, in for care that is compassionate, continuous, and fact, that the students did not need to be cre- complete. To accomplish comprehensive health ative in starting programs, but were content care in all areas, more black and Mexican- to do "band-aid work," the day-to-day helping American doctors are needed. of established programs. Nevertheless, this The Denver Project used students as scouts; turned out to be a valuable experience for all each was placed with a community organization students. The community uses the center, which as a stepping stone into the community as well seems readily accessible to the neighborhood. as an observer of the organization, to learn the Attitudes vary; some do not like the element of role of the particular organization in its com- Black Power within the center, but it is Black munity and the response of the- community to Power in constructive sense-self-pride, group it. We worked in two of the major poverty pride, and the idea of black helping black to areas in Denver, an area in East Denver, pre- get ahead. The idea of white health science dominantly black, and an area in West Denver, students going in to help should be seriously Predominantly Mexic,%n-American. considered before next year's placement. Black 19 COLORADO STUDENT HEALTH r.KUJrjU.L students could serve as more of an identity formation and a good model of community in- figure for the teenagers. volvement. C. Curtis Park Community Center-place- E. Denver General Hospital was not one of ments here were hampered by the vacations of the original placements, but was a focus of in- the preceptors. Footing was never truly estab- terest for the students. It is not unlike similar lished, and the students Nvorked on independ- general hospitals in other major cities. Trying ent projects. It is a questionable site for next to blunder one's way through red tape to the year. source of the problem resulted in little feedback and less change. Howev er, one of the precep- 2. West Side tors, who had his office in the hospital, proved A. Aura@a Community Center is a beautiful to be a wealth of information and the needed new building that looks as if it were built by encouragement during the summer. He will accident in a low income neighborhood. It is be an invaluable source of information and very clean inside, but also very empty. The big ideas for next year's project or anyone inter- recreation room is idle all day, and the entire --Sted in the West Side. building closes at 5 p.m. These factors male i@ Of all the placements '. the most successful seem as though the center was not well received seemed to be the least structured, where the by the community and the students soon became students were forced to make their own ap- involved in more creative projects elsewhere. praisal of the situation and their onvn plan of Placement next year will depend on the current action. "Band-aid work" designed by someone programs and staff. else does not justify a summer project. '-\Iany B. Mdiiposa Health Station. Though oni@ a other projects were explored, too many in fact. few blocks from Denver General, it seems to t)e The J.F.K. Recreation Center, American Can- much preferred by the neighborhood. It is an cer Society Pap Smear Program, and the Den- active, friendly place; neighborhood aides from ver branch of the "Hielga Delano" did not re- day one were willing to take students with them ceive adequate response from SHP, Nvhich was on home visits and to help them get involved already spreading itself too thin. Nonetheless, and meet people of the neighborhood, which led the overall goal for the summer, that of gaining j understanding of a previously foreign area of to numerous smaller but very rewarding pro - Denver and acquainting the communities with ects with individual families. The aides are whites who were genuinely interested in becom- from the immediate neighborhood and have a ing involved, was a success. For the individual, good grasp of what is happening and will be specific memories will fade, but each has a good source of information as well as help grasped a more meaningful perspective towards for RMP and SHO in the future. The students the field of medicine, that disease is a symptom were actively involved throughout the summer of the environment and the life-style of the and should definitely return next summer if v not before. patient. C. West Side Action Center was the site of LisA WILSON, the SHO office, though no students worked ex- Area Coordinator, clusively with the center. Just how it relates to Denver Project. the community is difficult to evaluate; opinions were highly variable. D. Inner-City Parish is run by the very en- B. The Health Care System-East Denver ergetic Reverend Beech with much volunteer 1. The Present System of Health Care for the help. It is a remarkably well-organized program Poor for the neighborhood; perhaps too structured There are two primary facilities of health to force the students to develop their own cre- care for the 40,000 persons in the east side area; ative approaches. But, as elsewhere, many hands the East Side Neighborhood Health Center and are needed to help. This is a good source of in- Denver General Hospital. 20 SUMMER 1968 The Health Center can care for the "physi- 2. The Most Pressing Health Care Needs of the cal, mental and dental needs of the. patients." Poor Like everything else, there are likes and dis- A. The problem of "personalized care" deals likes about this center. On the positive side, one with the unfriendly nature of urban areas com- student commented that, "This facility makes pared to friendly rural areas. Since most people a gallant effort to give excellent medical care are from rural areas or at least extended family on a rather personal basis." The criticisms are situations where relationships are much more concerned mainly with the amount of time a informal, it might benefit these people if the person must take to be seen and to have his hospitals were less formal. medical prescriptions filled. B. A better communication system should be Transportation to the center is arranged established. This would involve things as (1) through the use of buses. There is one group of informing more people about what is available buses that costs 60 cents for a round trip and at the center and Denver General Hospital; (2) another group that is free of charge. However, community residents becoming more educated in one student felt that not enough people knew the functioning of the medical facilities; (3) about the free ones to take proper advantage making information on birth control and vener- of them, while another felt they were doing eal disease more available; (4) educating per- an "excellent job," as all one had to do was to sons in the health professions to understand call them and they would pick the person up. better the culture of the people they are work- Denver General Hospital was not looked upon ing with;. (5) orienting poverty people to the in as favorable a light as the center and was importance of keeping appointments; (6) es- used mostly for emergencies or when the center tab-lishing community boards to take part in could not handle a specific illness. Besides the decisions which effect their relationship to the long waiting lines there, the staff, particularly health facilities. the administrators, was very "impersonal I and C. "The circumstances which have gone into cold" to the patients whose preexisting fears producing the negative attitude toward Denver of hospitals were already great. Denver Gen General Hospital must be corrected." "Attempts eral Hospital is also rather difficult to get to should be made to make Denver General Hos- when one is without a car. This adds to its un- pital more adequate to the community." This popularity with the poor in this area. would involve such things as the community One student felt that in spite of the goals and board mentioned above. attempts by the center to create a favorable image, it is being seen by many people as a 3. Bureaucratic Probleras Which Hinder the "little DGH." If this negative trend continues, Usefulness of the Present Facilities to the it, too, will become a place to which one comes Poor only in emergencies. A major problem here identified by four of Folk medical practices have been mentioned the six students is the "lack of communieatioif' by several students as being a part of health among agencies. In connection with this the care for the poor, but they are used mainly in overlapping functions of agencies and the often unambiguous and nonserious cases. Because of confusing picture of who can do what and for this, they are not seen as a threat to helping whom is the picture often presented to the poor. the poor when they are sick, as they do seek a Agencies seem to constantly refer community doctor when the illness becomes threatening. In residents to other agencies, giving them the fact, the practices could be a good thing if they proverbial "run around" or as one student put keep those patients who are less ill from length- it, "Nobody takes a stand or wants to make a ening the waiting lines at-the clinic and hos- commitment of any kind." Pital. This is not praising ignorance, but rather The lack of agency communication and their looking at the useful implications of the litent overlapping and referral oriented natures have functions of folk medicine given the crowded not only confused the poor but made them skep- hospital situation. tical of coming to any agencies at all. In addi- 21 COLORADO STUDENT HEALTH PROJECT tion, agencies often are involved in a competi- ing lines and/or the hiring of more people to tion- for "cases" and "work at cross purposes" fill prescriptions. to one another. The latter is due perhaps to a 5. Waiting rooms should be made more at- lack of clearly defined agency goals, and the tractive. desire to "do well" so that the agency can be 6. The health education programs should be recognized as a good thin increased. 9- One student suggested that bureaucracies are 7. A geriatrics clinic "where doctors have too interested in maintaining the status quo, and more time to listen to old people" was seen as for them to feel that change should occur would an overt need. be an admission on their part that something 8. At least one other health center is needed was amiss . . . . .. Innovation involves stepping to serve the poor As the one available is not on toes because someone is not doing his job large enough to handle the volume of people. well," and this is demonstrated by the need for 9. Communitk residents should become more change. involved in decisionmaking capacities. A problem connected to the above involves B. Alteration of the neighborhood represent- the large number of people who come to the ative program. Two suggestions were offered: homes of the poor trying to "help them." Just 1. The program should be expanded so think, a family that has a neighborhood repre- that there will be more "reps" who can sentative from the action center, a social worker reach more people. from welfare, a social worker from the health 2. One "multipurpose neighborhood rep- center, a teacher or parent program aide from resentative" should be used who knows the Head Start (or both), and a child welfare so- people and who could refer them to the cial worker coming to its home can get mighty various agencies in an attempt to eliminate confused if all these independent agencies start all the other persons from all the agencies trying to solve the same problems. bothering the poor. 4. Concrete Proposals for Better Health Care 5. Cultural Problems of the Poor as Problems Programs for Medical Care A. More "personalized" health care for the A. All six students mention that folk medi- poor. cal practices are a eult ural problem for proper 1. At the health center, the following are medical care. One student felt it played a suggested: giminor role, if any" while another said, "The a. Patients should see the same doctor use of folk medicine plays an important part whenever he comes to the clinic. Like.pri- in health care. It is often used rather than ac- vate practice, the doctor should know the tual medical treatment'" patient's name and something of the na- B. A distrust of white physicians, and a dis- ture and history of the patient's com- trust and fear of Denver General Hospital. plaints. C. Most persons are not oriented to preven- b. Personnel in contact with patients tive health care, and many will wait until they should -be out of uniform and wear gireg- are quite ill before seeing a doctor. While this is ular, common civies" with name tags. in part a function of their value for health care 2. A @definite need exists at Denver General and their definitions of what is illness, it is also Hospital to treat the poor like people and elim- linked to their distrust of physicians and hos- inate those long waiting lines. pitals mentioned in B above. 3. There should be some doctors or other D. One student felt that "a major problem qualified personnel who can make house visits. for medical care is that of broken homes and 4. A home delivery system for prescriptions mothers for whom children are mostly bio- might be instituted to help eliminate long wait- logical events." 22 SUMMER 1968 B. The Health Care System-West Denver C. The need to improve image of Denver Gen- eral Hospital. "Thru fear and rumor, it is 1. The Present System of Health Care for the looked upon by some people as a slau r- Poor house." There are three main facilities serving the D. Need for more health facilities-i.e., more west side of Denver. One is Denver General clinics, doctors and nurses. Hospital which has been discussed under the E. Community residents must learn to keep appointments and come in before they are seri- section on the east side. The two others are ously ill. Mariposa and West Side Health Centers. These And when they do keep their appoint- centers are concerned with "checkups, minor ments, they should not be forced to wait so long illnesses and injuries, chronic manageable dis- to see the doctors. eases, immunizations, dental work, lab studies, F. A better understanding of the poor by and drugs and nutritional guidance." Another Denver General Hospital staff should know student stated, "the West Side Health Center about the values and attitudes of people they provides comprehensive care, including pre- serve and should be tolerant and empathetic. natal, maternal and infant, adult, dental, social Again community residents should be more in- service, et cetera. . . . The Mariposa Health volved in decisionmaking roles and there is a Station is a smaller facility providing prenatal, need for staff conferences on "social rather than maternal and infant care, routine lab work, but purely medical issues." no pharmacy." . G. Need for more neighborhood family health Family health counselors, who are usually counselors. These people should be trained to residents of the neighborhood, makes "rounds" deal with the total problems of the family as to peoples' homes encouraging use of the health sort of a multipurpose worker. These counselors station and center, and try to mediate problems could be useful in getting more people to use the in keeping appointments, getting prescriptions clinics, through a trust and understanding filled, et cetera. In addition, there is the Denver which they could elicit from the people. Visiting Nurse Service which has nurses mak- ing home visits as well as helping to @ff the 3. Bureaucratic Problems Which Hinder the health centers. Usefulness of the Present Facilities to the These agencies are free, except for small min- Poor imal payments from those who can afford it. A. Denver General Hospital administration And, "Medications are provided free of charge has not responded to the needs of the poor. It to the patients at the clinic at the conclusion of seems to be a structure that fears change. a visit with the doctor." B. The inconvenience of "forms." Often the I A point which several students felt was im- fear of having to fill out many forms is enough Portant was the emphasis by the clinics on the to keep the poor away. keeping of appointments. Over 50 percent of the C. Lack of organizational cooperation in people do not keep their appointments but there sending many different people into homes for are always enough people around the clinics to followup. Called by one student a "fragmenta- keep the doctors very well occupied. tion of services.'@' D. The problem of long waits to be seen at 2. The Most Pressing Health Care Needs of the the hospital and rudeness of the clerks and Poor some nurses help intensify the difficulties here. A. There is a great need for informing the A People about the clinics and when to use them. 4. Concrete Proposals for Better Health Care The orientation to health should be more pre- Programs veiltively oriented, and residents should be made A. The employment of neighborhood people aware of clinies availability. to act as health representatives in their own B. Need for transportation to the clinic and neighborhood. These people could "provide in- babysitters while parents go to the clinics. formation about the neighboihood's health fa- 23 SIV@VA'.ZXlJ%J 0 L U.LJJ2'L'4 L cilities and programs to the people of the in making all decisions which will effect ti neighborhood" who in turn could relate to the services provided by the clinic. representative how things were working for H. A reduction of the number of people wl- them. In connection with this could be an oppor- visit area homes seems necessary. This could I tunity program for qualified people from pov- accomplished through more agency cooperatic erty areas to receive training and education for and organization of activities. participation in the health fields, i.e., techni- I. Health clinics should be kept open evt cians, nurses, and doctors. Vertical programs nings so that working people may find thei must be established in health training schools. more available. B. An adequate transportation system from J. An "emergency" food bank created b homes to the clinics and hospitals must be in- food chain donations would alleviate man troduced. Also an emergency system would be acute crises. This is a difficult situation because most beneficial. people must be taught to budget, but it is a C. A preregistration program at the clinic most impossible to provide adequate food, clot] for all poverty area people is recommended. ing, and shelter on a welfare check. This would replace registering only after one 5. CulturalI'IProblems of the Poor as Proble-ni becomes ill and is in no position to find out if for Medical Care he is eligible or not. A preventive type program could be worked into this scheme by providing A. The non-time orientation of the poor wE annual or semiannual examination for all reg- again seen as a problem. The absence of th istered people@ Since the people realize the need value for being at a certain place at a certai for medical care when ill, perhaps a value for hour causes difficulty in appointment makin prevention could be begun by such a pre- and keeping. registration program for all Deoi)le irrespective B. The value of preventive medicine is nc of their present physical condition. strongly established among the poor for the- D. An accurate appointment system should seem to use the clinic only when quite ill. Thi be introduced by Denver General Hospital in- is especially true of the males. stead of telling all people to be there at either C. Many community residents have the belie 9 a.m. or 1 p.m. and then forcing them to wait. that "if it's free (the medical care) it is n, A corollary to this would be a system of ap- good, it's second rate." This helps propa pointment reminders for the people, especially double standard of health care. just prior to the date of a long term appoint- D. The low socioeconomic status of the poo: ment. presents problems itself, regarding nutrition E. There is a great need for educational pro- sanitation, clothing, et cetera. grams for medical staff people in the culture of E. Some people have the attitude toward i I poverty. ness that you just bear with it. "For example F. Health education programs for poverty one lady suffered from severe joint pain, think., residents in such areas as health care values, she has arthritis, but won't go to the doctor, an(- birth control, first aid, glue sniffing, alcoholism, she happens to be one of the few people who likE drug pro blems, TB, tetanus, et cetera, must be Denver General Hospital." increased. F. There seems to be a fear on the part ol G. A committee of area residents sfiould be the poor of uniforms and professionalism-lan- implemented to work with the clinics and help guage, mannerisms, et cetera. 24 Chapter 2 The Student Reports COLORADO STUDENT HEALTH k'-UU.)@U'JL' The papers in this chapter convey a spectrum SOME ASPECTS OF COMMUNITY of individual experiences and philosophies rele- ORGANIZATION vant to the involvement of SHO, DRMP, or any predominantly white group in ghetto com- Webster defines community as a "body of munities. They express a deep sense of urgency people having common organization or interests and frustration. This cannot be taken lightly or living in the same place under the same laws in view of the social disorganization witnessed and regulations." On the west side of Denver firsthand by these students, and the realization the latter part of this definition is most appli- of our own impotence in confronting even the cable as the area is notable for its'lack of or- smallest of problems in a 10 week period. ganization. The residents of the area are just be- A recurrent theme here, as in other parts of ginning to get together to discuss the problems the report, is that we can justify our existence of common interest, an activity which will lead in ghetto areas only by demonstrating concrete to a more structured community. At the present changes produced as a direct result of our there is, on the whole, little communication be- presence. This may be a shortsighted point-of- tween neighbors about matters of concern to view. Ultimate justification for these projects the entire community. The basic unit is that of may lie in future changes in-the health care the family rather than that of a block or neigh- system based on the insights, personal growth borhood. and firm commitments established now as It is difficult to introduce the concept of or- health professional students. These are pre- ganization for the purpose of bringing about sented below.... desired reforms because this has never been Ida Jean Newton is a Junior at Women's Medical done here, and people must be convinced that College of Philadelphia who worked with the Mariposa they have the power to change things. Health Station on Denver's west side. The paper deals The problems which an outsider with ideas of with problems relevant to community organization: community organization dancing in his head defining a "community"; identifying its problems from faces when he begins work on the west side are both community residents and community service cen- ters; and assembling community people to discuss these many. How does one actually identify the prob- problems. A basic axiom in our attempts at community lems of the community rather than starting organization is alluded to in the last paragraph: That work on a project which one feels needs doing meaningful change must be initiated and carried out but in which the neighborhood is not especially by the people whom it affects. The question of whether interested. It takes quite a bit of talking, both SHO should even be involved with community orga- to the members of the community and to the nizing projects is dealt with at length in chapter 4. power structure which purports to be work- Ida Jean mentions the methods used by SHP in an ing in the interests of the community. This attempt to improve conditions of a neighborhood pool. method is very slow and unless one has already The situation. was described more fully by Steven established a rapport with the people, one runs Berman: the risk of being very politely yes'd to death A very real medical problem was recognized by 't'ne on all actions proposed. Organizing the people high school interns who complain94 about the state of the neighborhood swimming pool. Some of the around one's own goals may be riiore fruitful problems included abundant quantities of glass if one has been able to ascertain who the leaders and trash in and around the ppol, no soap in the are who are both closest to the members of the showers, and a faulty chlorine system. The Mari- community and respected by them. This re- posa clinic sponsored a community meeting during quires time spent around agencies listening and health week on the pool problem and invited the watching who is listened to. The summer worker dir6ctor of Parks and Recreation to attend. The can then do the leg work for projects for which important feature of the pool controversy was the the busier agency members do not have time. insight certain members of the community, espe- The people of the community, of course, play cially the high school interns, acquired in the im- the most vital role in identifying which prob- portance of documenting a problem and confront- ing the establishment through political and direct lems are the most acute and in organizing to solve them. How does one m channels in order to get action. eet the members of 26 SUMMER 1968 the community? For the purposes of community munity are planned, the people themselves will organization, it is probably best to be affiliated begin to initiate positive action. with one of the local agencies which is well liked rather than, say, meeting people in the IDA JEAN NEWTON. park. For instance, being able to say one is from the Mariposa Clinic opens many doors. Jim Pachl, a second year law student at Berkeley, was After one has both informed and been in- placed with the West Side Action Center in Denver. As formed by the community about problems and in the last paper, these excerpts again deal with the actions being taken to solve them, there is the frustrations of defining and relating to given "com- difficulty of actually getting people together to Tunities." The role of SHO in bringing people from discuss possible solutions. They are not accus- these areas together with local agencies is mentioned. This has been a most productive and effective aspect of tomed to and probably do not like to attend many of the projects this summer-particularly re- meetings, and have a tendency not W show up garding health care facilities and health care "con- when one is arranged. This may be solved by sumers." Much concern has been expressed in our dis- -- cussions as to whether "agencies," as suggested here, several reminders and providing transportation should be in our base of operations. This is dealt with in even to those who live very near. Also, what other parts of this report. form is the meeting to take? Should it be large and advertised by posters which may or may not be read or should it be composed of a HOW CAN I DO SOMETHING? small group of friends and relatives who will, If you are going to work for a summer i@ hopefully, later spread the message around? a "poverty area," you will ask this question Both methods of getting members of the often. Hopefully, my comments, based on 10 community together have been used to discuss weeks in the west side in Denver, will be of two of our summer projects - (1) The problem assistance. of uncleaned swimming pools in the ghetto To work on the west side you must know the area; (2) setting up a cooperative store. The people. The blood is a mixture of Spanish, Mex- necessity of improvement in both these areas ican, American Indian, and Anglo. They are a was discovered by talking to members of the people unique to New Mexico and Colorado who community and the power structure. People in are searching for an identity-Spanish, Mexi- Positions of authority with knowledge and in- can, or something different. "Spanish" is the fluence in these areas were found and meetings safest name, but some prefer "Mexican." Better were scheduled. In the case of the pool, official notification was posted at the various age ncies; yet, don't use labels. These people are much People went'door to door to inform the com- like anybody else. They are individuals-many are intelligent, some aren't; some are fine munity. Rides werl- offered and people were fathers, others beat their wives and children; reminded again the same evening. This brought some are hard-working, some are lazy. And all the desired result of having people from the are different from each other. neighborhood attend a meeting with city Offl- Words are all important in college, but they cials. An earlier attempt, in which transporta- don't mean much in west Denver. Many agen- tion was not offered, failed. cies, "militants," and others have made prom- A meeting for the co-op store was planned ises and broken most of them. Few will serious- on a smaller se-ale with a nucleus of friends ly listen to anyone with an idea. "Why waste and family of people in the neighborhood and time" is their idea. It is said that people on some interested officials. The store had ear the west side and in other "poverty areas" are been discussed in smaller groups in peol apathetic. This is inaccurate. The young people with steady jobs-the potential leaders, leave homes. The s6cond attempt, when rides were the west side because there are better p ces offered proved a success. in the west to raise families. Many people If these projects,succeed in attaining their side have too many personal worne@large goals, and others of vital interest to the com- families, intermittent employment, debts, et 27 COLORADO STUDENT HEALTH k'.KL)Jn%al an be in the absence of the Student Health Project." He exam- cetera. Many don't feel that anything c munit@ ines our roles as "patient advocates" and corn done or don't know how to do it. organizers, and concludes that in some instances wc Knowing the people (wherever you are) were useful in these capacities. won't change anything-it's merely a prerequi- site to do anything. Before you can do anything, you must learn what is going on, who is capable A QUESTION OF NEED and who isn't, and what are the genuine prob- A few weeks ago I was asked by a doctor whc lems and issues. Do this at the beginning of the has considerable interest in the activities of thE summer so that you have time to accomplish Student Health Project if I thought there was q something. Don't jump to conclusions about in- need for such a project here in Denver. He pui dividuals and issues; you will make a fool of some emphasis on the word need in the phras- yourself. Remember that the interests of a@y ing of his question, which meant that I woulO, community are divided-single teenagers ao have to do some deeper thinking than was usual- not have the same prob ems as parents of large ly required in answering questions about thE families. proj ect. You should work with people in the agencies Does Denver need the Student Health Project' and in the community who are capable of help- The issue of need is one which is related to thE ing the community. You can't do much without stated purposes of the project, these being: them and someone must carry on when you e (1) service to the community, and (2) ducat leave. You may find capable persons who know I - the community but don't know the system, and ing ourselves about the problems in the com- persons in agencies who know the system, but munities in which we work. But it is not E word used often, if at all, in justifying oui not the community. Get these persons together; presence in Denver for the summer of 1968 they will be much more effective. You can teach My first impression on arriving in Denver wa,, a little about the working Of the system, but that the system of health care delivery is re- YOU don't know much yourself. Be wary of markably advanced and well organized, com- feuding factions in the agencies and in the pared to Detroit where I came from. I has community. brought with me some vague ideas about work- I have found that the "good people" in the agencies and in the community don't have much ing on development of facilities along the line,, of neighborhood clinics. But the prior existence time. The agency people are swamped with day- of the Neighborhood Health Centers and Sta. to-day work and the potential community lead- tions indicated that the city had already madE ers hold jobs and care for their families. Maybe the commitment to such facilities. The neee these persons have some "pet" projects whicii in this particular area, then, no longer existed they don't have time to begin. Maybe you have an idea that people like, but don't have time to and it became necessary to identify some othei problems for which the project was 'needed. initiate. Health science students could lay the After a short time on the west side, whict groundwork, get the information, do the leg- is composed mainly of Spanish-Americans, ii work, and leave something for somebody else was seen that one kind of need was that ol to continue. personal concern for individuals, families, oi small groups. It is a near certainty that n( one on the west side would have perished ir JAMES PACHL. the absence of the Student Health Project. What is less certain is that the several individ- Jerry Yucht, a sophomore medical student at Wayne uals and families who were directly assisted b3 State University in Detroit, poses questions which might project members would have managed to gei serve as an introduction to the discussion of our role in through some difficult situations as quickly oi '4ghett,oty conmnunities presented in chapter 4. He sug- gests here that the "needs" for the project were largely efficiently. People were helped in getting med- our own, in terms of self-education. "It is a near cer- ical assistance, helped in moving, taken shop- tainty,that no one on the west side would have perished ping, and helped with legal problems in man3 28 SUMMER 1968 cases by project members. But was this sort better idea of what we were doing in their com- of need justification enough for our presence? munities, as well. The problems we have been is this evidence of community need great -exposed to may be even more trying than that enough to bring 30 students, most of them of convincing government and medical profes- new to Denver, into minority or disadvan- sion to make the commitment to comprehensive taged areas of the city? I think not, since community health care. I was educated about many of the problems dealt with by proj- the problems residents face in dealing with wel- ect members could probably be handled by fare, food stamps, prescriptions, transportation community people trained in these areas or by and a myriad of problems relating directly or existing agencies in the community, if they had indirectly to the use of health care in Denver. adequate staff and the desire It is possible that To better deal with these kinds of issues we this kind of personal service could be provided might use this summer's experience to call by others on a long term, continuing basis; in on only those agencies which we have found this capacity we have served to fill a gap be- truly responsive to community needs in the tween what could be done and what is being future. done. But in filling the gap we have gained in- The real need, it seems to me, was actually sights which could not have been otherwise ac- ours, not the community's. We needed educat- quired. ing, and I think that all of us got an education. In addition to services rendered to individuals It is a very real possibility that what we have or groups, we helped in the initiation of projects learned this summer can be passed on to our which were designed to involve people of the successors in-Denver, as well as put to use in community on a continuing basis after our de- our own cities. This bene-fit can be multiplied if parture. The two swimming pool projects are we follow the persistent advice of our black examples of this kind of action. The problem associates, that is, "go home and spread the itself, in this case inferior swimming pools in word I" With the knowledge that 10 weeks time project areas, was not necessarily of earth- is not enough to accomplish much of any great shaking importance. What was important was import in the community, we can work for local the involvement of community residents in the Student Health Organizations along with exist- solution of the problem, demonstrating that city ing community agencies and organizations, and agencies will respond to demands made by be more effective. The summer projects could groups of the poor if they organize. But again then be continuations of year-round efforts, the question of need. Did the west side of Den- concentrating manpower and energy on problem ver need the Student Health Project to initiate solving, as well as using the project as an in- these kinds of actions, or were the vehicles the-field classroom in community organ izing. already present in the community? It seems The most pressing needs of the summer were that in this area of the city there are agencies, ours, since we were the ones to whom the prob- such as the Action Center, which could provide lems were alien. Hopefully, the education re- the impetus, but for reasons of lack of staff, or ceived this summer will make us better. equipped initiative, or cooperation the community re- to deal with needs as they exist, and not as we mains unorganized. Again, we tried to supply perceive them. It was necessary for us to be some manpower and ideas to fill, a gap. Un- here this year in order to deal with the needs fortunately, it became painfully apparent that of the community next -year. 10 weeks was not enough time for implementa- JERRY YUCHT. tion of the grandiose schemes some of us brought to Denver to solve problems real or Joe Bergquist is a junior medical student at the Uni- imagined. versity of Colorado who spent his summer ih west We might have been more effective in corn- Denver. He again examines the "need" for summer niunity organizing if we had defined our izoals projects, but here on a more intrapersonal level. He more specifically and at an earlier date;. this concludes, "I don't need the false satisfaction of doing something for a person which he could and should do might have resulted in our interns having a for himself." 29 COLORADO STUDENT HEALTH PROJECT "WHAT CAN I DO FOR YOU?" for a person which he could and should do for himself. I spent the summer of 1968 working with the Student Health Organization in Denver. Osten- JOE BERGQUIST. sibly, we were to work in the poverty areas of Denver trying (1) to understand health prob- Nancy Adams is in Social Service at the University lems of the area; (2) to recognize the communi- f Colorado Medical Center. . She spent the summer in cations problems between the poverty people 0 Grand Junction and Fruita setting up an "Aftercare and the power structure; and (3) to stimulate Program" for patients recently discharged from psychi- these same poverty people to organize them- atric hospitals. This is described in some detail below. selves into a community body which would, it, She mentions, ". . .the fine line between motivating people to act for an ostensibly good cause, and pushing self, gain desired health services for its area. people into something you are convinced is good." This Most of the first month was spent trying to became an issue of frustration to many of the students and should be of great concern to any group planning understand the existing conditions of the area, "community based projects." It might be construed as which, in my case, was predominantly a Span- an argument for expending a great deal of initial effort ish-American area served by Mariposa Health toward just talking to community residents and in this Station. It should be noted that to truly under- way becoming attuned -to their problems. However, she states that the first 3 weeks in Grand unction were stand the problems, one should probably live or ,pent "... like dogs chasing their tails-madly circling at least work in the area he is studying for sev- and finding no direction.... inexcusable." Still, in the eral months which for me was impossible. It period of 10 weeks Nancy developed a well-constructed I . Iprogram which will continue in her absence. This ques- did not take long for the bad side of the esTaD- tion of structured versus unstructured situations was lisbrnent to raise its ugly, deaf, blind, and ignor- a subject of much debate in the planning stages of the ant head. One would have to be almost totally project. A logistic issue finally settled the matter; impervious to external stimuli to fail to recog- although the grant proposal had been in Washington since February, final funding came on the first day of nize the desire by the establishment to attempt orientation. To offer our presence and then not be able to maintain its role as the father or perhaps. to follow through would be another case in the com- benefactor of the poor. The attitude I ran into munities' files of promises not kept. In addition to this, it was felt that much of the time in the first year of time and again was what I can do for you. This these projects must necessarily be spent in "learning attitude is one of the very concepts which guar- the communities." A major point here is that the com- antees that the people in the ghettos will re- m'nications which we have established this summer must be continually built upon during the year. This main in the ghettos. A further extension Of this would provide at least a sense of direction for future attitude is the objection to "letting ignorant projects. This point was discussed in our final evaluation people run their own lives and handle their 'Ission: The only point that I am trying to bring out is own problems." that I think you have to decide once you are in Frustration became the rule, not an occasional the community, not before, what its real needs are. happening. Projects are not set up in a month. I don't think you can go in and say we have a Friends are not made quickly among people who project in mind where we could analyze the user of the neighborhood health centers as compared to have been shot down for so many years by the the nonusers, and we are going to devote all our so-called I.iberals. not energies to that. I think we have to go in and In fact, some people will find out from the connnunity what the problems accept friendship, no matter what. Some people are and what the conununity thinks. may say friendshi is not important. It is. p Believe me. To me one major aspect of friend- AN IMPRESSION ship is the necessity for letting my friends do for themselves. I don't believe a friend is one The first 3 weeks in Grand Junction were who will not allow a person to develop self mainly ones of frustrated confusion. Skip, Jeff pride through personal achievement. I don't and I were like dogs chasing their tails-Madly need the false satisfaction of doing something circling and finding no direction. We began to 30 SUMMER 1968 follow each other around-a real trailing syn- the same neighborhood center. So, by a simple drome which produced three people anxiously rationalization, I decided I could be more effec- peering in corners for places and ways to get tive working alone and with mental health. involved. Thus, the most important criticism Besides, it is the field I in'.-end to enter and it's I can make of this project is its lack of organiza- health related. tion before bringing people into the community. The after-care program here was terribly in- I realize time was limited in being able to pre- adequate for ex-mental patients. The only half- pare for this project, but in the short amount hearted attempt made at rehabilitation was to of time we had to spend in the areas, to waste herd them in weekly for a crafts class and a good third of that was inexcusable. Sure, the "ladies from the community" would serve re- idea for us to come into the community to learn, freshments before they were herded back home. to create our own jobs, sounds good in theory, Lovely! Most of them had retained the institu- but may lead nowhere, depending upon the tional style of life, which is basically antilife, community and/or the individual. Project and continued to be completely withdrawn. people must realize that lack of structure so as Many lived in foster homes whose operators to allow room to move, to tap all that potential encouraged this due to their own psychological creativity, is not and should not be mutually needs. The result was a zombi-ish atmosphere exclusive with having definite, structured plans that was just too tempting for many of those foi- action. It took us 3 weeks of relative inac- who wished to withdraw from the living, real tivity to discover that Grand Junction is a very world, which may not be such a bad idea with conservative, "don't rock the boat" type of com- America in its present condition. munity. But, is it necessary t(> take 3 weeks to But not working under that assumption, I learn a lesson as basic to a small rural commun- set out to see if aftercare could be changed. ity as that? So the alternative is simple. Rather And here came my first real lesson-there is a than getting vague promises from kindly people, very fine line between encouraging and moti- such as a welfare director, which quickly vating people to act for an ostensibly good cause, evaporated into, "We're very busy this summer and in pushing people into something you are with the budget," et cetera, get specific things convinced is good. In wishin to convince othe.rs 9 which each student can be involved with. The of this, you stand the chance of alienating them. student could spend as much time with that as It takes a sort of sixth sense to know when to he likes and still have ample time remaining approach a person and how to approach him on to exercise his own creativity in other areas. his own, individual level, and make him accept Now, as I've said, my first 3 weeks were frus- your way of thinking. It takes time and I'm still trating, boring, purposeless. Basically, I felt un- learning, but this seems to be the essence of essential, and that wounds one's ego, but per- getting things changed. It was essential that I haps a necessary lesson. not alienate the foster home runners for they Then, I stumbled quite by accident on to were the ones 'responsible for getting their the Mental Health Association. These people, people out and involved. My initial hostility the executive director of the Mesa County Men- against one foster mother who babied her people tal Health Association, and the psychiatric so- and encouraged them to be totally dependent cial worker who is the liaison person between upon her, had to be hidden, for I needed her Pueblo State Hospital and the western slope, help. (I never did get it, to the extent that I were in marked contrast to most others I had had envisioned.) The second lesson I learned spoken to in Grand Junction. Their attitudes was that maintaining high ideals while being were the reverse of keeping the status quo. involved is unlikely and may be more detrimen- They were eager to change and improve and tal than helpful. have new ideas. How could I pass up an oppor- Setting up programs was a unique experience tunity to work with them? . . . especially when for me. Major support came from the Mental' Skip's, Jeff's, and my jobs tended to overlap Health Association and from a zealous, reform- when we worked with the same people through ing type of woman who had been a mental 31 COLORADO STUDENT HEALTH PROJECT patient herself. She and I spent time contacting being "more like holding actions than definite solutions." the ex-mental patients in Grand Junction and Thi.s is in contrast to the next. paper where the idea that Fruita and I started weekly meetings in both such activities are important parts of our function is developed. Charles is a junior medical student at the places. The goal of this type of group is to pro- University of Colorado. vide a place for companionship and social inter- action and to motivate them to take increased amounts of responsibility for themselves. The SHP-A CRITICAL EXAMINATION group was theirs. They decided what they The purpose of this evaluation, presumably, wanted to do (it was mostly recreational) an@ is to examine the values of the 1968 Colorado I tried to be as -nondirective as possible, though Student Health Project. In order to term it a I offered suggestions when I felt they were success or failure, it is necessary to look at the needed. The Fruita group went so well that I original goals of the project and to determine opened a biweekly canteen program in the rec- reation center donated by a priest. whether or not they were reached by the end These groups and canteen programs will be of the summer. This task is made doubly diffi- continued after I'm gone. Plans are being made cult by the fact that these original goals were, to get directors and volunteers. Mesa ege at least abstract or unclear ones and, at most, provides great potential for volunteers which nonexistent ones. All was not lost, however, for has not been tapped. In working with a similar in the course of the summer certain goals were group in Boulder, we found college youth could at least approached, if not attained. Others were recognized which had little hope of attainment. add a good deal of warmth and enthusiasm'to The latter were more numerous. a group such as this. I met with several people from the faculty and they were eager to begin In discussing each of these goals and the suC7 recruiting in their classes for volunteers. The cess that each enjoyed, I must confine my eval- canteen program will hopefully be the precursor uation to my own experience and not that of of a day-care program when the Mental Health the project as a whole. I see five goals worthy Center is built in Grand Junction. They hope to of discussion. The first of these was the edu- cation of both myself and the middle class com- have the funding approved next year. It has been gratifying that I began something munity. The former has been rather successful which will be continued. The aftercare program and the latter I think rather unsuccessful. My would have been revamped anyway, but the op- own education has been not so much in the portunity to develop something myself provided reality of poverty (although, what I already a good learning experience. And what I did knew of poverty has been indeed brutally ex- learn was mostly about myself. emplified this summer) but more in the culture of the Spanish-American people, a culture which I feel is analagpus to that of the American NANCY ADAms. Negro 20 years ago. That is, a culture char- acterized by subordinance, passivity, and Charles Holt',s placement was with Denver's West apathy. A culture not lacking in heritage, but Side Action Center. The paper examines the success of in pride of that heritage. This is changing with the project with respect to (1) education of . ourselves the Negro, and presumably will change with the and the middle class conuniinity, (2) conununity orga- Spanish-American given time. -nization, (3) improvement of health care for the poor, The education of the middle class community (4) individual crisis solving, and (5) the development has not gone so well. A notable example is that of the high school intern program. As in the last paper, he mentions the frustrations of a relatively unstrue ured of the American Cancer Society. The American situation. The discussions of the projecVs encou iters Cancer Society came into the Chicano and black with the American Cancer Society and the conclusion communities of Denver this summer with a pro- that "perhaps our job is, as our black friends have re- irram of education about cervical cancer, fol- peatedly told us, in spreading the word to the ite [owed by free clinics to give Pap smears. We middle class community" will be a major consideration in planning next year's project. The aspect of the offered the advice that they should enlist paid project concerning crisis solving is criticised here' as neighborhood people to distribute the educa- 32 SUMMER 1968 tional information throughout the community@ sonnel improvements that should be made, or an idea about which they originally showed to suggest to the people receiving this health much enthusiasm, even to the point of vague care. that they demand these improvements. commitment. They later claimed that they had Which of these courses to follow obviously de- no funds for this purpose and were therefore pends upon the circumstances of the particular unable to meet this commitment. However, they situation; after considering the circumstances would be able to enlist the aid of middle class surrounding the pool, we chose the latter meth- housewives to canvass the poverty areas to try od. So in this case, at least, the goal of health to convince the local black and Chicano women care improvement is contingent upon attaining to have a yearly Pap smear. This copout un- the previous goal of community organization. fortunately (but predictably) alienated most of This latter goal was successful and I think the the community workers with whom they al- former will be too. ready had contact, including this one. It is A fourth goal was the solution of individual places like this where I think we can do the crises. The instances in which I was able to most good. The cancer people can't learn from help were successful, but they seemed to be the poor community because not only are they more like holding actions than definitive solu- on a different wave-length, but they aren't even tions. As a result, I felt less effective in this in the same ball park. And while we, hopefully, capacity and spent more time working on col- aren't on the cancer people's wavelength, we lective projects than individual ones. are from their side of the tracks and regrettably The fifth goal was to stimulate our 1 speak the same language. So, perhaps our job school interns to continue in school and per iaps is, as our black friends have repeatedly told us into health careers. This goal has, in my esti- in spreading the word to the white middle class mation, been the most successful one of the community. summer. Several of the interns have been "stim- The second goal was that of community ulated" I think, and are anxious to go on to organization. We have been moderately suc- college. We are presently in the process of cessful in this effort. I say moderately success- trying to obtain scholarship funds for them. ful because several early attempts at having But beyond this, and perhaps even more im- community meetings to discuss this or that portant to me, is the rapport we have estab- problem failed dismally, while the last attempt lished with these kids. One of the most valuable was pretty successful. This last meeting was relationships,that I personally established this to discuss the health problems at a neighbor- summer was with the intern that I worked most hood swimming pool. Many neighborhood people closely with. Most importantly, I feel that these presented grievances about the pool facilities young people are really the only hope of the and management, which were loyally, but not poor community. justifiably, defended by a director of the Depart- ment of Parks and Recreation. A committee of CHMMEs HOLT. interested citizens was formed to carry the prob- lem further. They did so, and the city cooper- ated by granting many of their requests. This Steven Berman is a sophcanore at Temple University to me was one of the high points of the sum@e@. Medical School. In his paper he discusses the community service and self-educational aspect of the project. He The third goal, and presumably that at wiiicn points out the importance of becoming analytical of the this entire project was aimed, was the improve- directions we are taking and suggests methods for this ment of health care for the poor. It is paradoxi- analysis with regard to his ow-.i placement, the Mariposa cal that this is the goal that we are probably Health Station on Denver's west side. He finds the role of individual crisis solving quite relevant; it is least able to achieve. This is true 'because as seen as the first step toward developing "individual niere medical, students we have no authority to power" which can then be mobilized into community meaningfully participate in the health care of action. This role can biso take responsibilty from the the people we are here to serve. What we can very competent community aides whom he found, and allow them to devote more time to organizing which is do is to either suggest to the existing health per- certainly more their legitimate function than ours. Al- 33 COLORADO STUDENT HEALTH PROJECT though the Mariposa Health Station was found to be help create or revitalize community orga-niza- an ideal placement, he advocates using caution in work- tions, which expand the power of the individual. ing with the community agencies before learning the The Neighborhood Health Station and the community's perceptions of them. Mexican-American family health counselors provide a good avenue for stimulating change A QUESTION OF RELEVANCE in an individual's life style. Bonds of trust are I worked at the Mariposa Neighborhood built between patient, family health counselor, and doctor through which the patient can be Health Station on Denver's west side, which is predojninantly Mexican-American. This station taught to cope with all of his problems better- not just "medical ones." I worked with family enjoys a very good relationship with the com- health counselors and developed a good rela- munity. Larry Sena, a high school intern, and , . VI Madrano and Rose Uruste, family iealth tionsiiip with two families. I also tried to ob- counselors, helped me greatly by patient y ex- tain a realistic overall view of the role inter- plaining how the neighborhood people pe -ceive action between the clinic (especially the health their problems. They allowed me to make home counselor) and the community. visits with them and introduced me to many There is an important role the student can play which many during the summer rejected people in the community. I was thus able to dis- as "band-aid solutions." It falls in the area of tinguish between problems created by my in- comprehensive medicine which I call "holding tellectualizing and the real problems of import- action." It concerns people who are totally ance to people on the west side. helpless and realistically unable to develop the As a. first year medical student I realized power to function adequately in society. Since that my "service" to the community would not these individuals can never assume an active involve direct treatment. If my contribution role, one is actually involved in providing in- were to be medical it would have to involve stitutional type care. Such families consume other areas of comprehensive medicine, -pre- @ great deal of the family health counselor's vention and rehabilitation. It is important to time and energy. The health science student recognize that the patient has a passive role in can substitute for the counselor with these the treatment phase, but an active role in both families during the summer and free the coun- prevention and rehabilitation. The active role selor to devote more time to those Nvho have can only be assumed when the individual devel- .1 ops the power necessary to control his environ- ttie ability to change their life styles. Indirectly, ment to some extent. Many low income individ- SHO can provide a great service to the com- munity in this manner. uals are forced into a "passive'.' existence as most decisions which concern their lives are The Student Health Project can also be the most important educational experience of any made in the end by others such as welfare health science school career. It can provide the workers, creditors, nurses, et cetera. Their pas- student with the opportunity of dealing with sive, crisis-to-crisis style of living must be the most crucial problem American medicine broken in some manner and the individual must faces today-how to deliver good health care to gradually make some of the decisions which inhabitants of low income areas. In order to affect his life. In this way he can gain power in approach the problem, the student must develop his environment and learn to budget his money, the means to observe accurately as well as par- provi'de adequate nourishment for his family ticipate in the normal life style of the poor. But and develop work habits. how can a student in 2 months understand a Prevention does not concern only the individ- basically foreign life style and community? The ual but the entire community, and therefore, the community must become an active organi- most important thing is to live in the commun- zation.rather than a group of fragmented, pas- ity. One can then walk to work to obtain a feeling for the physical layout and natural sive recipients. SHO should strive to help "passive" individuals break their . crisis-to- boundaries of the community and most import-: crisis life style, to assume active roles qnd also ant become known to the residents. One should 34 SUMMER 1968 shop in the area and become acquainted with dant exposure to both kinds of people. Only the local merchants and their attitudes. Learn how one who communicates his concern for other hu- the different local agencies are perceived by man beings is accepted on the west side. Honest people not affiliated with a given agency. It is communication of feelings in a manner which important to be certain of the image of an can be understood and respected is an art, and agency in the community before one associates one who can relate to people in this way is recog- himself in any way with that agency. nized as a brother. I believe that too much em- There are many questions relevant to health phasis in medical education is being placed on care delivery which can only be answered when becoming "do-gooders" and "brain pickers" the life style of the people served by the clinic relative to learning to relate to others as is understood. How many meals are eaten a "brothers." The realization of this inadequacy day? What are the common measuring devices in our medical education has led 'me to believe used in the home? i.e., a teaspoon of medicine there is a need for similar experiences in com- may mean a tablespoon. What emotions do uni- munity medicine to be incorporated into medi- forms and white coats generate in the people cal school curriculum. of the community? What are the barriers which exist between the health professional and pa- STEVEN BERMAN. tient which prevent meaningful communica- tion? How important is it to always have the Steven Feig is a sophomore student at the University same doctor-"your doctor?" of Maryland School of Medicine. Through his placement A good example of how a phenomenon com- with the East Side Action Center he was exposed to mon to the poverty area has practical medi- many aspects of the black-white communications barrier cal importance is the relationship between mentioned above. Excerpts from his paper amplify this "Mother's Day" and medical appointments. problem. This phenomenon recognized by the family health counselors relates a high rate of missed "WHAT WE HAVE HERE IS FAILURE appointments to the days surrounding the arri- TO COMMUNICATE" val of ADC checks. Just prior to the day the check arrives (Mbther's Day) the men return ... Unfortunately, little effort in the area of home to try to obtain part of the check. The direct communication is being made. In a re- women being very lonely for companionship in cent incident, a Parks and Recreation Com many cases accept the man's presence and a missioner of Denver stated that he had been P- looking for 12 years to find qualified black life- Pointments become unimportant or forgotten. guards to staff an area pool. He even had an- I observed this same phenomenon when I dis- nouncements made over the public address sys- covered that the local dancing club always had tem of the predominantly black high school. its biggest day the weekend closely following However, no one applied for the jobs. The stu- the ADC check and the men were obviously dents, knowing the "system," really didn't be- trying.to hustle money from the women. lieve that they would be hired. They had heard A Physician should not merely be a technolo- promises before. It was not until we organized gist and scientist but an artist as well. These a group of poverty mothers who were concerned three sides of the medical profession have been about the city's lack of concern'in keeping the identified in slightly different ways by the ghetto pool clean that the difficulty in finding people of the west side. The technologist is black lifeguards was brought to the attention labeled a "do-gooder," one who undertakes cer- of area residents'. Within a week, a list of qual- tain tasks without taking the time to discover ified black lifeguards was presented to the their implications or if, in fact, they have any Parks and Recreation Commissioner. In short, value at all. The scientist is the aloof, detached it was only a matter of contacting the people in- observer who has become known as a "brain volved. But, the commissioner and his depart- Picker" exploiting the poor without any concern ment never thought of it. After the meeting their lives. Th'e community has had abun- some of the tension was out of the air-the city 35 c H PROJECT OLORADO STUDENT HEALT had a better feeling of the people's needs and toward the eradication of the foundation sup- the residents came to understand that the city, porting poverty. too, has problems. Sometimes, the "establishment" does go out STEVEN FEIG. of its way to communicate with the Negro com- munity. They seek out Negroes for the Bi- Marylou Buyse is a junior medical student at Wom- Racial Committees and Civil Rights Commis- en's Medical College of Philadelphia, who worked on sions. And if there is any pressing community the west side of Denver. Most of the projects this problem involving black people, they look for summer were developed as loose affiliations with com- a Negro with whom to speak about the situa- mu@i@y agencies. Here, Marylou presents a project tic,n. Thus, they make two mistakes in their moaei of problem rather than site orientation. She worked directly with the residents of a community, efforts for a dialogue-both of which are fatal alling on numerous agencies only where they could be to the course at hand. The first mistake is that expedient in the problem solving. This same type of it is the white power structure that picks the project was discussed in the final evaluation session Negro to represent "his people." In this e-aca as follows: -t I think that what we are talking about is places the blacks haven't even received the benefit of to work with, not places to work in. I think that a democracy to pick their representatives for is one of the things that has come out, we should be negotiations involving themselves. Most often, working with, not working in or under.... I think the Negroes picked to represent the black com- we should organize around issues rather than agen- cies. It may take I or 2 weeks to identify the prob- munity are those with ideas similar to the ideas lems, those which may have changed or arisen of the "establishment." The white man picks during the year. After we have identified these people who tell him what he wants to hear in- problems, we should regroup and work around is- stead of what actually exists. While the white sues. If you take one issue, you might have to deal man is patting himself on the back for his pro- with all the agencies in the area on it. We should gressive, benevolent attitude in instituting these be coordinating the agencies; there should be some kind of link and also be a continuity. dialogues and for making great inroads in race Marylou also discusses the physical immobility of the relations, the town explodes around him, erod- "west side" as well as the subsequent exploitation of its ing some of his power. He is dumbfounded. residents-particularly regarding food pricing. The es- The other mistake, perhaps even more easily tablishment of a cooperative grocery store seemed a 1, reasonable solution to this problem. At the time of this made 'is the exclusion of black people from aii writing, the West Side Action Center has set up the dialogues that do not involve them directly. organizational framework for the co-op and is using Black people know that they are never called students from the University of Denver as researchers upon to offer their opinion on things that con- of information for obtaining funds. They plan for most cern the whole city and not specifically Negroes. of -the money to come from the Small Business Associa- tion and, for this reason, have to call themselves a They know that their opinions are not needed Corporation, although the co-op will be of and for the or wanted and consequently, they'are again community. They expect to. be able -to train community made to feel alienated in their own home ci+,t7, people as clerks and managers so that they can obtain @.y , jobs in other stores. Presently, a credit union has been This, too, contributes to the upheavals in our established on the west side and is. proving successful. cities today. It mig lit be said that one of the most pricing "WHEN IT COMES TO FOOD STORES, needs of the American society today is an en- THE SITUATION IS PARTICULARLY compassing exchange of information involving ACUTE . . ." all-its segments so that each can better come The west side of Denver is the most isolated to know and understand the needs and prob- section of the city. Enclosed by its boundaries, lems of the other. We need to communicate so its people are natural targets for exploitation, that we can be acculturated enough to live with deprivation, and neglect. This is'evident in the one another and so that we can be enlightened noninclusion of the west side in the Model Cities enough to see the causes of the existing poverty Program. Its isolation is intensified by the lack culture. This would then enable us to work of mobility of most of the residents, few cars, 36 SUMMER 1968 little money, and large families. All of these tion to the problem. The establishment of such things tend to keep west siders in their own a cooperative store is even more attractive area. With this in mind as one walks the streets when it is seen as a source of jobs for men in and goes into various shops, most of which tend the area, as a @ite for job training and a business to be concentrated on or near Santa Fe, it soon that will keep money on the west side and re- becomes apparent that many of these businesses turn profits to the shareholders. The cooperative are owned and operated by Anglos, not west can also serve as a bridge to the community or- siders. Certainly there are some businesses run ganization so badly needed on the west side by west siders, but the fact that there aren't (so they can exert enough pressure on organi- more indicates that something is amiss. It seems zations like Model Cities and not be overlooked that the Anglos come over to their stores or jobs again). If successful, the cooperative would not on the west side, make their money, and then only serve as an additional source of income take it back with them. When it comes to food for west siders, but also would be a source of stores, the situation is particularly acute. There community pride, a pride in their accomplish- are only a few small grocery stores in the area, ment. We have talked to people in commun- no large supermarkets (Safeway moved and ity about the cooperative and have, for the does not plan to return). The stores that do most part, found th em to be enthusiastic. Our exist are not only mostly An o run (this just meetings with them and community leaders . 91 helps you look for exploitation), but are small have likewise made the cooperative a likely and dirty, poorly run and have high prices and prospect, one that is possible but at this stage low quality meat and produce. When you dis- presents obstacles. To get it going, enthusiasm cuss the shopping situation with the neighbor- must be maintained and more community people hood women, you discover they are pretty much must be interested in the cooperative and in- confined to their home area. They did complain vesting in it. A source of funds must be secured about such things as shortchanging, especially to start this endeavor. And then someone from when the children were sent to the store (which the community must be found who is willing they very often are), and the favoritism shown to organize and get the co-op going. These are by the grocers to some customers, i.e., some admittedly formidable obstacles, our work for people get charged more than others. (This is the summer is over, and while we have tried to easy to do since most items are not marked with lay some groundwork and spark interest in prices.) I have been in the neighborhood stores the co-op, it is now up to the west siders. The and done comparison pricing and evaluations. co-op is completely in their hands. The prices are quite high and can often fluc- tuate @even on @ple items. For instance, milk MARYLou BuysE. is 60 cents per half gallon, while elsewhere in Denver, the prices range from 43 cents at Safeway, to 49'cents in a small store. Meat is Marcia Looney is a fourth year student at the Francis not only very high, but generally of fairly poor Payne Bolton School of Nursing in Cleveland. Many quality and reportedly can be just laden with of her efforts this summer involved attempts to est is fat. You can often find bad meat under a top a "community board" to mediate complaints and be- - come involved in the decisionmaking of a general hos- fresh layer in a package. So, for all these rea- pital in Denver. She gives examples of -the community sons, some change in the shoppink situation is residents' perceptions of this facility. obviously needed and wanted. When all factors Many large city hospitals throughout the country are considered, i.e., the relative competition, have been ineffectual in responding to the needs of in- the lack of opportunity for the people to do digent health care consumers. These consumers often onfuse the health care received with the mechanics of much shopping out of the area, the lack of a cfilling out numerous confusing forms, extremely -long large, good supermarket and the unlikelihood waits before seeing anyone, clinic systems lacking ap- that any large chain supermarket would move pointment systems, the disrespect shown them by certain into the west side, the idea of establishing a hospital personnel, et cetera . . . On the other hand, hospit@l administrators often - ignore the consumers' consumers' cooperative seems to be a good solu- feelings about these mechanics. 37 COLORADO STUDENT HEALTH PROJECT of the SHP in chapter 4 is that said, "You feel poor just sitting here." One A criticism voiced our community orientation has directed us toward "Tumor Clinic." cliiiic has the reassuring title of dealing with the end products of the health care system I sat for 4 hours with the two patients I accom- rather than stimulating basic changes in health care institutions. Marcia's acivities are a first step toward panied. The wait is due to the fact that every- this latter type of involvement. one who is to be seen in the morning is told to SHO speaks of its role in terms of patient advocacy come in at 8:30 a.m., and everyone to be seen and maintaining the principles that health care is a in the afternoon is told to come in at I p.m. As basic human right and that all people have the right we sat for the 4 hours, not one nurse approached to self-determination. If we do have a role in ghetto communities, it might be in extensions of the type of a patient, other than to tell him that the doctor project mentioned here. Setting up community boards is was ready to see him. When the patients were only one way in which we can use our leverage with our finally seen by the doctors, the physical care own health care institutions, still acting as patient advo- seemed good and thorough, however. cates. Other areas of involvement might include insuring It seems that this hospital could greatly that paramedical employees come from the ronnnunities served, and that our -schools put out more health pro- heig'nten its community image if it improved fessio-nals from minority groups. Only in these ways upon two things: (1) If waiting time in the can health consumers feel that the facilities are really emergency room, clinics, and pharmacy was theirs and begin to relate to them in a positive way. The shortened, and (2) if the staff, particularly implications of these measures to better health care the administrators, developed a more sympa- delivery are obvious. This whole question is dealt with in more detail in chapter 4. thetic and helpful attitude toward the people they serve. When the new hospital is built, the clinic ap- PROFILE OF A GENERAL HOSPITAL pointment system will be changed. Computers are being used to set up hourly appointments. A large, red building of unimpressive archi- However, according to a sociologist associated tecture sits on the periphery of Denver's west side. Sometime in 1969 the area is to be blessed with the hospital, the clinic problem could be with a new building which should be quite alleviated now if organization was improved. He stated that an efficiency expert drew up a beautiful. But a building, after all, is only to report on the outpatient department and found contain an operation. And the operation of this that with organization of the staff 's use of time, hospital seems to leave something to be desired. It is one of the most hated and feared insti- there would be no need for the long waits. Re- portedly, the hospital's administration will not tutions in the city of Denver. Many people say make this report public. they would not go there even if they were dying. Reports from the community of malpractice Stories abound of the atrocities committed and poor judgment by doctors is a very hard there. One may hear tales of a girl who lost an eye because of slow service in the emergency thing to prove. Professional ethics would stand room; of a boy who lost the tip of a nzer be- in the way of any validation of those charged. It is also more probable that these feelings in cause grafting was not performed promptly-, the community ar-ci more a result of lack of ade- of people dying and being left in their beds all quate explanation to the patient of his diagnosis day to be finally dumped in a sack and carted "dirty Mexican" ancL treatment in terminology he can under- out.; of a woman being called a stand. The patient misunderstands what can be by someone -in the collections department. done for him and what is being done, and, as a One of the biggest complaints concerns wait- result, feels he has not received adequate treat- ing, especially in the clinics, emergency room, ment. and the pharmacy. I attended the clinic one It is my feeling that the staff needs education, day with two patients whose appointments were and that regular staff conferences should be for 1 p.m. The inside of this ins "Itution is paint- ed in gloomy, hospital green. The clinics are arranged, probably through the Social Services squeezed- into two hallways. There is one wait- Department. This same department has ar- ing room consisting of several rows of hard, ranged such conferences at Colorado General straight-backed wooden benches. As one lady Hospital where a group of fairly verbal ADC 38 SUMMER 1968 mothers talked to the staff. In order to try and The last paper dealt with a strictly health related om- pr4Dject. The basic question, "How is my project related effect some change, we decided a health c to health and medical problems-" has been asked by Inittee from the community that could work several other groups during the summer. It was brought with the administration would be the best up il our fnal session: solution. In this way, the community could help Over the course of the summer I have come around itself instead of us doing the work for them. to the idea that the SHO should be more concen- We discovered that the Model Cities Program, trated with "health" problems, and if there are one of the most active grass-root organizations, not enough health problems in these areas to keep us busy, then we shouldn't be there. This is my had such a committee already formed. The personal feeling. Certainly, there are lots of social idea of working with the hospital was presented problems to be dealt with, but I think there are to them and they were most enthusiastic. A other agencies to deal with them. SHO should look meeting between SHO, a representative of more seriously toward defining health a little more narrowly than we did this summer . . . stress the Model Cities, and a representative of the hos- importance of health and we can do just about any- pital was arranged. The hospital's: chief admin- thing. Quite a few people at my placement told us istrator stated that he would be glad to meet they were glad to have us there, and they had quite with Model Cities anytime they had proposals. a few things for us to do including cleaning up a We informed him that Model Cities could work swimming pool, developing a co-op grocery store for the hospital, too, by doing studies of the . . . They say that next summer they are expecting us and they will have something all set for us to community, such as, why people fail to keep do when the people come in-this will take the load appointments, or by imparting information to off them and get something done. Should we be the community concerning any changes in the doing this? It is better than nobody, but we should hospital thus improving this hospital's public impress on the neighborhood centers .and action image. centers that we are a health organization and we Therefore, it is left up to Model Cities to do would like to work with health problems. what they can. I think they have the potential The counter argument is stated by Dr. Bonnie to develop into a strong pressure group. I feel Camp in chapter 4. that pressure will be necessary, since groups have previously presented proposals with lack THE MAINSTREAM OF SUMMER@ of results. Model Cities is a new committee, and they have been mostly involved thus far Mainstream, Inc., is a group of 20 boy@ in their own organization. But they are a group ages 13, 14 and 15, who formed a corporation for the purpose of doing lawn and garden work. of intelligent, enthusiastic people, who seem to The boys all attend Cole Junior High School on have the ability to organize the community to I)enver's east side and, therefore, use the East bring pressure to bear on this institution. Hope- Side Action Center as a base of operations. Our fully, SHO will be able to follow up on the roles with Mainstream consisted of advertising committee's activities during the coming sehod year. for jobs via news media-free public on ra- dio, TV, and in newspapers was easy to get- handling the requests for jobs as they came in, MARCIA LOONEY. taking the boys back and forth, to their work and supervising the jobs, keeping the power lawrlmowers and trucks running, handling the Bill Walker is a sophomore medical student, and Joe finances and helping the boys make up the pay- Sprague, a third year law student at the University, of. rolls every Friday. Colorado. Along with Joe's wife, Linda, they helped co- ordinate Mainstream, Inc., ". . . a group of 20 boys- One of the main problems in keeping the or- ages i3, i4, and 15,-who formed a corporation for the ganization running was that of operating ex- Purpose of doing lawn and garden work," on Denver's penses. Three power lavnmowers were donated east side. The paper deals with many implications of which were in a continual state of disrepair. this kind of project, wnong them, learning the attitudes The corporation purchased two new power of the "white middle claW, toward these youths and ers, and Public Service Company donated blacks in general, while at -the same time giving the mow boys a glimpse of other life iityles." two pickup trucks on which we had to have 39 TH PROJECT COLORADO STUDENT HEAL mi,.ior repairs done in addition to purchasing one lesson this summer-that you sometimes insurance. Gas and oil expenses were also con- have to invest money in order to make money) ; Federal or local (3) an impo rtant part of the project is that it siderable. Because we had no funding for the project, these expenses were allows concerned white citizens to aid the Negro paid for out of the corporation's earnings and community in a meaningful way-by providing by selling some advertising space on the sides jobs and buying advertising from the corpora- of our trucks to local businesses. tion, supplying volunteers to take the boys out, The boys voted to keep 60 percent of their and donating equipment. We met many middle earnings as salary, put 10 percent into savings class people who were frankly surprised that which was to be matched by a local service "those people are willing to work." We met club, and use 30 percent for operating expenses. others who expected the teenagers to be able However, to boys of this age, 30 percent of to do a man's job because they were black- what they made seemed somehow less than $3 looking at them not as teenagers but as "poor out of every $10 of their Friday paychecks. We people who need money so why don't they work had minor complaints at the beginning which for it." Confrontations with these people may built up to a crescendo by the end of the sum- or may not have changed their viewpoints but mer, but we could find no other way to pay served to make us more acutely aware of the for the expenses. attitudes we are fighting in this society. For The service club did not come through on what it's worth some people were very inter- their promise to double the 10 percent savings, ested in the project, invited the boys in for but we were fortunately able to do this with a lemonade and cookies and solicited jobs from small excess left over in the operating expenses their neighbors. From the boys' viewpoint it fund, so that the boys ended up keeping 80 per- gave them a glimpse of other life-styles. cent and spending 20 percent for expenses. Mainstream is as unrelated to health and Ideally, the corporation will eventually be able medical problems as any SHO project could be. to cover all operating expenses with advertising On the other hand, it is our viewpoint that com- money. We were unable to this summer due munity health has to encompass many aspects to delays in obtaining the trucks and the signs of life and among these are getting jobs and (which were also donated to us by Coca Cola). earning money. The boys are also learning val- Mainstream will continue in a limited way uable lessons in how to deal with the community during the school year with teachers from Cole outside the ghetto, i.e., estimating jobs, asking driving the trucks to jobs after school and on for their money, selling advertising, etc. weekends. We hope to have Denver Opportunity Whether or not Mainstream could ever be fund us to hire two full-time drivers and one turned into any kind of activist group is ques- full-time secretary for next summer. With an tionable. Boys at this age don't have many early'start on selling advertising, new equip- interests beyond sports, recreation, and spend- ment should be available by the time school is ing money. If they remain together as a co- out and Mainstream should be able to expand hesive group in the years to come, they coule, considerably both in the number of jobs handled very well branch out into activities other thar. and the. number of boys involved. just earning money. It is hoped that we will b( The value of this project is threefold: (1) It able to follow on into high school those boy@ does the obvious thing of allowing young teen- who might have talents and interests leanmi agers in need to earn money at a time when it toward medical or paramedical professions anc- is extremely hard for them to get jobs of any possibly get them jobs in the medical center. kind; (2) it gives the boys practice in handling BILL WALKER, their ovni business and making their own finan- JOE SPRAGUE, cial decisions-something which was done to a limited extent this summer and which should LINDA SPRAGUE. iricr eAge as time goes on and the boys gain Marion von Buettner, a sophomore medical student a more experience (they have learned at least the University of Colorado, worked with a number o 40 SUMMER 1968 elderly patients through Denver's East Side Neighbor- he was drunk. She has two sons-one on east hood Health Center. She suggests the need for imple- coast and One on west coast, but neither can be nienting many programs, particularly topical to RMP- I better nursing homes; neighborhood geriatric clinics; Dothered. This lady is practically blind and has coordinate efforts "'to bring older people together for great difficulty walking because of arthritis. mutual entertainment and outings, the hiring of 'quasi- Because she cannot see enough to write or rea@ social workers' from among the elderly poor. or watch TV, she spends most or her time brood- ing, mainly over her aches and pains. When AGING IN THE POOR COMMUNITY someone ]ends a sympathetic ear and gives some advice (even if totally unprofessional) that Aging in the poor community is accompanied pain seems less and if she is taken out for a by all of the disadvantages which accompany ride, the pain disappears completely. She can- aging anywhere-poor health, loss of physical not resign herself to a nursing home as long self-reliance, financial. difficulties, and loneli- as she can still crawl, because that would mean ness. The latter two, however, are compounded giving up all independence. in the poor community for the obvious reasons The two alternatives for people such as these that financial difficulties beset all ages-even are to enter a nursing home or remain at home more so the elderly-and that the isolation and under the care of visiting nurses, visiting home- loneliness of the elderly poor are natural prod- makers and social workers. The sorry story of ucts of a system which forces one's neighbors many nursing homes needs not be reiterated. and children to spend all of their waking hours This is one crying need: More and better nurs- scrounging for their own livings. ing homes. The other alternative-to remain As cases in point, consider the following pro-, home-finds the elderly with many of their files of two elderly women living in the poor daily needs taken care of by the visiting workers community: listed above. One helpful innovation might be a geriatrics clinic either within or without the Case 1 neighborhood health center. Often the elderly Age 63, never married. Ex-profession-prac- are well taken care of medically, but resent tical nurse. Worked most of her life and had what they feel is a rush-job from the doctor. saved some money but several years of illness What they need more than medicine is a sym- ate up her financial resources and put her on pathetic ear and this takes time-more time crutches. Now on welfare. Budgets her money than the average GP has to offer. well and is happy with the visits of the visiting The problem of loneliness and isolation re- quires, among other things, a more coordinated nurse, the health aide, and the homemaker. But she is not in her grave yet and enjoys things effort to bring older people together for mutual all of us enjoy like window shopping, movies, entertainment and outings. Another solution rides in the park, church on Sundays, et cetera. might be to hire quasi-social workers from There is, however, no one to take her. She nor- among the elderly poor whose sole job would mally goes out only on Christmas and on her be to visit and socialize with other elderly poor. birthday. The rest of the time she sits in her A monetary impetus and an "official position" room and gets nervous. may be all that is needed to urge some of the elderly to forget their own troubles and pay Case '2 some attention to their neighbors in need. Married twice. Buried last husband 8 years ago and hasn't been out of the house since. MARION VON BUETTNER. Would love to go see her husband's grave at least once a year. She has three children. Jeff Kluger, who is a second year medical student at Daughter has been married twice and is living the Medical College of New York, examines the health care system for migrants and seasonal workers in with a third man now, who is an alcoholic. Fruits, where he worked along with @ Eva Adler and Daughter never comes to see mother because Judy Lindauer. He mentions an attitude toward health mother threw the man out of her house when care which seemed prevalent in many of the rural place- 41 COLORADO STUDENT HEALTH PROJECT ments: "There were no health problems in Fruita.... for in cash. One example of this that I encoun- Fruits needed union organizers and industrial develop- tered-Mrs. V who could not work because of ment, not health students!" The approaches which the back trouble. She went to her doctor but could group took toward changing "the low priority on health" not afford the money for the medicine he pre- are described. In addition they documented the need for a mobile clinic in the area to be run in conjunction with scribed, and when I left Fruita, she was still a Grand Junction hospital and cooperative local physi- laid up, over a week since she visited the doctor. cians' Unlike the tax-supported hospitals in the big These students interviewed several families cities like Denver, the hospitals in the Fruita they had met in other contexts during the course = summer. The information requested was: (1) in the area are all private and charge for every serv- event of a major illness or injury, how would the family ice performed, from X-rays to lab work to bed meet the costs of treatment; (2) Are there any family occupancy. If the poor person is -not on welfare's members acutely ill at the present time7 Under treat- medical assistance program, which requires I ment?; (3) What types of chronic illness are prese @t? vear of residence in the State, or if he is in- Under treatment; (4) Have there been any serious in- - juries? Describe problem and treatment; (5) Does the eligible for disability or Aid to Dependent family have a primary physician? Who7; (6) Is it Children programs, he must undertake the difficult to obtain medical treatment?; (7) Does the debt of a hospital bill that is usually quite high ' family use the services of the Health Department? One -neighborhood aide received a bill of $700 Explain; (8) What does the. family do for dental ca!e? from an osteopathic hospital for an appendee- (9) Does the family have an up-to-date immunization schedule?; (10) In the event of a medical crisis, where tomy performed on her 9-year-old son. It is go- would this family turn for help?; (11) To what extent ing to be a long time and much hardship before has illness progressed before the family sees a physician? she pays off that bill. A sponsoring hospital and physicians have been found Although the Health Department does offer and funding is presently being sought. This mobile clinic some free medical clinics, they must be on re- should be in operation by next summer. ferral from a.private physician. And then they RURAL HEALTH are only diagnostic, with the cost of treatment shouldered by the patient. There are no other Clinics in the Fruita-Grand Junction area. After spending 2 months in Fruita, Colo., as From what I saw this summer, there is no part of the Colorado Student Health Project, I preventive medicine practiced by the poor, es- find myself overwhelmed with the number of things I have learned about the system of health specially the Navajo migrant. No one goes for care for the poor in rural areas like Fruita and a checkup., because no one has the money to indulge in that sort of luxury. That goes for the the life style of the rural poor as well as about poor person on Welfare's Medical Assistance the agencies that contend to help them. Program, old people on Medicare, and just reg- The system of health care for the poor re- ular poor people that do not fall into any pro- volves around the concept of crisis medicine, m, because in each case the'individual must that is, the poor person sees a doctor whe@ he grar foot the bill himself. hurts badly enough so that he cannot worx or The life style of the rural poor utilizes a cannot bear the discomfort of his illness any hierarchy of importance that puts health very longer. And then it is up to the charity of the close to the bottom when there is no medical doctor as to how much of a debt the poor per- crisis. Brushing one's teeth is a novelty anc' son has to incur because of his illness. Fortu.- having a checkup at the dentisVs is unheard of nately, many of the doctors and osteopaths in The children of the Navajo migrants that the Fruita area are understanding of the poor have worked with had the worst teeth that man's inability to pay his bill and usually the dental hygienist from the Health Depart allow him time to pay it off. But there are some ment had ever. seen. While the need certainl: doctors who have turned people over to the credit bureau for not paying bills as little as is there, and I gave two sets -of toothbrushes $6. Even though the poor person makes it over and an adequate supply of toothpaste to on to the doctor, he cannot pay for the drugs that family, the children never brushed their teet) the doctor prescribes because they must be paid even once, I learned later that the reason wa 42 SUMMER 1968 that I gave the brushes to the mother and they ents of these children were beginning to put never got to the children. some importance on the idea of preventive med- When we came to one of the neighborhood icine and good health. centers in early June as medical and nursing Finally, our presence itself in Fruita as health students, the coordinator of the center brashly students, visiting many indigent families and told us that there were no health problems in inquiring about their health, working closely Fruita, and that Fruita needed union organizers with the aide from the neighborhood center and industrial development, not health students. on health referrals, and most important, be- People's top priorities were jobs, money, and coming known and liked by the people and food and rent. Health was a luxury. Very few children in the community helped increase the people practiced preventive medicine and very community's knowledge of preventative care. few bothered with immunizations, which hap- Hopefully, the new health perspective that we pened to be free at a Health Department clinic. have helped to establish in the community will No one bothered to come to the center on Tues- not fade in our absence. day afternoons, the time when a Public Health Nurse came to answer questions on health and JEPF KLUGER. make necessary health referrals. It was in deal- ing with this low priority on health that we Ken McConnochie is a second year medical student had our biggest and most rewarding success. at Dartmouth Medical School. He, Mary Jaegli, and By the time we left Fruita, the neighborhood Nancy Roland worked in Palisade and Cli@n. The center was as health conscious as job conscious, paper describes this group's impressions of the health and many kids in the neighborhood knew about care system in these areas, as well as their activities. The need for continuity of care for migrants is stressed. germs and the importance of immunizations as It is suggested that this might come about by increased well as about stethoscopes, heartbeats, and good communication between groups involved in migrant dental care. health, by providing "traveling records" and educating We accomplished this in three ways. First, migrants concerning their importance. The mobile clinic we held health education classes every Tuesday mentioned in the previous paper could also help relieve the health manpower shortage in these communities, as afternoon for the children of the poor families they are all within a 10-mile radius of Grand Junction. in Fruita, showing films of various aspects Of This is presently being investigated. Ken also points good health and holding discussion groups. One out the heterogeneity of migrant groups. The implica- of our best sessions consisted of showing a film tion is that no generalizations can be made and that s need, must be dealt with individually. on the family doctor and then letting the kid hear their hearts beat with a stethoscope, tak- SOME ASPECTS OF RURAL HEALTH ing their blood pressure, and showing them CARE DELIVERY what an otoscope and percussion hammer are used for. This particular class helped to intro- Palisade duce the concept of a checkup and to show The most pressing need is some way of co- them there is nothing to be afraid of when ordinating health care to migrants throughout they go to see a doctor, which was the case as I observed with several of them. the route of the migrants. This would insure continuity of care. Another possibility would be Second, we started an immunization progra@ an increase in local health care staffs, enabling getting over 60 kids who needed a variety @i the Public Health Nurses to make rounds with- immunizations into the Health Departinenvs immunization clinic. The success of this pro- out being overburdened. With more people, a nurse could conceivably visit every migrant grant as far'as our concern to establish a higher family. There is a need for some way of know- Priority,of health, was due to the fact that it ing. where migrants are throughout the summer. was conceived in conjunction with a Neighbor- This would help get information to the people hood Aide, and not solely by the SHO group. who need it. Also, there is a need for better In addition, several of the parents came with broadcasting of information to the migrant us, and the large turnout told us that the par- about facilities available. 43 COLORADO STUDENT HEALTH PROJECT The foremost step in solving the.health care they do not understand. Some speak little or problems of a mobile population would be no English. greater cooperation among major groups in- volved in migrant health. One way of insuring Clifton this could involve providin g records for patients There is need for a GP in the area to care to carry with them. Another is education about for local residents. There is -need for general continuity of care and the importance of rec- education for the population of Clifton, and ords. possibly need for another Public Health Nurse Education could take place in the local rec- in the area. reation center which we helped to develop this Clifton is a poverty pocket of primarily re- year for migrants during harvest. These ac- tired people. Health care is provided by the tivities were in the form of movies, lectures, two doctors in Palisade and the Grand Junction and pamphlets. We sent letters to growers to doctors. There is one nurse for Clifton, whose increase their knowledge of the facilities avail- work load is monstrous. There will be a Com- able and provided 1)am-ohlets to the migrants to munity action center which intends some edu- inform them of these services and how they cation eventually. To them, this is smoking and might best take advantage of them. The addi- drinking lectures. There is no clinic. Health tion of a Public. Health Nurse who would work' care is purely individual and there is no re- in Palisade during harvest and Clifton the cruiting. These people are the invisible poor. rest of the year would help -get better coverage It was not until the end of the summer that we of both areas. became aware of this aspect of the community A plan involving the cooperation of growers both in Clifton and Palisade. It deserves fur- in registering all migrants in a central list ther exploration and concentration in the would help provide care to all. future. Because of the diversity of the migrant pop- ulation, it is difficult to place any culture or KFN MCCONNOCHIE. values on them. As to the winos, there is highly individualistic feeling among the group. They will not ask for help until they really need it. Daniel Kraus is a second year student at the Univer- Most are educated Caucasians who, for some sity of Rochester Medical Center. He was one of the four health science students assigned to man the Sangre reason, have dropped out of society. They are de Cristo Medical Unit in San Luis. Although this was hostile to any help "offered" and will come only the most clinically oriented of all the placements, he on a take it or leave it basis.This means "soft focuses on the welfare system rather than the more sell." narrowly defined health needs of the community. The Negroes, are generally from Arkansas PROSPECTS FOR TRUE WELFARE and are teenagers. They are fairly well educated IN COSTILLA COUNTY and eager to learn more. They generally seem interested in health.. From my daily log: The Mexie-an-Americans have been picking July 18: "Asked Evan M. (Chama Can- up our pamphlets. They don't seem to talk as yon) why his wife and child didn't come to much as previous groups. They travel in fam- Well-Baby Clinic; said his battery was ilies, generally. They are concerned with the dead, would I ask around town for some- welfare of their families. one to buy his homemade fence posts so The Indians seem to be the least receptive he could pay $15 for a new battery so he group. They do not watch the films as do all could drive his pickup into town and earn a living." the other groups. They bring their children with August 13: "Told Dave S. (LaValley) them, even to the fields. They do not ask ques- that he was ineligible for disability for tions and seem suspicious of health officials al- his bad hand (though his alcohol-enlarged though they do cooperate. It may be because liver may be worth something), but could 44 SUMMER 1968 get 100 percent food stamp support and present allocation of OEO resources. Surely, free medical care. He vowed to get a job it is inconceivable to withdraw support where here or leave his wife and go to California it already has been given. But I am struck by to make enough money to pay his bills." the ways in which the Government is acting Evan and Dave, residents of two of the most at cross purposes. For, on the one hand, monies isolated corners of the San Luis Valley, differ are being spent for institutions in this county, in their means of subsistence. Evan hunts and for the benefit of its inhabitants, while, on the sells elk in the winter, and Dave relies on full other hand, little, if anything, is being consid- Government handouts. Nonetheless, it is plain ered for making Costilla County a more desire- that they have in common a hand-to-mouth able place for youthful people to continue in- existence, secure against starvation today, but habiting. On the contrary, it is almost as if necessarily lacking a view into tomorrow. the CAP opportunities are concentrating on The unincorporated village of San Luis, the arming the youth for success "on the outside;" Costilla County Seat, is the headquarters for in industries and the professions, which at this the regional Welfare Office and the Community point would be least likely to settle in this re- Action Agency. The government pursues many mote expanse of sagebrush. "Community Ac- programs here which, as the names imply, un- tion" might more accurately be renamed "Ac- dertake to replace deprivation with welfare and tion for Community Disintegration." inertia with action. Basic and advanced educa- Was it purely instinctual revulsion that I tion; training in job skills; FHA loans; subsidy felt when it was suggested that the only hope for food; and, eventually a comprehensive health for improving this county would be to move care program in the valley; all these and other those remaining citizens out of the valley? Love well intentioned projects are operant at this for one's homeland and its great natural beauty time. notwithstanding, abandonment is neither an Yet Evan and Dave and many more residents unprecedented nor an inviable solution to the of this county are being overlooked in the allo- problem here. Lacking an economic base, a com- cation of Federal funds for OEO programs. munity has no reason to continue. Given greater These are perhaps especially important people, opportunities born elsewhere of technological heads of families who might choose to remain progress, Costilla County shows signs of be- in the county, rather than move away at the coming a mammoth ghost town, i n much the first opportunity, yet still quite alone in their same way that the old mining towns decayed long term fight for survival. and died. It requires no more than a brief in- For it is unclear that under the best of con- spection of this area to be convinced not only ditions, the Federal funds would be acting in that without water, there is no life, but that two general areas-one which we would term without industry, there is no prosperity. In a "stop gap" measures, such as the food stamp county that lost 50 percent of its population Program, and the other, which is the establish- between 1950 and 1960, it is folly to entertain nient of excellent institutions, such as the Neigh- hopes that private enterprise would consider borhood Health Center concept. investing in any plant as far from a main These more lasting efforts, while potentially transportation route as this. significant improvements of conditions regard- And yet, here my anger is backed not just less of the prevailing economic conditions of a by instinct, but by reason as well-the desert region, will be seriously hampered in their use'- has been made to bloom in the past. Where en- fulness unless still more fundamental steps are trepreneurs were unable to act, governments taken., I am primarily concerned about the have been the miracle workers. If there exists economic future of Costilla County and the ap- today no economic base in the county, perhaps Parent Federal circumvention of this entire it is the responsibility of the Federal Govern- expenditures to date. Though talk ment to create such a base. With land becoming it is not without reason that we even scarcer and distances less prohibitive, it on the economic wisdom of the would be something less than prophetic for the 45. COLORADO STUDENT HEALTH PROJECT Office of Economic Opportunity to appreciate certain-so a 13-year-old kid walking home tential of an area such as this. Is it nec- from his piano lesson has a fair chance of get- the po to wait until Evan gets thrown in jail ting arrested for vagrancy and maybe of get- essary for poaching and Dave dies of cirrhosis before ting his head beat on. an attractive industry moves into the valley I know a big dog on the east side that I don't to employ them? If so, perhaps some thought even like to look at for very long-I mean I might be given to the altemative-the evolution only look at him sort of out of the corner of of an almost complete Iwelfare community. my eye or with my hands over my eyes. I don't Even if the Government were to make a bad think the people out in South Denver could even investment, and granted its wastefulness and do that. He's awful lookin. The thing is that inefficiency, it would almost certainly repre- people in South Denver* don't have to look at sent less of a total cost than to support by com- that horrible giant dog enough. I mean that dog mon dole the population it might otherwise have isn't very easy on the eyes. employed. This is something private enterprise Anyhow, the real question is whether the big has not had to be concerned with. A reevalua- dogs on the east side aren't really MONSTERS tion of the priorities of government spending FROM THE ID. Something's up when you got might do well to consider the possibility of these crazy awful looking alien dogs around. taking the important steps which the reversal These dogs come from somewhere else if you. of the current trend in Costilla County demands. know what I mean. I mean they're really some- thing else. God, you oughta look at em. They're DANIEL J. KRAUS. scary lookin mothers. It's pretty clear they don't come from any little doggie mommies-prob- ably born of some unspeakable mental process. Joe Sprague is a third year law student at the Uni- You know what I think? I think those dogs are versity of Colorado, who did extensive work with Project some kind of SYMBOL!! Mainstream, welfare rights groups, and various families ide of Denver. with legal crises on the east s Just a Little Bit NOTES FROM THE OVERGROUND . . . I don't want it all, just a little bit. (EXCERPTS) if an enormous thing like the United States can introspect and really wonder (like 'geeze, Forbidden Planet what is goin.g on?), then it can find an answer. There's an answer. Uh huh, there is an answer. The east side has a lot of big dogs. If some- body walks down an alley you can hear it all The answer is that you have to change. The over town. Those big dogs yelling their heads only trouble with that is that nobody in the off, turning around and around, and hitting history of the world ever changed except Mis- the fence like a rhino (sort of). ter Scrooge and he only changed into Jim They're funny dogs . not just routine big Backus. dogs' These dogs are sort of weird (dig those weird dogs). Their heads areconnected in many Alors Que Passa cases to their bodies direct! Everybody knows that human conduct is Anyway, what kind of a deal is it when mostly incoherent reflex' and if it has any somebody makes you live in a place and then meaning, it has to lie in a slim vein. I'd bet cuts you off so you can't get any money so you that personal mortality, in fact, is the only got to steal everything you can from your thing that counts, and given our terrible per- neighbors and you all have to go out and find ception that adds up to not lying to ourselveIs. these alligatok-dogs and keep them in your back It's lying that hangs up dissent in the United yard to seare off the stealers. Oh yeah? States. The question is whether lying to our- It's sort of like everything else around here. selves isnpt a fundamen;a process. The questio Ten million vicious circles. The police are ner- 0 Denver's south side is a predominantly white upper middle vous (maybe at best), the environment un- cl"s area. 46 SUMMER 1968 is whether anybody with any interest in the and Dr. Brothers then invited me to watch process can reflect on it honestly. The night- their surgery and tag along with them. There rnare is the unquestionable accurac'y of the most was nothing particularly rural about their new insanely radical voices around. clinic either, with lab technicians and phone re- You know it's not them bad Russians-it's ferrals to specialists in Grand Junction. not those weird, hysterical Chinese-it's the I occasionally tagged along with the Migrant personal devil, baby, on duty all the time and Association nurse, volunteered to help her do just iookin' for a home. And the time to beat Denver Pediatric Development testing, which that cat was day before yesterday. never panned out. I took quite a few sick kids to the local doctors to get penicillin-and JOE SPRAGUE. balloons. At this point, I was beginning to get desper- Norrnan Chenven is a junior at the Downstate Med- ate. Particularly so, as my community repre- sentative (intern) was a Commanche among ical Center in Brooklyn. He, along with his wife, Dinah, and Jane Patterson, spent the surnmer in Delta, Colo. Navajos (traditionally bitter enemies) and also The following events are true, only the names have very "American." He had less ability or desire been changed to protect. . . . to communicate with Navajos than 1, except to the female VISTA Associates with whom he THE DELTA PROJECT established considerable rapport. The three of us moved into the town of Delta I was relieved of the burden of dragging my without a shred of legitimacy. Luckily for Jane, Indio" around by a stroke of mutual good for- Joe Lawson of the school district had a project tune. Adrian was accepted by HEP (High ready to go for the summer. Jane was then a School Equivalency Program) and he left on 3 SHO member working for the Joint School days notice, owing me wampum to the extent District 50, preparing materials for a grant of $140, (more than enough money to buy Man- proposal that the school system hopes to put hattan Island). Since this Indio was an all- into effect in the coming year. It deals with the American spendthrift, I took the precaution of Spanish high school dropouts. Thus, Jane was having the Great White Father in Denver send a SHO member doing a job that would have his check directly to me when it was issued, been salaried b the school district. Fortunately, approximately 5 weeks too late. Adrian was y thus subjected to the indignity of receiving the program should be a very valuable one to $14.50 from a $180.00 paycheck after Unple the Spanish population in Delta. Sam and the Indian Agent (me) did our work. Dinah, liking children, found a daily 7 a.m. This is known as Indian giving. to 7 p.m. job working in the Day Care Center In a burst of unprecedented energy (probably run by the Migrant Association. They were derived from despair), Adrian, two Navajo short-handed and welcomed reliable and respon- Vista Associates and I began to put up a basket- sible help since those qualities were rare among ball goal in the Holly Sugar labor camp. We others stationed in Delta. Thus, Dinah, like finished it a week after Adrian had left and Jane .1 had also discovered a legitimate actv'ty' 2 days before the Holly Sugar labor camp closed Again it was in the capacity of a volunteer the season. To date, the only people to play worker for an established organization. Thi! for job had a medical slant to it; taking care t ball on that court are Ritzy (Adrian's 14-;year- old sister) and myself. kids, feeding them, and bringing them in for With the departure of the Navajo migrant Physical exams with local physicians. workers, I redirected my inexhaustible energy That left only myself high and dry. Dr. Stark and multifaceted talents toward the Spanish- Was wonderful. He invited me to the hospital American, community in Delta. Marching for- to observe surgery and allowed me to tag along in his office for 10 days to observe his "rural ward under the banner of SHO, and always -Practice." There was nothing particularly rural bearing in mind that racial discrimination, about it except,that he was a G.P. Dr. Ronald school segregaton, and second class citizenship 47 COLORADO STUDENT HEALTH PROJECT must be fought with every means at hand, I bling, and the decision to go to the Migrant charged into the community as a salesman for Association office the following day to find the Food Stamp Program which is directed by out about HEP. One of the kids said he sure the Department of Agriculture, but adminis- would like to go to HEP, but he had to pay off tered by welfare. Three Spanish Vista girls his Mustang first (3 years to go). reluctantly drove me around for a few days, On the following day, Sid Lucero showed up introducing me and then letting me give my because Mario picked him up, -,vhich was a spiel. "It is a REAL good program. . . ." I pleasant surprise in itself. John Montoya, who visited 25 to 30 households to find approxi- had been the most enthusiastic about going to mately five families that qualified for the HEP, was asleep and couldn't be roused in spite stamps, and only two families willing to sign of two phone calls. Sid got a spiel from Frank with welfare for the program. Trujillo, the head teacher with the Migrant . It took me seven visits to the Montoya family Association at the end of which he was given to get them signed up. Also, it necessitated the an application, told to -fill it out, and soon stood chartering of the Special Food Stamp Loan in mortal peril of being accepted by HEP. He Corporation of Delta which extended its first seemed vaguely uneasy about this prospect and loan to Mr. Sam Montoya for $10 on July 20, so we told him that he would have a month to none of which will ever be seen again. think it over before he'd have to go. He has The Lopez family also made an application since gone to Utah. for a'loan of $10, even though they received a About this time, the great depression hit $200 ADC check on the day that food stamps Delta. The area director for the Migrant . Asso- were being sold. The president and board of ciation on the western slope was already 2 directors of the now tottering corporation exe- weeks late in returning from his vacation in cuted a dramatic suicide of the mind by diving California. gracefully out of the third floor window of In the director's absence, the acting director Renfrow's Furniture and Appliance Store on and educational supervisor decided that early Main Street. The Delta Independent noted that August was a perfect time to shut down the this was the most newsworthy event to occur Head Start and the Day Care Center for re- on.the north side of town since the McCarthy pairs and renovations since the only people gang held up the Farmers and Merchants Trust around were migrant families; everyone else Corporation in 1893. was on vacation. So one Monday morning Dinah While the food stamp campaign smoldered found herself temporarily out of a job and I with only sporadic bursts of activity, we de- was tired of observing surgery at the Delta cided to attempt to interest local high school City Hospital. We went cherrypicking. dropouts (whoops! pushouts) in completing high Much to our surprise, we found nearly 50 school, joining HEP or GED programs, or get- migrant families in the orchards, for some ting job training. We enthusiastically ap- reason unknown to the Migrant Association. proached Mario, Mary Valdez (secretary to the With the evident embarrassment of being pre- Migrant Association and lifetime resident of sented with 30 to 40 young children that needed Delta) , Lucy Renfrow (GED teacher and life- Head Start or the Day Care Center, the acting time resident of a neighboring town), Sally, director and educational supervisor reluctantly Nancy, and Carol (VISTAS, Spanish and 8 prepared to reopen the Day Care facilities. Then months in Delta). Mario said he had four lightning struck from Denver. friends, Mary had no friends, Lucy didn't The Migrant Association auditor had dis- know who her friends were, and the VISTAS covered that the Head Start and Infant Educa- hadn!t known that there were any pushouts in tion branches of the Migrant Association had Delta. exhausted its money for the year, with the Consequently, we had our meeting with largest rush of migrants not yet arrived. The Mario's four friends. The joyous occas ion con- two Migrant Association nurses and all of the sisted of two packs of Coors, 1 hour of mum- teachers were fired with 2 days notice and with- SUMMER 1968 out being paid for hundreds of hours of over- Other than this burst of activity, the Delta time pay that they had. earned. And so the recession had lasted for 11/2 weeks before Jane Migrant Association Child Care Program was came to the rescue, offering salvation in the closed down for good, due to poor fiscal man- form of a census of the Spanish population for agement, as well as an overabundance of mi- the school district. Thus, in the nadir of our grant children. despair and desperation, we charged into our The two nurses asked me to follow up on new found project. All our goal-oriented, bour- four kids who were in need of referrals to a geois middle class hangups welled to the sur- pediatric diagnostic clinic. The earliest appoint- face. Here was a job that could be ' completed ment possible, according to the Public Health by the end of the summer and also could be Nurse, was in February. put in a book. During orientation week Dr. Jordan said that The census turned out to be a SHO worker's if we found any kids that needed pediatric care, dream. Meeting the community, getting to know he would make arrangements in Denver for our community, et cetera. Also, we got an them. So I called Dr. Jordan and was referred occasional piece of pie and milk. to Dr' Boyd who talked to me as if I were one However, as we got to know our community of those enthusiastic SHO kids. From our con- in more depth, we were stricken with dismay versation, I gather that he knew all about us. and despair as we discovered that many of He then gave me a list of protocol procedures to Delta's Spanish population were middle class follow before turning to the Denver Children's Clinic. I struck pure gold when I called the in both aspiration and attainment. As we went fourth name on the list-Dr. Nelson Scott from from door to door, it became increasingly evi- Grand Junction. He cancelled two luncheon en- dent that revolution would never come in Delta. gagements in order to see the kids, which is This is entirely in keeping with the character of just what I envisioned SHO to be all about. the town. It gets no snow in winter, no rain What better way to eliminate the fat cat image in summer, and in case of nuclear holocaust, it of the American physician. Dr. Scott has agreed has been projected by competent meterologists to follow the case of one of these children which that the whole thing will pass Delta by, in- may result in transferring the child to another cluding the fallout. family because of neglect. Another child will be placed in a special school for retarded chil- dren. A third child will be placed under vigil- NORMAN CHENVFN. ance for a bad rheumatic heart. Chapter 3 The Interns COLORADO STUDENT HEALTH PROJECT local -Lyan-g leaders to a black ranged from udent of a predominantly The development of a g'high school interre militant$ to the head st program was one of the biomedical careers arant proposal. black high school- turned but to three objectives of the original The Denver intern program of the s in former student health etured because Like similar PrOgran" p be the most highly stru it consisted of hiring high school ag- owup and the many OPPor- projects, in which we possibilities Of fOll pectrum Of ,students from the conununities ems tunities to demonstrate a full s would be working to sensitize us to PrObl health careers. Each week the entire Denver areas and for us to acquaint them with e of health in their bio- grou would tour a different typ the possibilities and realities of entering p . ate weeks the interns would medical careers. A corollary to the biomedical facility On altern z seminars on their ging these stu- be responsible for conductin- careers program was encoura ements communities, and the health science students for dents to enter college, and finding pla(' arranging proLrams on health careerst college and financial aid for them. admissions, et cetera. @ The proposal stated this rationale for the The interns conducted their own meeting at program: ities and the final evaluation session. They presented five people from ethnic minor major recommendations to the group. poverty groups are grossly under- t epr@- professions. (1) The need fo'r Increased minoriY 'r epresented in the health ority r sentation: They felt at more min This disproportion reflects limited em- should be represented on the project-b in- ployment and obstructed career oppor- terns and health science 'students. heir ra- ch aggravate the social They were at home in the tunities whi professions. tionale was s e. em far better than is on of the health olati communities, und science students training and we, and would be on( ed by POB'- -Dron&ing disadvau- working with tive action and ha d b V. taged youth can raise as ons, in- (2) The need C'i crease self confidence and provide int career-relevant experience. in the light Throughout the S in the 1 oup. sorganiza- because they lacked autonomy of contemporary social di They had no say in anning of the - oiect, ti in the United States and the lim- they were not pres( ientation f - g health manPOwerp olls 0 existin becomes a meetings, and Mal this new career element jected during the crucial bridge between the health pro- ssions and the disadvantaged com- were selected'becai this autc fe The interns felt munity. tive values: T ey could he were found POSI. d students in Denver year'.%, basis of t I d Youth Corps and mg throul the Neighborhoo Centers. Those in the which ed t] the N referred to us by VISTA the ye., then Pr rural as the local school systems. ity for and. provid nthe year. voiun for selection. uity I Th d standards ' ' eri e Droblems to They The rural areas Posed uniqu- - need i uld be difficult, the program. Followup wo uton an( the areas )rovided few fora o. should They ing the interns a full slogs aT repor opportunities. For th media inter in own ii to who not only show w sought equal basi and negoti the project and their communities, but who also direct eers. interns science eet were oriented toward college car le: in the Denver projects represented more of a es sn of their because a cross section of their communities: They The interi that SUMMER 1968 program was concerned with biomedical ca- been the enrollment of three interns, who had reers, they should have more time to work in not before considered a college career, as fresh- health facilities with health professionals. They men at the University of Colorado. suggested that this was the only way for them At the end of the summer the interns were to make their career plans more concrete. In all asked to write evaluations of the project. addition they wished to work on projects in These papers reflect many of the attitudes and other are" than their own; exchange rural for criticisms discussed above. They are presented urban placements and get out into white com- largely unedited. Selected papers and excerpts munities. are included. (4) Selection p@ties for future projects: The interns proposed that they be given top This summer I worked with SHO. The pur- priority next year if they.desired to work again pose of this employment is that the medical because they already knew the problems and students I work with are not familiar with this could provide continuity throughout the year. community. Since I grew @ up in this district, I (5) The project next year: Most of the in- should know more about it than the medical terns encouraged SHO to return to their com- students. Through the summer we attended munities. They did offer certain suggestions many meetings with staff of Denver Gen for changes in the program, however. They felt Hospital, Parks and Recreation, Denver Hous- that it should be their job to find the problems ing Authority and other government posts. e and outline the power structures responsible results of the meeting fr@m the staff of Denver for dealing with these problems before the General Hospital were, :why were the I people project,started. In this way they could eliminate the initial frustrations felt by all members of not using the local health stations?" Some of the SHP. They also noted that "SHO took up the answers: (1) PeolDle were not familiar too many projects that couldn't be done in that what was available, and (2) Fear of social period. If you are going to take up a project harrassment. The meeting with Parks and Recreation s it should be something.that could be continued to better a neighborhood park-the main recre- through the winter, or something that just ational spot for children, teenagers, and adults. pertains to the summer. If you take up a project, and you start it and then let people down. they A problem was the swimming pool. The ol arIe: not zoing to trust you next year. @rt with had a rough cemented bottom, it was unpainted, the little roblems and work up to the big contained broken glass and other debris, d ones.ts the shower rooms were not adequat@no like This report reflects a great deal of growth other community pools. The projec 7 on the part of the interns during their summer was improvements in the pool, e ience It demonstrates an externalization court, an unused'tennis court, a probl s which many Iof them had consid - baseball team, and other recreatioi personal before. Their statements are all A great help on this project was quite positive, their commitments to future !in- olvement and their constructive ideas ior Center, one of the sta-,ions of SHO er alterations in the program. At the same time Housing Authority, lo house : I the an intense feeling of frus- chronically deprived people, A loc do- the inadequ es of this nated food, supplies, Clothing, and help aci needy. A local health clinic, whose i ar the failure of SHO to put @a I existing ghetto conditions. The health counselors would -oo into tt they have stressed are concerned root out the problems, als helped residential stations a @@s pp@r aspects of the projiect. This is health science students, :we can munity. How we d o educiation.... to the peoples' a I po ive outcome of the program has organization. D@ 53 COLORADO STUDENT HEALTH PROJECT probably prove that the community is organized high" sniffing glue. They also were doing well as of this date. with their other group. My last and probably my best project was LAWRENCE: SENA, a report on "brown history." I was told that West Denver. there was going to be a meeting on 'brown history" and my supervisor wanted me to get this meeting ready. First of all, I started ob- I first learned about SHO (Student Health taining information about my subject: om Organization) through some friends who were books and other printed pamphlets. I also made employed by this organization. Asking what their i a trip to the "Crusade@for justice". office. Here ob was, they explained. From what they T -1 told me I was impressed and went to see about iL Talked to a man about where I could ain an opening. When talking to one of the health the best information on this subject. He ave me names of books where I could find e sub- students, I told her what my qualifications were ject and told me where to find the books. For 2 and they met standards. Then I was interviewed . by the director:and was hired. I started work- weeKs I studied the history of the "brown ing right off with one of the interns. The proj- people." When the meeting@ began, I started my ect was to hel better the Lincoln Park Swim- talk. After a short time talking, I was halted p by questions. The answers to these qu I ming pool. We started by asking questions and gave started a whores new talks ver r- talking to the staff of the pool. Our next step was interviewing other public swimming pools esting one. Mainly, this was "black people" arguing against the "Mexican people," ly in the city. By this we found that pools in the Minority area were the worst in the city, such on which is making more progress and 'as bottoms were not painted on the pools, not This was not all that we accomplish p but - poor fa ities in the locker rooms in my opinion, the mo interesting. I did enough cil tion trips we took, su a a trip to Rid -these a e just a few of the poor examples. Our, Hospital where in @ and retarded dren next step was lettinir the community know about were boarded. We al :went to Colorado ni- it. Then we arranged a meeting. People in the versity and toured I We d community raised havoc to the manager of the Fort Logan, another and we pool, its staff, and administration of the public I visited Craig Rehabill 1% ey Pools. er the meeting, everyone- in the pool help the crippled. s Of and park area saw much improvement. the iDlaces we we an We held a meeting about children in the west ide area sniffing glue. These children ranged in the atmosphere v fro 11 to 15. At this meeting we arranged meetings with th eni that in people would work with certain Hospital and ha Th- children. Jerry and I teamed up together and SHO. We had, West Center. These E worked the two brothers, and we went and time I worked visited home. When we talked to their them very in ducatii mother, e found out that they had been worx- opinion in the St I have v Ing wi another group. The mother informed feel Iliad an intere and succes us that they worked some days and on other days went to the. museum, to the park, et GARY etera. And she told us if we wanted to see and t West De talk to the two., for us to return at five in the evening. I returned myself several times. When the boys alone, they were more This sumi me from my regular information mainly because realm of WI ed in( and probably thought I did the type of .9til da3 From the talks I had with the July 1 at -m first in I out they had stopped "getting would be wor The li4 SUMMER 1968 we would be doing was extremely cloudy to me the clinic not to be overlooked, but rather given from the beginning because I was used to work- a second look. Joann and I made personal gains. ing physically and not in the sense of applying To elaborate on my feelings about another myself to this job. SHO project, I said before I strongly favor such July 1 also marked the first meeting of our a project because with this year's project the group; from that point it was decided that we seeds were only planted. So if you want to har- would man the Sangre De Cristo Medical Unit vest your total results, you will have to make a since there were going to be no nurses for the place for another project. If you should decide SHO appointed doctor. From this time on we to bring another project down next year, here were engaged in familiarizing ourselves with are a few suggestions derived through our own the clinic and the specifies of our jobs. We then experiences that may be helpful: (1) Have a proceeded to set up a schedule by which the group (student) leader, one who is truly rec- clinic would be manned and still provide for a ognized by all; (2) The first 2 weeks should be@ team to be out in the community learning the spent learning the power structure , (3) An- ways of the place. It worked very well because 8wering the questionnaire to one's self may the people of San Luis have always looked up help in many ways; (4) Possibly for each per- to medical people. This has provided the group son to set personal goals; (5) Continue Con with a great degree of acceptance into the com- La Famlia. munity. This has primarily been our line of Here are the things that next year's project work all summer. may pursue: (1) Help carry out -preventive I feel that personally I gained a great deal medicine and introduce it to the people, simply in the sense that this job has boosted or rather because this objective will not be completely raised my hopes and wants of going into medi- reached in a few years even with a permanent cine. I learned a few simple basic operations doctor in the area: (2) Setting up a survey of like checking patients into rooms, and taking some sort which may help people Lret insights e, respira their vital signs of temperature, puls - into the community, its problems and tion, and blood pressure. Some days even taldng (3) Keeping eyes and ea oDen to any @ fe d- care Of the reception desk, taking hematocrits back on this year's pr iect which would Oi and giving Tine tests. The SHO gains, or rather vesting your crop. accomplishments. in my eyes are as follows: services to people and filled JOHN LA ComBE, IV between the last doctor and the San Luis. (2) May well have set the stage HO project which I favor greatly. I worked for the Student Health Project for to a greater point of enligbun- 10 weeks and now that it is over, I feel it has t for the grant a few things that may be' - - helpful. been an experience. r me. I learned many things which will y help me out in the Another way of looking at what this SHv future (I hope). Project accomplished is by the looking at what I was asked to wri an evaluation on the personal goals were visibly accomplished, again - project but I really what @ say;, in my eyes, by each member; personal gains in- what I mean is, that we were sue- cluded- Bob liked the clinical work but made cessful or I can't say we were not because we Some exceptionally good followups; Dan basic- were used as flunkies for someone else. When ally made personal gains; Gail setting up or someone got an idea wasn't from SHO, dding ore encouragement to a referral 'Sys- 'they figured if th co d get SHO to pass to make im ortant patient followups; Sue's th - p eir little pam material,, all rk in the survey overlaps everybody else's by they would do is a ite a bit, Rocky@trong personal gain, moti- credit. A lot of that 90 to college -and he made it a point was a group Of their d the transportation of people to and from This is one reak I f so unsure 55 COLORADO STUDENT HEALTH PROJECT I feel that I haven't done much for the com- people in this ghetto area. These extra 16 -Vvill- munity itself - it seems that if we started a ing and able people are SHO. project, people in agencies would often say this SHO is the Student Health Organization, a is not needed in the community. I don't know group of Health Science Students from differ- whether the people didn"t want or need help, ent States who have come into the ghetto area or if they wanted help and then we were afraid to help with the many, many community prob- to get something started and be let down. And, lems. Among these health science students, if they felt this way, I don't blame them. I, my- there are high school interns. The interns ,vere self, would be afraid to put faith in a program hired from the neighborhood to @ identify thIe that will be in action only 3 months. I feel if problems to the health sciencc- students. The there was more time, the SHO would really be problems identified were social and health prob- an active program. lems. Their goal was to set up facilities for a health center. However, there -a,as one here in JAKE PINO, the west side of Denver, Colo. Therefore, our West Denver. goals were really "social goals," such as work- ing with family problems and the community problems. Some of the @ problems Nvere. (1) Get- In working with the Student Health Organi- ting a Mexican family welfare and information zation this summer, I have felt that I, myself, about the health center and movitilr other fam- didn't accomplish too much. On the whole may- ilies and obtaining food for them; (2) Ge ing be we did help out a little on the east side, but a youth out of a reformatory; (3) Showing the it wasn't enough to look back at and be proud younger children (age 10 to 14 years) sex of. And I am sure I speak for the rest of the education movies because lack of communi a- high school students when I say that none of tion between them and the -Darents; (4) Sh us really got the full effect of our jobs this sum- ing teenagers (age 15 to 20 years) mer. What I mean is since the first meeting we movies, such movies were on di have been hearing about helping our community, smoking, et cetera, (5) To bet but so far, we haven't done too much. The com- pool, trying to make, a better @munity seems just the same. The only way I ation facility for the people in can see to better it or make it a success is to . What would have been accompli ? thi stick to what they plan to do besides grabbing the swimming pool, but we didn't' at something big and failing, and just giving time to really accomplish anything up. I ink they should work with the little time here. People i the communit3 things, then work up to the big ones and take terested. There were many things it from there. If things keep going this way, have accomplished but we were Of I @ think the project is going to be a flop. But The shortcoming the program was tt if the project can stick to one specific program, wasn't planned p Orly. I felt that some e I'm sure the ball can get rolling and the project in the Action Center uld have kno can be known throughout the differ ent com- about SHO, wh it was there, et cetera munities because I'm almost sure that there the health nts could are a lot of people on the east side who don't hired the hi rns and gone @t 'know a thing about the project or its purpose. right away. rtness of tim the maj ori- th science VINCENT C. ROBINSON, should com and to the East Denver. And please-not@ so mai meetings! My impression of the program was od, but There are 23,000 people in the ghetto area in only one (or two) bad things. It was od be- the west side in Denver, Colo. in the midst of cause it helped a I people in the comm ity. 23,000, there are an extra 16 willing and It helped me leam o t health and educ on able peo e who have come to help the 23,000 and to understand e people in the commun- Pi bummk;.K IU(ib ity. It helped me look into my future as far as crete and worthwhile project that will help the school and to 90 on to college-to be someone community. For instance, our project of clean- and help the people in the ghettos. Especially ing a neighborhood pool was very worthwhile, the younger group because the younger group but because of our short time on it, we didn't are going to develop into future leaders in the get to finish it and complete it. If we had started community. I want to inspire them to do some- at the start of the summer, I believe we could thing good and worthwhile and to stay in the have said of ourselves that we of the SHO of community and help develop it. The bad part the east side had helped the community help was that we were short of time. SHO changed themselves. my feelings toward the ghetto because I felt people there didn't try, didn't have the intelli- NORMAN HARRis, gence, and they were all bad. Yet, I found out Ewt Denver. different, because I never realized that some people didn't know about their rights, how hard some have tried, and how some misuse their high During the summer of 1968 I worked as a intelligence. There are many intelligent, kind, student intern in SHO on the east side. I feel and happy people in this "ghetto area." Now I the group could have been better if it had had realize why they remain like that. a better understanding of what it was to ac- I felt that -SHO was a worthwhile project complish. The main problem was getting andInow that the health science students are started. Some had great ideas but when it more familiar with these problems; I hope they came to actually putting them to work, this was reniai . or come back. I felt there was a short- another story. One of ou problems (I think) age, of funds to carry on certain projects that was how some of the peo that talked to us involved actual cash. My biggest concern is kept comparing and tell!nLr us that we could more time. a 10 weeks is hardly adequate. do what they did in other cities. Maybe this was a mistake because Denver is different from @ARET ANN LOVATO, other cities, and it also has many different West Denver. problems. I don't feel much can be done in 9 weeks. I think SHO should start little earlier n I learned a lot about my community this year. I feel we accomplished something a summer. I found out how people of the com- summer but it wasn't very ch. When we first munity look n outsiders. I believe we accom- started out, we were not cepted by the a lot. Our first couple of days at one of munity people right away. We had to gain ir 's health stations, the nurses and doctors trust. Many people still @don't trust us a gave me the mpression that we weren't needed don't want us to be here. However, th@s was and were in wasting their and our time. I only a small portion of the i)eolDle. We fi also ink the organization was used as a se-rv- I - tried working with the larger problems but w ice duct, ecause we were used as free labor didn't get anywhere. W et p with an awful more or less do service for the health center. uld have gone into the com- I al think lot of criticism. When found out sho more. I feel th@ place we were needed. couldn't really accomplish all d rn the community. I also believe that we wanted to with the larg4 too many projects and found ourself take years to do, we ,R too ung uD and sOpping on projects to go on ones. This was better b c to ers when they weren't finished. put our fingers on sor, I think in order for the project to be a sue- least this way we didn't years to come the organization up@ high and then disapp a goal when the summer starts pened so many times t it. This plan e very con- will be a greater help must b IC COLORADO STUDENT HEALTH PROJECT since it now has a better view of what it should even fight with people just because I didn't like be doing. them. Also, when we w'ould want to go to a dance and we didn't have a ride, we'd steal a MARIE ARRINGTON, car, but sometimes I would get caught alone East Denver. driving it or with my friends. My friends taught me how to steal and drive a car. We would steal just Chevy's. because they had an I felt that the Student Health Organization ignition that you could start with the turn of was a good thing because it had a lot of good your wrist. One time I was drunk and stole a ideas for the community. People were interested car and ended up wrecking it. I got away, in what they had shown to them. They also though. I've been caught twice for stealing helped the younger kids out. For instance, one cars, but all because of my friends influencing student helped a family from Mexico get help. me and letting me help them only because I He also helped another family move closer to was dumb, or should I say I wasn't smart the Neighborhood Health Center. All these enough to think. This is how I grew up ... If people appreciated it, too. Because when I was I had another chance I'd try to show the kids younger I never had an opportunity for any- that are growing up the -wrong way the right one to help me like they have helped the people way. Through SHO, 1 have had it lucky even here. When I was younger, I was bumming the that I got a job like I have now. It helped me streets looking for something to do because understand people and their problems and there was nothing to do. This is why some of helped them get in the right road to a better the kids today get into trouble. I know, because and more convenient life. So I say the SHO is I used to when I was younger, so I had to find a good thing for me and the community and out my own fun. When my friends and I would hope they can come back next year because our get money, we would spend it on something to part of town can ALWAYS have help. "get high on." My friends influenced me to smoke, steal, and to get into trouble. I would Name withheld. 58 i@ @. Chapter 4 i Perspectives ,t @@ i@@ @@ I I I I i 4 i I COLORADO STUDENT HEALTH PROJECT The final evaluation session for the project Robert Taylor Homes, or tried to begin a health was held at the University of Colorado Medi- clinic at Robert Taylor Homes, and by the end cal Center. In addition to health science stu- of the summer, all that we had succeeded in dents and interns from the project, the meet- doing was to organize some residents into some- ings were open to our advisors, members of the thing that was called the Robert Taylor Health communities where we worked, members of the Committee; through the winter SHO people health care community and the press. were working with people with this committee It included a discussion of individual place- to try to get permission from the City Board of ments, their assets and liabilities, successes and Health to open a health clinic there. It was failures, as well as a hard retrospective and going to be a very modest kind of clinic, doing prospective analysis of Student Health Projects mostly diagnostic work and feeding people into in general. nearby hospitals. Finally, about half way Peter Bonavitch, a third year law student through June, the Board of Health gave its per- at the University of Chicago, who has, been mission to open up this clinic, and Student integrally involved in both Chicago SHP'S, de- Health people from this summerps project were livered the keynote address to the conference. going to work to finally get the clinic set up, He spoke of the frustrations of SHO's involve- get equipment in and to get it opened up. About ment in ghetto communities and the very basic 2 weeks into the project, the clinic was about moral questionability of such involvement. He to open. It was going to open on a Monday. The suggested that we not only reexamine our pres- Thursday before, we had a meeting in the same ence in these communities, but also channel the church where the clinic was supposed to be to experience which we have accumulated there discuss something entirely extraneous, and about into more productive and effective roles. We eight young black kids from the community have learned much from the communities often showed up at this meeting because they saw all at their expense; we have learned that insti- these white people going into their church and tutions are responsible to a great extent for they wanted to know what was going on. About existing problems in the ghettos. It is these half way through the meeting, they asked us institutions which are truly our constituencies, what we were doing there. Some people tried where our ability to catalyze changes in health to explain what SHO was and explained that care lies; in basic analysis of health care insti- we were meeting in that church because it was tutions, specifically our own health science where the Robert Taylor Clinic was going to schools, and in white middle class communi- be. They said, "What Robert Taylor Clinic? We ties. . . . live in Robert Taylor Homes and we don't know about any clinic." We explained that we had a NEW PERSPECTIVES health committee which was composed of resi- dents in the community, and they said, "What residents in the community?" We mentioned The final state of several SHO projects reaiiy some names, and these kids didn't know any of is confusion, division, and hopelessness in many these people-they were young black militants. ways. I will just try to communicate that to -would like to meet with They said that they you.using Chicago as a model. I will start oy the people who were going to be working in telling you the story of what happened about this clinic and find out what they were going to 3 weeks into the summer project in Chicago be doing. They asked if any black people from this summer, and that which happened at R b- SHO were going to be working at the clinic. ert Taylor Homes. Robert Taylor Homes is tne @t happened that one of the girls was black and world's largest high rise urban renewal project for low income people, which means it is the tne other five were white SHO people. world's largest vertical ghetto. There are about They agreed on meeting the next day to dis- 27,000 black people who are housed in Robert cuss how the clinic was going to be run, how Taylor Homes along about 30 blockg of Chicago. it was going to be staffed, et cetera. What came Last summer, SHO began a health clinic at out of that meeting was an edict from these 60 SUMMER 1968 black kids that they didn't want any white sponded by saying the health clinic is something people running their clinic, that they had had that is needed in the community. It doesn't enough; the essence of what they said is that really matter Who @ffs the clinic-it is a .they had enough white people coming in and health clinic and it is going to start healing telling them how to run their own community, people and that is all that counts-white, green, and if they were going to have a clinic, they black, yellow, or whatever. Still, a third faction wanted it to be staffed by black people-they said that it is really good that this thing hap- wanted black people to be deciding how big the pened. We are really performing our function clinic was going to be they wanted black people by acting as a catalyst to the community. We to decide where the money was coming from go into the community with our white middle- and what the money was going for, and no class selves and the community responds by white people had better show up that Monday. throwing us out and organizing itself@rga- if they came Monday, they wouldn't leave nizing its own health clinic. again! This stresses the importance of becoming There followed a long series of negotiations analytical and starting to ask some basic ques- back and forth. After about another week or tions about what SHO wants to be doing in the two, the SHO people agreed that they really communities, and beyond that what SHO wants didn't have any legitimacy running the Rob- to be doing itself. I think you can set up a ert Taylor Clinic, that they would do their best progression of the way that white liberals have to try to find black doctors, to try to find black seen their role in the black community. I think nurses to run the clinic, but there would be the first stage is that a white liberal tends to no white SHO people involved. The black mili- see himself as the savior and healer in the tant kids agreed that they would also do their community. I am talking about a white, liberal, part to find black doctors and black nurses. The medical student. I think this was the initial end of the story is that the clinic is being run idea of many people who come into Student and operated with a black staff. The mothers, Health Projects. They see themselves as going the people who were on the Robert Taylor into the community and fixing things-going Health Committee, a puppet organization for to save the ghetto in 9 weeks. It takes much less SHO, have been phased out of the operation than 9 weeks to realize that we are not going to some extent and these black militant kids are to save the community, that sometimes the com- having much more of the say of what is going munity doesn't want to be saved, and even if on. it does that we don't have the time and we The whole story points up something that. don't have the resources and we really don't is going to happen or already is happening more have the skills to do it. and more in Chicago. I think it is something The second phase is that we feel if we can't that will happen in Denver also-at least in the save it, we can organize it, and pretty soon we black communities. In these conununities there - begin to realize, especially if we go into the is really an upsurge of a feeling of identity communi ties which are beginning to feel their which you are going to start running into. This racial identities very strongly, not only that we raises some pretty basic questions about what can't'organize it, but that we shouldn't be or- SHO should be doing, about what the real pur- ganizing it-we are white and the community pose of SHO is. In Chicago, this touched off a is black. We can't do it effectively. because of Crisis within the organization because about the hostilities that exist in the community. We one-third of the people felt that these black should not be doing it-it's really not our place kids were absolutely right, that we really had to do it. This is the kind of point-of-view that no legitimacy in the community and that SHO SHO in Chicago is coming around to. should really have never gone into the com- The third stage is that SHO should be acting munity in the -first place with this kind of atti- as a catalyst in the community, that we can go tude-like we are going to give you now a into the community and try to set up some health clinic-lucky you! Another faction re- kind of ongoing program and hope that the COLORADO STUDENT HEALTH PROJECT community will respond by saying, "No, we upper class, middle class community. The other want to do it ourselves." You can argue that type of constituency you can talk about is other that is a good role for SHO, more effective than . medical students, hospitals and health institu- either of the other roles, that is, going in and tions, and just the institutions in our society saying, "We know what is best for you, you that provide health care to people. are not really getting any place, you are not It is a premise of the SHO that health care really very far advanced politically. We have is a basic human right. It is another premise thought about this a lot and decided that we of the SHO that the institutions that provide were going in and try essentially to turn you health service should be organized so that they off, try essentially to mal,-e you mad and get give health service according to the'needs of you mad enough to do it yourself." There is the people and not according to how much still a kind of condescension implicit in all this. money there is in it for the doctors or how If you reject all the three that I mention, much money there is in it for the hospitals or we can say that we have no role in black or the drug industry. The obvious question fol- brown communities, that those communities lows: Is the system organized to give that kind have to resolve their own political crises, they of health care? I think we would agree that have to resolve their own identity crises. They the answer would have to be "no." It is orga- have to get themselves together at their own nized on the basis of fee for service. It is or- pace and with their own leaders as they want ganized on the basis of what the doctor can to. Or you can say, I am available-I as a medi- get out of the patient. The patient who can pay cal student, or a social work student, or a den- gets good medical care, some of the best medi- tal student, or whatever, have certain skills cal care in the world. The patient who can't that I can offer to the community, certain tech- pay often gets the kind of medical care that nical skills. If the community wants to come you can get in any underdeveloped country in to me and ask me, I will be happy @ offer the world. There are all the statistics, like them, but I am not going to make any policy Wo-odlawn, a community in South Chicago has decisions, nor am I going to try and run it an infant mortality rate that is approximately for them. That is where we are at the end of the the same as Nigeria's. In 1963, the nonwhite project in Chicago. child (92 percent Negro) under 5 years of Now the next question is if the Student age had a death rate twice that of the white Health Organization does not have 10 week child.* In 1961, the United States ranked 15th summer projects that go into ghetto communi- in infant mortality statistics,** all of which is ties to perform basic services, then what is the intolerable for a nation that is as industrialized role of SHO? In order to answer that you would and urbanized and highly developed as we are. have to think about what kind of an organiza- The welfare medical assistance system oper- tion SHO is and you would have to think about ates not to give people the best possible medical the people that SHO gains its forces from. You assistance, but to keep them from starving and would have to face up to the fact that the to keep them from dying in the streets. Welfare medical students are largely an affluent, white recipients in Chicago are shuttled to Cook middle class group.* The statiatic@'are that only County Hospital which is the city run hospital 15 percent of all medical students come from and is a chaotic kind of mess of a hospital. And, families whose income is less than $5,000, and I am told, that Denver General Hospital sounds 14 percent come from the 1 percent of families very much like Cook County Hospital, an whose incomes are in excess of $25,000 per year. welfare patients in Denver are also forced to So you have to start asking who is the constitu- go to Denver General Hospital, just like they ency of SHO? There are two types of constitu- are forced in a slightly more subtle way in encies that you can talk about-the constituency Chicago to go to Cook County Hospital. that the medical students form from a white We had better start talking about i e way *Health, Education, and Welfare Indicators, P. 29, June 1965, Lasagna, lAuis. Life, Death and the Doctor, Alfred A.. Knopf, U.S. Department of Health, Education, and Welfare. New York. 1968. Epidemiology, Vital Statistics Report, WHO 19, 4S4. 1966. 62 the medical schools recruit their students. The and constant source of ideas during the development of ,Way medical schools set up their curriculum. this SHP. She speaks below on the legitimacy of our We have to talk about the mechanics of the involvement in ghetto communities in terms of our personal growth and ultimately of positive effects on niedical school system. We have to talk about the ommunity . . . the reasons the medical schools discrim'M-al-.- against black people in admissions policies. We COMMUNITY PRESENCE-A have to talk about the way that medical schools JUSTIFICATION exploit interns and residents by paying some- thing like $4,000 to $5,000 a year for doing The implication in much of the discussion I really the bulk of the work in any teaching have heard is that if one were really dealing hospital. We have to talk about the way that with "health" problems, particularly the analy- hospitals operate in their admissions policies sis of health care institutions, SHO would be and in their staffing policies. This is the kind able to accomplish more and students would of analysis that SHO really should be doing. spend less time in frustrating, useless activity; SHO should be dealing with the institutions or the alternative argument that low-income that it knows best and those are the health communities don't need SHO to show or tell care insitutions. We should be researching the them anything. My remarks are addressed to institutions that deliver health care and find the idea that there is a good deal that SHO can out who controls them and find out why we accomplish by continuin to go into the com- 9 have such an anachronistic system of health munities both in personal growth to the Stu- care delivery in the United States and find out dents and ultimately in returns to e com- where the health establishment's leverage is in munity. the Federal Government, in the Department of First of all, at least one Public Health Com- Health, Education, and Welfare. Who are the mission has pointed out that racism is the num- people that really make the decisions? We have ber one health problem in this country today. to start finding out where we can get at the If you are not talking about a narrow definition power structure so that we can begin to change of health, that is fine. But a narrow definition it and how we can change the whole orientation has been implied in much of the criticism that of the system. It really amounts to turning the I heard yesterday, in much of what everyone whole system upside down, because what we has been saying today, and apparently implied are asking for, if we really believe that health by the representative from RMP in what he had care is a basic human right, and if we believe to say about funding. Personally, I feel that that the system should be oriented in that way, for you to adopt a narrow definition of health is to completely abolish the whole fee system is as much a flight from the real problems as philosophy. We ask that people get health care has been the tradition in the past. Perhaps one as they need it-not when they can pay for it. of the things the health science students could If we can't analyze our-own institutions and do a little more effectively would be to acquaint how they relate to the ghettos what possible the interns with some of the things that- are legitimacy can we have in these communities involved in a broader definition of health. One at all? ... None. I realize that most of -what I could say, why is racism considered the num- have said has been directed at white SHO Stu- ber one health problem? Well, it is probably dents and white professionals, but that is the because of the kind of information contained in bulk of medical professionals in general and the U.S. Civil Rights Commission Report, the this is exactly what we have to start changing. Kerner Report, and the Coleman Report on Education in the United States and on racial PETM BONAVITCH. isolation in the public schools. You can call these social issues or racial issues; but if you A reply to'these remarks was offered by Dr. Bonnie want to bring it back down to the narrow defini- Camp, a pediatrician at Denver's East Side Neighbor- tion of health,'you can even talk about how you hood Health Center, physician for the San Luis Project, can make sure people keep their appointments 63 COLORADO STUDENT HEALTH PROJECT in a health clinic when a child needs continued something that should be continued. A lot of followup care, about how much you can rely effort and energy should be directed toward upon mothers to give medicine to their children, this; and if nothing else, expand your intem and about the delivery of health care. You just program about five times. So if you want to can't separate the problems of delivery of health talk about a program, don't worry about it care from these other broader problems. I think not being relevant to a narrow definition of if you want to confine yourself to a narrow defi- health. Make it relevant to the broader problem nition of health care, you might as well flee of delivering health care. back to biochemistry and microbiology, anat- omy and physiology. You can escape the broader BONNIE CAMP, M.D. problems which are the hard things to deal with and the things that will tear you apart. Emo- DISCUSSION tionally, I think that is what you all have been faced with this summer.... the fact that it is These two points of view provided the nu- the social, the mental, the little menial tasks cleus for an evaluation of our presence in ghetto that make delivery of health care in a poor communities and the future direction of Stu- community a big problem. It is the problem of dent Health projects. Excerpts from this dis- taking care of a family of eight children, all cussion are transcribed below. They reflect not of whom have a different kind of medical prob- only the frustrations of 10 weeks of an ex- lem, a mother who is psychotic and a father tremely intensive involvement, but also the who is in a penitentiary for having molested marked personal growth, the constant reevalu- one of the little girls of the family. That is the ation of our roles as individuals and future kind of problem you could spend your Nvhole health professionals, and new directions to firm time with. . . . just trying to deal with one commitments made over the course of the sum- family like that. I feel very strongly about this, mer. Few answers are provided, but perhaps that the more you cling to a narrow notion of the evolution of these ideas is a necessary first health, the further away you get from the real step- advances of even having SHO. The very fact that there are medical students who are con- ON DEFINING A COMMUNITY cerned with other problems than starting IV's Throughout this report people have been and doing gallbladder operations is really un- referring to an ostensibly straight-forward enI:- usual in the history of medical education. And tity: "the community." SHO has classically as far as getting black people and other minor- is thought of itself in the role of community ad- ity people into these kinds of schools and edu- cation programs, you may be interested to know vocates." One of the greatest sources of frustra- that the Howard University School of Den tion to all the SHP's has been the problem of - deciding who are truly representative of these tistry was unable to admit black students to census tracts, these "communities," in which its freshman class last year because of the lack we have been involved. This dilemma arose con- of applications. So they have 70 white fresh- tinually over the course of the summer: In the men in the school of dentistry. One out of every decisions of whether or not we should work 670 white people go into one of the health science with agencies which- may or may not have fields; but only one out of every 5,000 Negroes been representative, in attempts to establish go into a health science field. It is an enormous a community board for Denver General Hos- problem to find people who are both represent- ative of their patients and well-trained in a pital comprised of "representatives from the health care profession. The impact of this kind community ... . . . AUDIENCE: In your talk you referred to a of problem is not something you are likely to vague entity, "the community." WhAt you had recognize on the basis of any 10 week personal in mind were militants, those eight black kids experience. However, I think that yo ur efforts who came into the meeting. They are the lead- to stimulate in health science professions is ers and spokesmen of the community. I'm not 64 SUMMER 1968 at they really are "the community" with those 40-year-old ladies. Who is going to leaders of 4'the community." I am use the health clinic, the 22-year-old kids or the black mili- 40-year-old ladies with six kids? ith some of the things ti done. I am unimpressed with others. PETER BONAVITCH: There are two commit- f eight kids ever confront the original ments really. One is the commitment to the prin- c that you formed? ciple of community control. Another commit- PETER BONAVITCH: Yes, they were eventually ment is whether you agree or disagree with the forced to get along with each other. There was proposition that clinics or institutions in black initial friction. communities should be controlled by the black AUDIENCE: Who comprised the original com- people or by the white medical establishment. nlittee ? AUDIENCE: We are talking about an isolated PETER BONAVITCH: Eight mothers. small clinic, but the implications are obviously AUDIENCF,: And which group of eight best much more general. This is a problem which represented the makeup of the Robert Taylor --nedical people are going to have to face now. Homes? There will always be one segment, the, users- PETER BONAVITCH:L have to make a value mothers and children; they are going to want judgment because I don't even know what it medical care. There is another segment which means to -represent the community. I don't is not looking for stop-gap therapy but for know what community legitimacy is. it takes long term solutions. These long range goals enecessita e MM a great deal of effort to find out You hav te that th co unity develop itself to talk to people, evaluate the kind of support without white intervention. But you were in these kids have in the community. We discov the position where you made the choice by ered that there seems to be an understructure either remaining there or withdrawing. to these kids in this particular case. And there PETER BONAVITCH: My personal feeling is is more sympathy for them and what they want that SHO should not put itself in a position to do than for the original mothers. There is where it has to make that kind of decision, be- obviously an age breakdown. All the 40-year- cause I feel that SHO as an organization should old mothers don't care whether they have not be even the force that is providing resource white students or black students manning the help to the community; that it should be pro- health clinic. They want a health clinic in vided by some other health institution. Robert Taylor Homes. But the militants, who are a pretty large group, want black staffing. A QUESTION OF LEGITIMACY AUDIENCE: But ultimately SHO made the de- cision for Robert Taylor Homes as to whom Because of the problems of defining'the com- their clinic was going to be run by. munities in which we were involved and our sub- PETER BONAVITCH: No, what we did was to sequent relationship to them, it was felt by some pull out. That is right, we deserted the com- that we should respond only to the requests of munity and we waited for the community which certain segments of these communities for our was running its own health clinic to decide for presence. In this way just whom we represent itself, and to ask us to give them whatever would be clear, as would our specific roles. help we could. Others felt that we had absolutely no legitimacy AUDIENCE: IIt is a very false assumption to in ghetto communit.ies bIecause "that kind of state that 27,000 people in Robert Taylor Homes-service function provides a safety valve which belong to the community; this is a complement releases some of the pressures which might of millions. There is a community of militants, operate otherwise to develop an effective poli- and there is a community of other people with tical organization." . . . Just because there is no local political orga- community interests. What you did was accept the most vocal group as the community. Who nization, political awareness or militancy in a was ive oup there? The community does not mean that it makes it open the most representat gr black militants wouldn't have anything to do to entry to any white liberal who Wan "s ;o 9 65 COLORADO STUDENT HEALTH PROJECT in and save the place. It really means that the long run if we ask them to come into the com- community is open to exploitation. It means munity to educate them to our ills." The com- that the entrance of a white liberal organization munity has a legitimate feeling that they have into that community will retard its develop- been studied to death. If they don't want to ment, because that kind of service function pro- perform the function of educating us, they vides a safety valve which releases some of the shouldn't have to. pressures which might operate otherwise to develop an effective political organization. THE QUESTION OF EXPOSURE 1 think you have to go beyond what is merely educational and talk about what is morally The grant proposal for this project stated right, morally sound. Going into ghetto com- three major objectives: service to the commun- munities is highly educational. The historic ities, the development of a high school intern- function of summer projects has been to Pull biomedical careers program, and self-education. medical students toward some kind of realiza- In the previous discussion it was implied that tion of the ills of the health care system. This our own education comes about at too high a is a very efficient way of accomplishing that price to the community. In this section it is task, but it is done at a very high cost to the argued that individual commitments toward community. At some point we have to take the changing the health care system in the future moral stand that it is wrong to do that. It can be made only on the basis of this type of just isn't right to exploit the community for the exposure to ghetto areas as health science stu- sake of educating medical students-at least dents. Those sympathetic with this view argue for an organization like the SHO which thinks that at some time we must find to what extent of itself in some kind of moral terms. It is im- we are capable of becoming involved with pa- moral because there is a kind of paternalism tients as human beings. The counter-argument involved and because we are not dealing with is that SHO has evolved by this type of com- the people as a group, we deal with them as munity involvement to the point where, "people some kind of pathological specimen, a show who have grown up with SHO have developed case. theoretical perspectives about their own lack I don't think it is true that the average medi- of legitimacy in exactly the things that caused cal student coming into the community would them to 4 oin the group in the first place." This see it as a disease entity under a microscope- faction argues that it is not necessary to re- something removed. In fact a very large func- peat our past history to maintain a sense of tion of SHO is to have its people relate to in- involvement. . . . dividuals in the community as human beings I think there is a point that we have missed. and not just as clinical case presentations. We have been discussing SHO's presence in I think that your coming from a white mid- ghetto communities in terms of medical educa- dle class community and going into a black com- tion. In medical school you are taught not to munity and trying to organize it. and set up get emotionally involved in a patient. "Don't clinical facilities and things of this nature is a go overboard or you can become involved with well meaning project. But coming from upper every patient!" But at one point in your'life middle or middle class white families, you don't you must become emotionally involved in a know any of the problems of the ghetto and patient as a total individual. Perhaps something you are trying to impose those same middle good will come out of a 2 month'stint working class values which you hope to avoid on people with someone on a medical problem out of the who don't want them. clinic, going over it every day, and trying as It is for the community to judge whether or hard as you can to accomplish whatever goals not they want our presence, and the judgment you have set. Through this you can begin to we are asking the community to make is, "It's understand-as students, or as residents in a going to be good for medical students, and hospital, or when you are practicing-what it therefore, it is going to be good for us in the means not to get involved with a patient. You 66 SUMMER 1968 aust see how far you can allow yourself to go. schools. This might be interpreted as passing before in of the proverbial "buck." On the other hand, f you have never become involved rour life, then I think that when you hear people our project experience has clearly demonstrated ,five this advice, you just have to find out where that a great many of the problems of deliver- he point is for yourself. This project is a ing health care to ghetto areas arise from an inique opportunity to come to grasp with that inexcusable lack of communication between .mportant question in your medical education health care "providers" and "users." Perhaps ind your lives. such service projects, if legitimate at all, should if you understand the inception of SHO, be the function of health care institiutions.... these were the people involved in civil rights; The question we have asked is: Should SHO they saw the conditions first hand, and that is be the institution that sensitizes medical stu- what moved them-not reading the papers. This dents to the problems of the ghetto in this is why these projects are so important because kind of direct experimental way? I don't think reading the papers you don't get moved as much it should. First, no one should enter these com- as you do working in the communities. The munities until they are asked, and then I would motivation to change the system comes from have the health systems of the institutions do it. the experience we have all had. The white liberal medical student has no These people who have grown up with SHO role by himself or as a member of SHO in the developed theoretical perspective about their black community even as a resource person. own lack of legitimacy in exactly the things The resource people should be supplied by other that caused them to join the group in the first institutions, and other institutions should be place. I don't feel that we have to repeat all facing that dilemma. SHO should not thinl- our prior history before we can develop a of itself as some kind of junior hospital or as better perspective. I don't think that every an organization that sets up junior hospitals. person has to live through the whole thing. I think the medical school and the hospitals Many of the people in SHO, many of the active which are actually in the ghetto areas should members, are people who have not gone through be dealing with the community at all times on the whole student health movement. Some of some kind of equal basis. The institutions them- the people in the project this summer really selves should be developing the relationships, never had any contact before with that kind of with the community, and asking the community sensitization, and yet they came to the project if they want medical students to come in. aware. They came into the project questioning Another point we mentioned was how are its validity. white liberal students to find out or to expose Some people like myself had to be exposed to themselves to the ghetto? I think the answer is this kind of experience. I came out of it with that our health science schools have to provide a certain feeling. If I hadn't done it-if I had that. SHO should not be expected to do this read the paper and saw it on TV, it would be since its goal is really to change the health care very hard for me to say I am going out and do system. We should not be expected to perform something. this kind of service function. The medical schools themselves should expand their e-om- munity medicine or preventive programs. That THE ROLE OF HEALTH CARE means that the medical schools themselves must INSTITUTIONS undergo a radical change. They must begin to One possible solution of the dilemma of the negotiate on an equal basis with the political urgent need for self-education and SHO's lack powers in the community. of legitimacy in ghetto areas as a group would be for the health care institutions to assume THE FAULT, DEAR BRUTUS . . . whatever roles the summer projec+iz have ful- If we have no legitimate role in ghetto com- filled. This would mean an incorporation of such munities, we must define new perspectives for activities into the curriculum of health science our energies. 4ii COLORADO STUDENT HEALTH PROJECT We are constantly being told by our black don't think it warrants going back again next and brown associates, particularly the militants, year. I think our job is on the outside working that our role should be in spreading the word to with the white community in general and spe- our own communities, in our own institutions. cifically with the white institutions presently If there is a role for SHO in black or brown bxerting control over certain aspects of ghetto communities it should be assumed by black or dwellers lives. brown students.... There is a faction of SHO called the black SHO has among its interests, not only chang- caucus. This group consists of all black stu- ing the health care system, but providing a more dents. There is a feeling growing in the black humane education for medical students and for caucus that their legitimate function is to begin all health science students. There are many to look for black students to work with the different interests involved. Instead of work- community organization in their communities, ing with ghetto communities, we should enter to organize them around the problems of health the white communities to help the health pro- care. Again, that all rests on the proposition grams that are in the black communities. Those that black communities are the constituencies white communities, our own communities, are of the black students and the white students responsible for propagating the double stand- are the constituents of the white communities, ard of health care. %vhich is practically all of SHO. I think the white community is much more I think that the way things are now socially, nearly the constituent or the source of the a black person going into ',-,he black community people who are in the SHO. If we have any and aiding in terms of the educational oppor- leverage, it is in the white communities. There tunities and things that you talk about would would be much more conflict, much more hostil- be more understood and appreciated. There ity if we even started doing anything substan- wouldn't be a development of hostilities on tial there, because that would mean real change. either side, and I think that you should be able If I learned anything this summer it was the to find some black people to work in this par- extent of prejudice among whites-even my ticular project. own parents, aunts, uncles, friends.... For in- stance, we came to this old man's house, and I A QUESTION OF LEGITIMACY happened to mention that after we had scrub- RECONSIDERED bed for 8 hours, and it was really dirty because Still, arguments remain for our presence in he was too debilitated to clean it himself, he im- these communities based on the present lack of mediately started spitting tobacco again. My involvement of other institutions in assuming friends started saying, "There, you see? Now you know, 'these people' want equality, but are our roles, the overwhelming immediate needs if of ghetto dwellers causing organization around just plain dirty. I think we should take high health issues to assume a low priority, and the school interns into the white community and go need for continuing the high school intern pro- see those people, make them see they are in- gram, one of the three objectives of the sum- dividual@no better or worse than themselves. mer program as well as one of its most success- The essence of this conversation is that the ful aspects.... problem is outside, not inside. I feel the same "What has SHO tried to do? Has it gone in way after working with +.he East Side Action and tried to organize the community?" Center, where we sat around for a few days "Yes, but we think that is a mistake." with our mouths open, trying to look like water "Well, they are not going to organize them- fountains and stay out of the way. We then selves. Their problems seem to revolve around jumped into a project called Main Stream just making enough money to live. Under such which engulfed us, and we felt like we were circumstances the existing conditions will re- doing something with 20 boys; it was a produc- main the same." tive summer for them, and for us getting to if our aim is to change health science stu- know the community at the same time, but Idents, but at the same time begin changing the 68 SUMMER 1968 health care system, then we might send new The agencies cooperate when we're around people in to help the communities. Let them see but then they do nothing. the problems first hand. You are not going to Our role in assuming responsibility for these get -new recruits to come around and work for agencies and our influence on them is dis- a summer on health care analysis, because they cussed.... don't understand it and they don't care! What we did as SHO's was to be dedicated One of the objectives of the high school in- and do the jobs for them. The Public Health tern program was to put individual problems Nurse should have been taking care of two into a community context. Before the project children whom I brought in fro these kids only looked upon their own personal The Council should have found out problems; they didn't realize that the whole about a migrant family for whom I got public community was affected by the same prob- health forms for health care. should lems, and we should give them a chance to have been handling food stamps, they were look at the problem as social rather than per- trained to do it. I took care of food stamps my- sonal, and to direct their own efforts toward self. I went around from family to family to organizing. try to get them in the food stamp program. Other arguments are based on certain in- The town where I worked has an ideal adequacies of community agencies and our role setup in terms of agencies and service organiza- in influencing them. A sample of comments tions which might encounter public health. concerning agencies with which we had contact They are willing to take anyone. There are in all of the project areas is presented below. . . .. eight Vistas, plus a supervisor, and it is a The agencies don't focus on health. They are community of 3,000. It has all these resources interested in jobs, money, houses, roads, water: there and the reasons they don't function is that Health is the last interest. I think that a re- the people in the organizations are lazy or don't orientation toward health considerations is our really care or are not dedicated. most valuable role. After our 10 week presence, the Public I don't think that our sanction by the Health Department now realizes that they can Center is a sanction from the com- do things that they have never done before. munity because I don't -think that the people They now have the first rush of activity they on the staff are really representative of the have ever seen; they now know what public community. health means-more than waiting for the people has a lot to offer but it is very to come to the building for immunizations. We defensive about letting information out to the showed them that 60 children would come for I eir aspira- such a program where they had only four pre- community because it just raises th and they start making more demands viously. on the director, and he just doesn't know what I think that this is the most important thing 'he is doing. about the project. It really doesn't matter if I can't evaluate the organizations because you go some place and set up a program or they are not getting anything done. set up a clinic-those are just additions to the The agencies are there but they are not good. structure already there. Our only legitimate There -was only one agency person in the whole function is going places,and opening up people's connnunity with whom we felt really comfort- able and he was a Spanish-American who eyes, making them more aware of what is hap- understood his people's problems. He was the pening and more aware of themselves-people only person that we could talk to. in Public Health Departments and Welfare De- The agency has a hard time partments. Then when we leave it doesn't matter getting anything done. They are more interr whether we have an existing program there or ested in rubbish rules, being on time to meet- not, because we have made some effect. on the and parliamentary procedure, than in structure. To affect the people there and make action. them aware of what benefits they can have is 69 COLORADO STUDENT HEALTH PROJECT a concrete change-you don't have to leave a marginal change, and you know the amount of monument behind. change you accomplish in a given time, it is going to be greater for this kind of study than THE CASE FOR INSTITUTIONAL it is for the summer projects. Our energies could ANALYSIS be better directed. If you don't do anything else but get a few more students to come around The point was made several times in our dis- to realizing the kind of health crisis that we cussion that what we have done in ghetto areas are in, then we really accomplish something. amounts to "band-aid measures" rather than The future of the health care profession is in gipreventive cures." We have been dealing with the hands of present health students. the end product of the health care system The idea of research really burns me because rather than with its roots. Our work is easily we will come up with these sophisticated analy- ignored by the medical community which ses of just how things got the way they are, but largely passes us off as "those idealistic kids." will that make any difference in the way we Yet it is the unresponsiveness of the medical are going to'be able to affect things? We will communities which has catalyzed growing stu- come up with some real nice sophisticated, dent involvement in preventive measures rather understanding- medical students, but no change. than our historical concern with crisis ther- "Why can't we develop an understanding apy.... that really attempts to get at the root of the We are posing a dilemma-we shouldn't go problem? If the root of the problem happens into the community, but the only way we can to be that a particular medical establishment learn is to go into the community. I think if is a white racist group, then that.is one thing we started working within the power structure to document." in our own institutions and if we ran into some "What happens then? Where do you go from of the dynamic people there, we might start there?" "You use the media. I really see that getting turned on just as much. The medical as a kind of educational function for ourselves, power structure doesn't pay any attention to the medical community and the general popu- our work in the black communities. We are not lation. This kind of exposure must lead to pos- going to be labeled for that. But, if we were to itive action." start mixing with the white medical establish- I think it is naive to assume any expos6 that ment we might have a chance to create some SHO could write of any institution or powerful change. city hospital could do anything but cause a de- We have been observing the end stage of a fensive reaction. disease process-we have been working in com- Maybe we shouldn't expect anything but a de- munities where you see the results of the pres- fensive reaction', but I think that is the type of ent health care system. We have been abandon- thing that we have to begin doing. ing the place where we have leverage. This is S. came up with the kind of documenta- in the medical schools and the hospitals. We tion we have been talking about, and if the have been patching up this end but ignoring the corruption and the kind of corporate exploita- process itself. In a way we have been retarding tion is the kind of control that interests like the the development of the people who would like medical establishment and the drug industry to change things in the affected communities. exert on the health profession, and is really as I think we should be analyzing the existing great as we think it is, then that is something health care institutions and change them beforeI that needs to be said and something that people they begin to affect these connnunities. will be interested in. The problems of the black communities are We agree that, with the kind of medical extremely well documented already. care that is being made available, we want to Research of health care institutions is a more change that system where we have the best worthwhile channel for our energies than going leverage. This is in the medical schools and into the ghettos for 10 weeks. If you talk about hospitals. If SHO has any power it is there. io SUMMER 1968 BRINGING IT ALL BACK HOME almost no mobility for licensed practical nurses, and they pay the hospital orderlies and the sub- The transition between these short but in- professional groups almost starvation wages, tense and commiting summer experiences and not to mention the wages of the house @ff. reunion with our health schools has been found I do think that it is a legitimate function painful. Many of the reasons have already been of SHO to begin to recruit people, and I think stated: The lack of communication between that SHO should demand that it be a function our schools and the communities with which of the medical schools to begin actively to re- we have been involved; the immobility of our cruit minority groups, out of high school into schools toward dealing with the problems which college, and out of college and into the medical we have seen. Some participants have dealt schools. I see this as more of a pull of SHO and with this transition by dropping out of their the medical schools rather than any kind of respective school,. not unlike those students de- push within the community. scribed in Kenniston's book, "The Young Radi- Even when you assemble numbers of minor- cals-Notes on Committed Youth." The opti- ity students with the right credentials, few mistic alternative to this course is the role Of know how to go about the whole application SHO in changing our institutions-living our process, which is a whole skill in itself. It is experiences, "bringing it all back home." really only the big medical schools, the fairly Once we know something that exists, what prestigious ones, which are doing anything do we do? Do we sit back and waste our time meaningful in that area. The State medica doing menial little jobs taking one family tq schools which train'the bulk of medical stu- the doctor. SHO now can have some kind Of dents really just are admitting token "black" identity as a group of people who are com- students. mitted based on some conunon feeling, but For the bulk of minority students an attempt there is the feeling that something needs to to increase admissions would require a supple- be changed. It can be changed within the health mentary education program as well as continu- schools, hopefully' We can begin to make de- ing financial aid. Students presently in health mands on the administrations of our schools to schools could aid in all aspects of su pro- set up some kind of quota system to admit grams. minority students, to begin to train minority The question now is what to do when we get professionals. We can 'begin to change the back to our schools? How do we start working whole structure of medical education which is with our own community right away? Ten uselessly long and brutalizing because they weeks of experience stands between us and our teach us to regard patients as specimens, some- schools. Can we direct ourselves from the Very thing to be worked on as interesting pathology time that we get back to utilize the things which under the microscope.,They bring in gangs of we have learned this summer and apply them residents and interns, third and fourth year to constructive projects in our institutions and students to look at "this case ... .. examine "this even to the basic concern of relating these ex- patient." Another concern is the fact that hos- periences to our classmates and influencing pitals provide no mobility for nurse's aides and them? That's our bag. That's where iCs aL Chapter 5 The Evaluation COLORADO STUDENT HEALTH PROJECT Alfred Claassen and John Quicker are sociol- Professional Background: Twenty of the ogy graduate students at the University of Col- students were from medical schools, all but orado. During the summer they examined many foui- of these being second year students, the aspects of the project including general changes others, third year. There were also four nurs- in student attitudes, the student's specific feel- ing, one education, three social work, and two ings about the project, and community resi- law students. dents' and agencies' reactions toward the SHP. Social Action Experience: Probably the most In addition, they compiled the logs of daily ac- valuable experience as a background for the tivities summarized below and the project par- Student Health Project is community develop- ticipants' descriptions of tlic@ health care system ment. 27 percent of the students reported pre- in their respective areas, as well as the study vious work in this area. Public health experience of folk medicine in the San Luis Valley pre- is another factor which 33 percent of the stu- sented in chapter 1. The r-qethods used are de- dents reported; 30 percent indicated participa- tailed in the appendix. tion in past action projects similar to the They worked independently of the project S.H.P.; 50 percent of the students had done staff. It was felt that in this way they might some tutoring of underprivileged children. A come upon a more objective analysis than if total of 70 percent could call on experience in they were considered a formal part of the proj- one of these areas. eet. As a result, the opinions expressed here are Residc-izee: None of the students were from their own although most of the project staff towns of fewer than 2,500 people, 23 percent and participants would likely be in agreement came from small towns, (2,500 to 25,000) ; 33 with a majority of their report and recom- percent from medium size communities; 14 per- mendations. I have taken the editorial pre- cent from cities of 100,000 to 500,000, and 30 rogative as project coordinator to control cer- percent from cities of over 500,000. tain points raised here in the preface of this Occupational Background: The occupations book. . . . of the fathers of participating students were very high in status as they have been in the other Student Health Projects. Table I indi- THE PROJECT EVALUATION cates the breakdown. Family income is also Alfred J. Claassen and John C. Quicker, Department of high, the median being $15,000, and a full Sociology, Universi ty of Colorado. third over $20,000. In this evaluation we begin with a discussion of the students, who they are, their back- Table I.-Father's Occupation grounds, where their interests lie, and what Percent their attitudes are like. We then discuss the Medical Profession ----------------------------- 23 Nonmedical Profession -------------------------- 20 effects of the summer's experience on the stu- Executive ------------------------------------- 10 dents and the interns, evaluate these effects, White CoUar ----------------------------------- 17 and suggest improvements for next summer. Skilled Labor ---------------------------------- 17 Semi-skilled Labor ----------------- 0 This concluded, we summarize some of the ac- Unskilled Labor -------------------------------- 0 complishments of the project in carrying med- Farm ----------------------------------------- 0 ical and related services to the poor. Finally, No Response ------------------------ I ---------- 13 we turn to some of the problems in this aspect of the project and again make recommendations. Religion: The distribution of religious pref- erences of the students was also not that of the A. The Students general population: 40 percent Jewish, 30 per- cent Protestant, 3 percent Catholic, and 27 per- 1. Demographic Characteristics cent had no preference. Age: Twenty-five of the 30 students were be- Political Party Preference: The political tween the ages of 21 and 24. The range was views of the health science students differen- from 20 to 28. tiated them most strongly from the typical 74 SUMMER 1968 medical student. The former's party prefer- liberalism in views toward the relationship be- ences we re 43 percent Democrats, 54 percent tween politics and medicine. Scale 9 measures Independents, 3 percent Peace and Freedom, knowledge of the culture of poverty. Scale 10 and 3 percent Republicans. aims at activism or militancy or the radicalism Other Characteristics: All 30 of the students of the methods of the student in approaching were of the white race; 16 of the 30 were males, our Nation's problems. and 75 percent had both parents born in the The first six scales were coded 4-3-27-1 and United States. the Colorado scales 6-5-4-3-2-1; in each case Main Concerns: When they entered the Stu- the highest score was given to the most liberal dent Health Program, 53 percent of the stu- answer with the exceptions of scale 1 where dents looked forward to the learning aspect "helping" was scored,high, scale 6 where un- with greatest interest, 27 percent to being able favorableness was scored 4 points, and scale 9 to help the poor, and 20 percent to a gratifying where sociological accuracy was scored high. experience. When asked to list their primary In the appendix, the high scoring answer is the apprehensions about the program, 33 percent one with the asterisk'There were 32 students were afraid that the summer would bring no in the Colorado Student Health Project and in concrete accomplishments, 20 percent were wor- 9 of the 10 scales the N was 29 with both before ried about personal inadequacies, 17 percent and after responses and for scale 5 it was 28. questioned their ability to gain acceptance in the poor community, and 23 percent listed other Initial Attitudes concerns. The most salient characteristic of the stu- dents' attitudes at the beginning of the summer 2. Attitude Scales was that they were extremely liberal for medi- Identical attitude questionnaires were admi-n- cal students in political views generally and in feelin I- istered to the students as they registered for gs about the medical profession and med' the orientation period at the beginning of the cal problems specifically. In order to illustrate summer and again at the evaluation session at these views, table II gives the mean scores on the end of the 10 weeks. The questionnaire was each of our scales. made up of the 10 scales to be found in the Methodological Appendix ranging from 7 to Table 14 items each. The first six scales have been Mean Mean Possible used in the past by the California Student Scale Number Score Score Score (In June) (In Augmt) Health. Project, the last four were constructed by us for the Colorado S.H.P. 1 Education --------------- 22.38 20.68 36 Scale I measures the relative emphasis of 2 Physician involvement the student on learning from the summer's versus aloofness -------- 45.31 46.25 56 work or on helping the poor. Scale 2 measures 3 Public health clinics ------ 29.97 31.45 44 4 Humanitarianism -------- 24.79 24.89 28 the degree of compas sion, as opposed to aloof- 5 Beliefs about the poor ----- 30.24 30.24 40 ness that the student feels the physician's role 6 The medical profession---- 24.86 26.10 36 should entail. Scale 3 measures attitudes con- 7 Liberalism-conservatism --- 52.67 56.67 72 cerning the idea of public health clinics. Scale 8 Politics and medicine ----- 47.03 47.44 60 4 concerns humanitarianism, or more spe- 9 Knowledge of poverty----- 44.87 44.87 60 y 10 Appioaches to change ----- 60.97 62.62 78 civically, the degree of respect for the poor and their characteristics. Scale 5 gets at beliefs and misconceptions about the poor and is coded In order to convey a feeling for what these for. favorableness and unfavorableness. Scale raw scores represent, we will give several ex- 6 measures favorableness toward the members amples of median answers to various items. On 'and practices of the medical profession. Scale scale 7, liberalism-conservatism, the students 7 involves domestic, political liberalism vs. agreed to the statement, "With our Nation's conservatism. Scale 8 measures the degree of great wealth, no form of poverty should be 75 COLORADO STUDENT HEALTH PROJECT tolerated." They disagreed to, "Anyone can pull those scales covered by it. Since our prediction himself out of poverty who has the will to do was that there would be change in a liberal di- so." With regard to the medical liberalism, they rection, the no change subjects are added to the agreed that "Considering +,he incomes of other negative change subjects in the statistical com- segments of society, physicians earn more than putations. Table III shows that with reasonable enough already." To further differentiate them- significance three of the eight scales confirm selves from the average medical student they our prediction. Thus, the students became less agreed that, "If community medical services favorable toward the medical profession, more are to be expanded, the Government should politically liberal and more activist-oriented. play the major role in backing this expansion." However, as can be seen, the changes noted in Concerning activism, they slightly agreed that, the table are all in the predicted direction and "The system has a way of corrupting idealists a Chi Square of the totaled items is significant who think they can work within it." They at the .001 level when including them with their slightly disagreed to, "In pursuing social change reversals. breaking the law is never justified." Table N Attitude Change Number of Number of Number of Level of Scale po itive no negalivo X2 signific=ce y .g Fortunately, social ps chologists have deve ch:nges changes ch es oped a large body of findings on the mechanics of attitude change. A survey of this literature 2 15 2 12 --------------- led us to predict a number of attitudinal re- 3 17 5 5 .43 .30 4 14 6 9 --------------- actions to the experience of the summer on the 5 14 3 12 ------ -------- part of the students. For two different reasons, 6 18 4 7 1.68 .10 we anticipated a general shift in the humani- 7 19 3 7 2.79 o5 tarian or liberal direction. First, the milieu of 8 14 3 12 --------------- the medical school is much less liberal than that 10 20 1 8 1 5.53 , .02 of the S.H.P. Thus, through association with a greater than usual percentage of liberals, the Again we will turn to changes in median re- general trend of attitudes should be to the left. sponses to specific items to illustrate these gen- Secondly, Festinger's dissonance theory would eral trends. To the statement, "Many physi- anticipate the attitudinal paralleling of actions. cians are in practice just for the money;" the Participation in the S.H.P. is a liberal action student,§ first tended to disagree and later tend- and conservative beliefs would lessen the im- ed to agree. Also, at the beginning of the portance of the summer's activities giving the summer they tended to disagree and at the end actor less satisfaction, The more successfully tended to agree that, Physicians are generally the student perceived his summer's activities, not responsive to the health needs of poor the more strongly this principle would operate. people." Third, constant focusing on the problems of the On domestic political liberalism, the follow- poor with a corresponding lack of attention to ing were the strongest shifts: (a) From slight- competing problems such as high taxes and mil- ly disagree to slightly agree that, "Police bru- itary obligations would be expected to increase tality was a major reason for our riots last the salience of poverty as a problem and hence summer." (b) from disagree to strongly dis- bring a liberal shift. agree that, "Minority groups are trying to move A second prediction was that, again because too fast in seeking reforms." (e) from disagree of the salience factor, our eight students as- to slightly agree that, "Conditions are so bad i signed to health clinics would change more in in our cities' ghettos that no Negro could be a liberal direction on the five scales touching blamed for rioting." (d) from slightly agree medical problems than would the other students. to agree that "The unemployed should not be Table III gives the results of our first pre- blamed for turning down low paying menial diction concerning the shift to liberalism for jobs." 76 SUMMER 1968 There were also several revealing shifts on consciously, or more often unconsciously toward activism items: (a) From slightly agree to adapting to his social environment, then large agree on, "Most liberals talk humanitarianism environmental differences are likely to parallel but are not willing to make the sacrifices de- important differences in attitude change. In manded by action." '(b) from disagree to only the Colorado 'S.H.P. half of the students worked slightly disagree that, "Nothing can be gotten in the midst of turmoil and a@sense of urgency from 'White America' without violence forcing pervading Denver's urban ghettos. The other the issue." (e) from slightly agree to agree half worked in rural agricultural communities that, "The system has a way of corrupting primarily with Spanish-Americans who settled idealists who think they can work within it." the Southwest three and four centuries ago Table IV summarizes the findings relevant to with a "mafiana" culture and emphasis on the our second prediction concerning the strong extended family that served its people well in "effect of working in clinics on medical atti- the past but in the context of American indus- tudes." Scale 9 is included because most of the trialism leaves them confused and in poverty. items concern knowledge about health prac- With such contrasts we felt certain that the tices of the poor. Here the students who had radically divergent experiences of urban and close contact with the medical problems of the rural students would show up in their attitudes. poor all summer, as expected, showed change in Table V confirms this supposition. It will be the direction of greater accuracy of knowledge recalled that -scales 7 and 10, the. political liber- in this area. On the attitudinal scales, even alism and activism measures were the ones though the trends are in the direction predicted, that most strongly confirmed our first pre- they are not strong enough to confirm matters. It is interesting that the only slight reversal comes on attitudes toward the profession. Stu- Table V dents from clinic placements maintained their Scale Site Positive No change or FUher exact same level of esteem for physicians in their change negative change probability general approach to the poor, whereas the other I----- Urban ---- 3 1 1---------------- students became more disenchanted. Rural ----- 6 9 Although we did not make further predic- tions, the theory of attitude change led us to 2----- Urban ---- 7 7---------------- become interested in another aspect of the Rural ----- 8 7---------------- questionnaire responses. This is the difference 3----- Urban ---- 8 6---------------- between the changes of those students in urban Rural ----- 9 6---------------- and rural placements. 4----- Urban ---- 7 7---------------- If attitudes are viewed as functionally under- Rural ----- 8 7---------------- standable responses which the individual makes 5----- Urban ---- 4 10 .10 Rural ----- 10 6---------------- Table IV 6----- Urban ---- 9 5---------------- Positive No change F13her exact Scale Site change or n probability ,=tive Rural ----- 9 6---------------- c ge 7----- Urban ---- 13 1 .001 2------ Clinic --------- 5 3 ---------------- Rural ----- 6 9----------------- Nonelinic ------ 10 11 ---------------- 3----- Clinic --------- 6 2 .10 8----- Urban ---- 8 6---------------- Nonclinic ------ 11 10 Rural ----- 6 9---------------- 6----- Clinic --------- 4 4 -------------- Nonelinic ------ 14 7 ---------------- 9----- Urban ---- 9 5 .05 8----- Clinic --------- 5 3 ---------------- Rural----- 4 11 ----------- Nonelinic ------ 9 12 ---------------- 9----- Clinic --------- 6 2 .01 10---- Urban ---- 14 0 .001 Nonclinic ------ 7 14 ---------------- Rural ----- 6 9---------------- 77 COLORADO STUDENT HEALTH PROJECT diction of a general liberal trend. However, we 3. Careers now learn when partialling by sites "lat ';.le Included in both the pre- and post-summer effect is entirely due to the urban students who questionnaires was the open-ended item, "De- almost unanimously become more liberal and ,cribe your immediate and long range career s radical. In fact 60 percent of the rural students plans." Since the program was almost entirely remained the same or became more conserv- made up of returning students, the immediate ative. plans largely concerned finishing school. The Now turning our attention to Scales 5 and change in long-range plans is indicated in table 9 (measuring respectively favorableness of be- VI. liefs about the poor and accuracy of beliefs about them) further light is shed on the differ- Table VI ences. Students in the urban setting changed tonvard significantly more accuracy in their Before After assessment of demographic and behavioral characteristics of the poor and, at the same Career type only mentioned ------------- 6 6 time, were less inclined to accept liberal plati- tudes about the poor. The rural students be- Undecided ----------------------------- 9 6 came less objective and more favorable. Career including poverty work ----------- 14 17 Different types of experiences must have influenced these findings. First, the great feel- ing of frustration, immediacy, and necessity Before and after, six students mentioneda in Denver with the constant threat of riots, specific career such as private practice asa incidents of police brutality, and militants pre- pediatrician or radiologist, without mentioning dicting chaos impressed the students with the a desire to become strongly involved with prob- need for extensive reform at the earliest time. lems of the poor. However, 14 did mention such "Go slow" methods were not working. The poor plans in June and 17 in August. This is not are angry and vocal, making their discomfort significant statistically but we feel it is a trend extremely visible. On the other hand, the rural worth considering because, if anything, there poor are still generally content with their life were perceived demand characteristics in the styles and in many cases are not aware of or questionnaire in June to appear committed and concerned with existing poverty programs. dedicated that were not as -important at the end Secondly, as we will explain later we feel of the summer. Thus, if our findings erred, they that the urban sites were generally more suc- would almost certainly have done so in a con- cessful than the rural ones. Thus, again from servative direction. At any rate, we feel that an dissonance theory, there would be a tendency increase of three professional medical practi- on the part of some rural students to repudiate tioners committed to a life of concern for the the whole philosophy of aiding the poor with the underprivileged is a noteworthy accomplish- existing approaches rather than identify with ment in the program. what they perceived as an unsuccessful ex- perience. Thus a conservative attitudinal re- - 4. The Summer as a Learning Experience action would be understandable. In addition to all of the above, which is cen Finally, it should be mentioned that at the tral to the question of the meaning of the sum- beginning of the summer the students put. tt mer to the students, we asked them to comment relatively higher emphasis on the educational on the success or failure of the summer as a experience goal of the summer program than learning experience. We coded their responses on the. concrete accomplishments that would on a continuum from 0 to 9 with 0 representing come. This became even significantly stronger failure, 9 representing total success, and 4 ind by the end of the summer. Perhaps this was due 5 representing moderate success. The mean rat- to the sobering realization of poverty's magni- ing -by the students was a complimentary 6.94. tude and their own limitations. Again the urban score of 7.56 was more positive 78. SUMMER 1968 than the rural 6.36. Thus, the students averaged Secondly, they suggested that the high school a rating of very favorable for the summer as interns be included in the orientation sessions. a learning experience. We wholeheartedly agree with this and will In addition to their own expressed satisfac- discuss it further with other aspects of the' in- tion about previously rp-entioned significant tern program. shift of the group as a whole toward a more humanitarian and committed approach toward 6. The Intern Program the problems of the poor, and to a greater Eighteen high school interns from the place- emphasis on careers associated with poverty ment areas aided the students throughout the work, their increased knowledge of the cui- summer on all but one of the sites. We have in- ture of poverty is an extremely important fac- tor. All of the students are nearing an end formation on this phase of the project from in- terviews with local citizens familiar with the to professional educations that in a few years ect, from the SHO students .and from the will place them in a powerful upper middle proj class where the impact of their experiences interns themselves. of living and working in poor communities There were three general goals for the intern cannot help but be felt. program. First, it was hoped that the interns would be helpful in planning and carrying out 5. The OTientation projects with the SHO students. Second, it was hoped that through the experience the interns The project began with a 3 day orientation gained from the summer they might have a for the students in a hotel in a deteriorating basis for doing further poverty work in their section of downtown Denver. The students then communities. Third, through close contact with moved to their placement locations for 2 to 3 well educated, academically successful role more days of on site orientation. Questionnaire models, it was hoped that the interns would be items asking for evaluation of this summer's encouraged to expand their own career plans. orientation and suggestions for future orienta- We will briefly discuss- the project's success tions were given out at the end of the summer. in meeting these three objectives and then offer Again, favorability was coded from 0 to 9. The some suggestions for next summer's project. mean rating was 5.21 or slightly more favor- Concerning the first goal, half of the 12 in- able than unfavorable. Two suggestions were terns who were able to come to the final de- offered by the majority of the students and we briefing session felt that "the best use" had are very much in agreement with both of them. been made of their skills in the project. Those First, there should be a much heavier emphasis who were disappointed almost unanimously on concrete problems wl-.ich are likely to be mentioned that they had never understood SHO faced and co.nerete options for meeting them. and its goals and thus were never quite able This would go hand in hand with a lessened to figure out what they were supposed to do. emphasis on the theoretical aspects of poverty. Those who expressed satisfaction were gener- The students enjoyed the lectures and talks of ally in structured situations with clear respon- the resource people but seemed to want in- sibilities. formation about how they might proceed given About a third of the SHO students felt that their skills and limitations. The rural students the interns had been quite helpful, another were even stronger in feeling this way because third felt that they had been of some hel@ of the greater relevance of most of the orienta- particularly in instructing the students in the tion to urban problems. We would go farther ways of the local areas and in serving as con- than the students did in recommending sepa- tacts with community people, and another third rate orientation sessions for urban and rural felt that their interns had been of no help' people after a joint introduction to the mechan- We feel that this goa o -; ie intern program ics of the project. If such a separation were not was not successfully realized. We would not set up, greater specificity would be irrelevant want to set an arbitrary success level but one- to one or the other of the two groups. third to one-half of both groups expressing COLORADO STUDENT HEALTH PROJECT satisfaction with performance is clearly not have said before, that they be included in the enough. The interns were very confused about orientation session. With very little idea of th e program and anxious about their role in it. what the program was all about generally and Several of them felt that because of this, much what their role in it was specifically, we feel of their time was wasted. Several others felt that the interns performed quite well this sum- that they were treated as inferiors and given mer. busy work of no real importance. On the other Second, we feel that there should be stronger hand, many of the health science students felt selectivity in the recruiting of the interns. A few burdened by the interns. Many felt that they of the interns were not sophisticated enough to had their hands full being productive them- fully benefit from and contribute to the project. selves and were unable to lead another per- To achieve this, as well as for reasons we will son around. We will discuss suggestions for bring up below, the project should be funded improving this situation after mentioning the for planning and organizing expenses begin- other two goals. ning around April 1. There must be expense The second goal, of providing experience in money to allow project and area coordinators to poverty work so that the students might con- spend time and careful consideration in lining tinue such efforts in the future was most def- up interns with high potential: Graduating initely fulfilled. The interns were in the midst seniors with intelligence and energy but little of planning Various projects and took part in direction. These individuals are often informal their execution. They are -now aware that peer group leaders with sensitivity and know- things can be done to alter undesirable situa- ledge of their communities. It is expensive to tions and that they are ip- just as good a posi- find them but the payoff can be immeasurable. tion as anyone else to bring about changes. Third, provision should be made for weekly Whether or not they will use their skills is an- pay checks to the interns beginning at the end other question and one which we cannot answer. of the -first week. This sununer they were paid The third aim, of stimulating the careers of bimonthly beginning at the end of the fourth the interns, was extremely well fulfilled. The week. This is strain enough for the SHO Stu- interns were asked if their plans for the future dents, most of whom had outside financial re- had changed during the summer. Seven of the sources, but it is far too difficult an arrange- 12 reported change, five reported no change. ment for low income high school students, and Four of the five no changes had planned to go it resulted in considerable difficulty and much to college before the summer and still planned borrowing. to do so after the summer. One intern had Finally, we reconunend that the proportion planned to get a job and was still planning on of high school interns be increased to one for it. Among the changers, three had planned each SHO student. We feel that the project some technical training, but now wished to be- should consist of two member teams, an intern come health professionals. Two had planned to and student each. Several reasons lie behind enroll in college but had no goal in mind @nd this proposal. First, we think that this would now were determined and confident that they more thoroughly cut through the status ga would finish. Two others had planned to get p between interns and students, enabling the two jobs and now planned to go to college. At the end of the summer,, SHO was able to arrange groups to participate on a more equal basis. full scholarships for three of the interns to the Second, it would greatly increase the exchange University of Colorado who would not other- between interns and students allowing each to wise have been able to attend. We feel that these learn from the other to a far greater extent career changes alone are important enough to than was possible this summer. The inter n's render the intern program very successful. future would be affected more, and the student's We would now like to mention our 'suggestions empathy with and understanding of those in for an improved intern program in- future poverty would be accelerated. Third, the interns projects. First, it is vitally important, as we would be more apt to be confident in the ambi 9- 80 SUMMER 1968 uity of an unstructured situation if he had close A run down of some of the accomplishments intellectual and moral support from a student. in the rural placements is equally impressive. In San Luis, students staffed the Sangre de B. Service to the Poor Cri@ Medical Unit, provided outpatient serv- In this section we want to look at what was ices and carried on an educational program about the facilities available to the townspeople. accomplished during the summer as far as con- in Grand Junction, students helped extend cur- crete action is concerned and then locate the weaknesses of the project pointing out ways of rent outpatient mental health programs while avoiding these difficulties in next year's project. drawing up proposals for new ones, and con- The primary sources of our data are the daily tributed to educational and recreational pro- logs, which most of the students completed most grams for children and teenagers at the local of the time; interviews with 30 people around community center. In Delta they conducted an I extensive survey of community needs to provide the State who were knowledgeable about the the documentation for an energetic school board program; the evaluations of the project com- to apply for the funding of health, recreational pleted by 31 of the 32 students at the debriefing and educational programs. They also brought session; the evaluations completed by the in- the attention of agencies to many specific cases terns; and extensive conversations with the where health care was badly needed. In Pali- staff and students.in the project. sade, three health science students opened a Elsewhere in the final report the activities teen center, helped the Public Health Nurse, .of the students are extensively dealt with, so published a resource information booklet for here we just want to run down a list of some the migrant laborers and worked on ways of of the valuable services rendered by the project. making the food stamp program more easily In Denver the SHP helped staff and get Proj- available to the migrants. In Fruita students ect Mainstream off the ground. The students helped bring low income families into contact encouraged and provided technical expertise for with the Neighborhood Center making existing the Welfare Rights Organization. They also programs much more effective. At one point procured a copy of the unavailable Welfare De- they took a bus load of 60 children into the partment rules manual and put together a Grand Junction Clinic to get their immuniza- booklet of legal information for the poor. The y tions. They also taught health education classes helped organize community pressure, and lobby that were well attended. for safer and cleaner parks and pools where an Just from this sample of the activities of alarming number of children had been injured the summer, we rate the Student Health Project by broken glass. A byproduct of this was two as very successful. It is our judgment that the new- organizations of neighborhood mothers. students were dedicated, creative, and ex- Students put a great deal of effort into helping tremely sensitive interpersonally, and that this the'Fiesta on the west side. They did some ou,,- paid off for the people served and in the re reach work, for a neighborhood clinic anci wards of a good learning experience. But this worked for more personalized health care at does not mean that the project could not be that clinic. A great deal of time was spent in improved next summer. The students them- various recreational efforts-ma-ny of high edu- selves would be the first to admit this. When cational value. Two bus loads of children were asked to rate the success or failure of the sum- given their first ride in a jet plane. A number mer as to helping the poor, their mean coded of career, sex, and healtb- educational classes response was 5.61 again using a scale of 0 to were held. Shutins were taken shopping and to 9 running from failure to success. The urban church on Sundays. A lot of work went into mean was 6.08 and the rural means was 5.13. the planning of a cooperative supermarket that Thus, their own view of their activities could be will not see final fruition for some tim'e. A free described as only moderately successful. bus was set up to take low income mothers With the knowledge that the summer was a shopping. good one, we want now to turn to the problems 81 COLORADO STUDENT HEALTH PROJECT that arose with an eye toward a still better ex- people or of the bureaucracy, and wait for the perience next year. The most serious difficulty end of the summer keeping busy enough not to this summer arose from a general deficiency in be conspicuous. Fortunately most of the activ- planning. We feel that this stemmed from three ities turned out to be quite reasonable and coii- factors. First, and most obvious, this was Col- structive. orado's first Student Health Project and some Finally, the loss in many cases of the first 2 questions had not been confronted before by the to 3 weeks of the 9 weeks in the field is a costly staff. Second and of great importance is the price to pay. Whatever the final course of already mentioned fact of the unavailability of action hit upon by the students, it could have planning funds to support the careful ground- been 50 percent more effective if the period of work that is necessary to set up a smoothly uncertainty had been eliminated. operating program. Third, we feel that this With a combination of measures we think summer's project put too much emphasis on the this could all be avoided. The first suggestion unstructured approach. involves a structured, preplanned assignment There were several undesirable consequences for the student for the first 3 to 4 weeks in the of this weakness in planning. Preceptors and community. It might begin with 6 or 7 hours sponsoring agencies were led to have false a day and taper down to 3 or 4 at the end. It expectations as to what the summer would be might focus on outpatient services or a badly like because the SHP wasn't exactly sure. In needed survey or anything else agreed upon most cases, sponsors expected somewhat closer that would render valuable service in the com- contact than the students were willing to oper- munity. A number of such positions could be ate under. The students themselves, who were agreed upon ahead of time by the preceptor and fearful of being drafted into meaningless work, area coordinator. When the SHO students and often avoided the sponsor. The result was some interns arrived in June they could settle upon unnecessary antagonism. The sponsors felt let which of.the possibilities best suited their skills' down and uninformed of the students' activities and interests and the community's needs. and somewhat suspicious. On the other hand, From this concrete starting point, students students lost the benefit of valuable support and and interns could get to know each other and information about the community. the community. They could also slowly be think- Another consequence of the unstructured sit- ing about creating projects of their own for uations was the sheer trauma many students' the last two-thirds or half of the summer, which experienced when they found themselves alone might or might not be connected with the spon- in a poor community with crushing social prob- soring agency. This should be open. lems and no idea whatsoever about where to This, or any other approach, would require go and what could be done. They then began to about $1,000 or $1,500 in planning expenses busily learn about the community, talkin with to enable each area coordinator to spend about 9 as many people as possible. But shortly, per- a week in April or May at each site carefully haps after 2 weeks, they would begin feeling setting up possible options for the students guilty about having wasted their time and tax- when they arrive in June. The s ponsors must payers' money with no accomplishments. It is understand the desire for autonomy and creativ- also very difficult to explain what you are doing ity of most SHO students and be willing to lim- to confused and suspicious townspeople. At this it their demands on them. For the first 3 or 4 point many students felt compelled to jump into weeks with the preceptor ' careful plans and any activity to justify their being there. Some- procedures should be set up so that serious worl@ times this resulted in unduly ambitious pro- could begin immediately on the students' ar- grams which couldn't succeed, and sometimes it rival. resulted in nearly trivial undertakings with We feel that this approach would have some little use. Then a few of the other students very worthwhile results. With the careful spell- would withdraw, feeling the situation was ing out of roles and expectations, the friction hopeless either because of the faults of poor between sponsors and students would be cut -to 82 SUMMER 1968 a minimum. With a productive, structured in- the timetable of the migrants, next summer's itial period, the pressure would be off the stu- SHP should not include a Palisade placement. dents to make premature decisions About what There is an acute need for the students all to do with the summer. None of the students summer long in (;rand Junction, Denver, and in would feel coerced into doing meaningless many other communities in Colorado, particu- things with the agencies. There would also be larly in the San Luis Valley. no embarrassment in explaining what they A final item we wish to mention is that the were doing with community people. They are two law students were as successful as any two "working with the health department's edu- other students in the project. They were very cation and information program," etc. useful to the program and beautifully supple- Planning difficulties were the summer's ce-n- mented the health care and community organi- tral problem and were most acutely felt on the zation work of the other students. We think western slope, but the students performed that five or six could be a still greater benefit, well in spite of them. We now want to turn to next year's project. to some more specille 'Problems. First, there were many occasions in which resource people C. Conclusion within the SHP were needed but unavailable. In conclusion, we have found that the first Important planning decisions about which way Colorado Student Health Project was very suc- to proceed are often difficult to make for rela-- cessful. The students learned a great deal about tively unexperienced students and interns. This poverty and problems in the delivery of health summer there were only two.area coordinators care to the poor. As a group, they also became instead of the proposed three and this was significantly more humanitarian in their atti- unfortunate. There was also a tendency for the tude toward poverty. The interns also had a two area coordinators to become too tied down valuable experience, becoming much more at their homesites which caused some hardships aware of problems in their own communities. for other students. In Denver this also led the More than half of them also raised their career overworked full-time project coordinator to aspirations during the summer. Most import- take a good deal of his time away from a heavy ant, the students provided a long list of services administrative load tG be of assistance in the summarized above to low income areas around solving of low-level problems. We recommend the State. On the basis of all of this, we feel that next year there be four area coordinators, that the project should be funded again next one each for east and west Denver and one year. each for the San Luis Valley and the Western We have also found some problems in the Slope, and that they be encouraged to remain summer's project. The rural students as a free and available. group did not become more humanitarian and The Palisade placement on the western slope tolerant of the poor. The interns were not as was also a problem this summer. There is very valuable as had been hoped in contributing to little poverty in the community during the year the project's activities. The orientation period except for the fruit harvesting season with its was somewhat too theoretical. Also, the struc- large influx of migrant'laborers. This usually ture of the project was loose in general, par- takes place about the first week of August. ticularly in the Grand Junction area, and the At this time there is a great need for medical area. coordinators were often inaccessible. services of various kinds which the SHP could In order to benefit from the knowledge of provide, but not before. This year the three these difficulties we have made the following Palisade students spent the -first 6 weeks of recommendations for next year: the summer there working energetically with (1) The orientation should place a heavier the Public Health Nurse in neighboring low in- emphasis on the practical: specific come communities, in setting up a teen center suggestions about possible modes of and in making preparations for the migrants. action when confronting common We feel that given the structure of the SHP and problems. 83 COLORADO STUDENT HEALTH PROJECT (2) Except for the first day, there should (6) The grant should include about $1,500 be separate urban and rural sessions to pay planning expenses for the during the orientation. area coordinators in the spring: (3) The interns should be included in all (7) There should be structured positions aspects of the orientation. for the students for approximately (4) The number of interns should be in- the first 3 weeks with the remainder creased to equal the number of stu- of the summer unstructured. dents. (8) There should be four area coordina- (5) Interns and students should be paired tors. into working teams engaged in all (9) There should be an increased number activities together. of law students in the project. 84 PV A k Appendix .1 ' i i I i I COLORADO STUDENT HEALTH PROJECT PARTICIPANTS High School Interns Health Science StUdelits High school Interns Health Science Studeitts Grand Tunction Daniel Kraus University of Rochester Nancy Adams Glenda Romero Med II University of Colorado Social Service Gail Wilcox, R.N. Jeffrey Reichenthal Denver-East Side Downstate Medical Center Larry Corinan Marie Arrington Med II University of Maryland Fruita Med II Bert Brussard Eva Adler Virginia Martinez Steven Feig Norman Harris University of Colorado University of Maryland Vincent Robinson Nursing IV vickey Martinez Med II Jeffrey Kluger Candy Medina Jack Lissauer Clara White Medical College of University of Maryland New York Med II Med 11 Joseph Sprague Judy Lindauer University of Colorado University of Colorado Law III Nursing IV Linda Sprague Palisade James Swallow Mary Jaeggli University of Colorado University of Colorado Med II Nursing IV Marion von Buettner Kenneth McConnochie University of Colorado Darfanouth Medical College Med II Med II William Walker University of Colorado Nancy Roland Med II University of Denver Graduate Student, Social Denver-West Si4de Work Delta Joseph Bergquist Gary Baca University of Colorado Norman Chenven Adrian Pebahsy Med III Wayne Barella Downstate Medical Center et lavato Steven Berman Margar Med III Mario Ramos Temple University Med II Jake Pino Dinah Chenven Marylou Buyse Lawrence Sena Jane Patterson Women's Medical College University of Colorado Med III Graduate Student, Education Keith Henriquez San University of Denver Graduate Student, Social Suzanne Campbell, R.N. Jo Anne Apodaca Work Robert Frampton John L4aCombe Charles Holt University of Colorado University of Oldahoma Med II Rocky Madrid Med III ,86 SUMMER 1968 Health Science Students High School Interns Health Science Students High School Interns Marcia Looney James Pachl Francis Payne Bolton University of California School of Nursing Law III Nursing III Ida Jean Newton Jerry Yucht Women's Medical College Wayne State University Med III Med 11 87 COLORADO STUDENT HEALTH PROJECT PRECEPTORS Grand Junction: San Luis: Robert Ross, M.D. Sangre de Cristo Medical Unit Medical Preceptor Mr. Charles Jackline, director Grand Junction Neighborhood Center Preceptors:, Dale Thomas, M.D., Lawrence Preceptor: Mr. Augie Reyes Andreini, M.D., Bo@e Camp, M.D. Mesa County Mental Health Association Preceptor: Mrs. Mary Humphries De?tver-East Side: Mesa County Public Health Department Curtis Park Community Center Preceptor: John V. Sessums, M.D. 929 29th St. Preceptor: Reverend George Turner Fraita: East Side Cormnunity Action Center Robert Orr, M.D. Medical Preceptor 2800 Glenarrn Place Fruita Neighborhood Center Preceptor: Mrs. Sarah Collier Preceptors: Mrs. Del Martinez, Mr. John East Side Neighborhood Health Center Montgomery 529 29th St. Fruita Teen Center Preceptor: Burris Duncan, Preceptor: Mr. Jack Chaney Palisade: Denver-West Side: Inner City Parish Chester Bliss, M.D. Medical Preceptor 912 Galap@go Mesa County Migrant Council Preceptor: Reverend Harland Beech Preceptor: Mrs. Harry Talbot Mariposa Health Station Delta: 1178 Mariposa St. R. J. Bennett, M.D. Preceptor: Andre Chabot, M.D. Medical Preceptor West Side Connnunity Action Center Delta County Public Schools 1042 Santa Fe Drive Preceptor: Mr. Harry Anderson Preceptor: Mr. Leo Rodriguez 88 SUMMER 1968 CONFERENCE SCHEDULES Colorado Student Health Project Orientation 1612 17th Street, Denver, Colorado Sunday, June 23, 1968 Arrival of Health Science Students 8 p.m.-"Mixer" Monday, June 24, 1968 7:00- 8:00 Breakfast 8:00-10:00 Registration 10:00-42:00 General objectives Michael Reiff Randall Lortscher Lisa Wilson Skip Bry "Health and the Community" Dr. C. Henry Kempe, Chairman, Department of Pedi trie-s, Univer- sity of Colorado Medical School; Sponsor, Colorado Student Health Project 12:00- 1:00 Lunch 1:00- 3:00 "The War on Poverty" Professor Howard Higman, Director, Action Research in Socializa- tion Processes, Boulder, Colo.; Professor, Department of Sociology, University of Colorado 3:30- 6:00 Free 6:00- 7:00 Dinner 7:30- 8:30 Movie: "Harvest of Shame" 8:45- Small groups: "Why are we here"? Tuesday, June 25, 1968 7:30- 8:00 Brealdast 8:15- 1:00 Community panels Mr. Paul Reese Assistant Director, VISTA Welfare Rights Mothers Mrs. Anna Deleon Mrs. Sonja Betts The Ghetto Scene High school dropouts 1:00- 1:45 Lunch 1:45- 2:45 "Some Aspects of Cultural Shock" Dr. Sidney Margolin, Professor, Department of Psychiatry, Univer- sity of Colorado Medical School 3:00@ 4:00 "Black Power" Mr. Frank Bailey and panel 4:30- 6:00 "Civil Rights and the Community" Mr. Warren Alexander, Civil Rights Commission 6:40- 7:00 Dinner 8:00- 9:00 "The Law and the Community" Mr. Edward Sherman, Public Defender, City and County of Denver 9:30- Small groups: "Where are We Going"? Wednesday, June 26, 1968 7:30- 8:00 Brealdast 8:15-12:00 "The Urban Community" Dr. James Kent, Mr. John Hernandiz, Mr. Nate Av os 1:15- 4:00 "The Rural Community" Mr. James Chavez, East Side Neighborhood Health Center; Mr. Tomas Atencio, Colorado Migrant Council 4-00- 4:30 "Malnutrition and Community Life Styles" Dr. Peter Chase, Department of Pediatrics, University of Colorado Medical Center 7:00- Sit down dinner 89 COLORADO STUDENT HEALTH PROJECT Midproject Conference Dr. Ke@pe's Cabin Friday, July 19, 1968 1:00 Arrival of students 3:00- 5:00 Group session-reports from individual projects Supper 8:00 Group session-reports continued Saturday, July 20, 1968 Breakfast 9:00-12:00 Area meetings-individual problem solving 12:00- 1:00 Lunch 1:00- 4:00 Health science student meeting High school intern meeting 4:00- 5:00 "Planning Methods for Change" Mr. Robert Hunter Action Research in Socialization Progresses Su-nday, July 21, 1968 Breakfast 9:00-12:00 Keynote: "The American Health Care Crisis" Dr. Quentin Young, Past Chairman, MCHR Final Evaluation Session University of Colorado Medical Center August 28 @,,@08 9:00- 9:30 Introductory remarks Dr. Conger, Dr. Kempe, Prof. Higman 9:30-1f):')n Selected health science students' reports of summer experience 10:30-1 Coffee lo-45-l' )O Selected high school intern reports 12:15- 1:15 Catered lunch 1:30- 3:30 Peter Bonavith: "New Perspectives" 4-00- 5:00 W.itten group evaluation Aug@c 29, 1968 9:00-12:00 Individual projects-successes and failures; prospective recommendations 12:15- 1:15 Lunch in hospital cafeteria 1:30- 3:30 Open forum 3:30- Mnal remarks: Project staff 90 SUMMER 1968 Demographic Data-Orientation Sessions 1. Birthday: 2. Father's occupation: 3. Check approximate income range of your parents: $0 to $4,999 $5,000 to $9,999 $10,000 to $14,000 $15,000 to $19,999 $20,000 to $24,999 $25,000 and over 4. Which of the following best describes where you lived at age 15? Rural farm community Rural nonfarm community Small town (2,500 to 20-,000) Middle-size town (25,000 to 100,000) City (100,000 to 500,000) Large city (over 500,000) 5. Sex: 6. Your race: 7. Your religion: 8. Political party preference: 9. Were both your parents born in the United States? (Yes) (No) 10. Have you worked with. any other action program such as the Student Health Project (SHP)? (Yes) (No) If yes, list all the programs you have worked with. 11. The one thing you are looking forward to most in SHP is: 12. What, if anything is the one thing you are most apprehensive about in SHP? 13. How important were the following items in making your decision to work in SHP? (Circle one for each item) a. Working in Colorado: None Very little Moderate Considerable Very high b. Working with the poor: None Very little Moderate Considerable Very high c. Helping in a health program: None Very little Moderate Considerable Very high d. Salary: None Very little Moderate Considerable Very high e. Friends applying: None Very little Moderate Considerable Very high 91 COLORADO STUDENT HEALTH PROJECT f. Opportunity to work with other health professionals: None Very little Moderate Considerable Very high g. Acquire better understanding of welfare problems: None Very little Moderate Considerable Very high h. Participation in a social experience: None Very little Moderate Considerable Very high i. Making a contribution to community improvement: None Very little Moderate Considerable Very high j. Other (specify): 14. What do you expect this summer to have in store for you? For each of.the items below indicate your expectations. a. How many hours a day do you expect to work on your project? h. How do you think your living conditions will be? (Primitive, Adequate, Ample) c. How much risk of physical danger do you expect to encounter? (Great, Moder- ate, Slight, None) If you answered "great" or "moderate," from what source do you expect this danger? d. How do you expect your working conditions to be? (Poor, Fair, Good, Excellent) e. How much do you feel you will accomplish in terms of (check one for each): (1) Learning about problems of the poor Very little Some A great deal (2) Your professional education Very little Some A great deal (3) Personal fulfillment Very little Some A great deal f. How much social. involvement do you expect to have with the persons you work with? (Circle one for each) (1) Patients None Very little Moderate Considerable High (2) Coworkers None Very little Moderate Considerable High (3) Project staff None Very little Moderate Considerable High (4) High school interns None Very little Moderate Con- siderable High (5) Preceptors None Very little Moderate Considerable High (6) Neighbors None Very little Moderate Considerable High (7) Community participants None Very little Moderate Considerable High 15. Why did you choose to work with the SHP this summer? 16. What are your short and long range career plans? 92 SUMMEP. 1968 Student Attitude Scales-Orientation: Final Evaluation Sessions Scale 1. It is very important to achieve some goals in my sum- A a d D mer work that will have an effect on the community. 2. Unless we do all we can to help the people in the corn- A a d D munity this summer, it is not likely that much will get done. 3. The chances of doing much more than getting an edu- A a d D cation for myself this summer are very limited. 4. While it is desirable that we help provide health serv- A a d D ice to the poor, our own personal learning comes first. 5. The major purpose of the work this summer is to learn A a d D about the problems of delivering health care to the poor. 6. Our main objective this summer is to get the best edu', A a d D cation we can about the health problems of the poor. 7. Even if no improvements in health care for the poor A a d D result from our summer work, the summer can still be considered successful if we learn about the health problems of the poor. 8. We have to try to do all we can to help the people in A a d D the community this summer and forget about any personal benefits. 9. Unless there are concrete accomplishments in the com- A. a d D munity as a result of my efforts, the summer work cannot be considered successful. Scale H 1. A patient's religious beliefs should take priority in de- A a d D termining the nature.of medical procedures. 2. Compassion is a luxury which the busy physician can- A a d D not afford. 3. Patients are appreciative of sympathetic treatment on A a d D the part of the physician. 4. The parents of an unwed pregnant girl should always be A a d D told. 1) Asterisks indi ate0G'm,,4ve,, highest score 2) SA agr A y Str Ong Aqr- a - SLA SI ght d - SLD I gr_ IYL D S ghtly D gr- SD Str..gly di..gr. 93 COLORADO STUDENT HEALTH PROJEI CT 5. The wife of a patient who has just contracted syphilis A a d D and refuses treatment, should be informed. 6. All patient-, that have a fatal disease should be told. A a d D 7. Patients from lower income groups are unable to un- A a d D derstand the nature of their illness. 8. It is important for physicians working with poor pa- A a d D tie@ to get to know them well so as to best serve them. 9. The patient has a right to demand a specific treatment. A a d D 10. A physician cannot just concern himself with things A a d D medical, but must consider all aspects of the com- munity life. 11. A physician must make every effort to preserve the life A a d D of a grossly abnormal baby at birth. 12. Itisimportantfortheattendingphysiciantodetermine A a d D if a hospital patient has received visitors. 13. The unconscious patient is entitled to, and should re- A a d D ceive, the same consideration as the conscious patient. 14. In dealing with patients, it is enough for the physician A a d D to advise treatment without explanations. Scale 1. Clinics sponsored by local health agencies are mainly A a d D intended to keep down the pressure for socialized medicine. 2. Public health clinics can provide good preventive A a d D health care. 3. Becauseofthewayinwhichpubliecliniesareorganized A a d D and-administered, it is just not possible for them to provide a high level of medical care. 4. Public health clinics can do very little for the people A a d D ihey are supposed to serve. 5. Medical personnel who work in clinics cannot provide A a d D highly individualized service to patients. 6. Physicians who work in public health clinics can get to A a d D know patients fairly well and provide them with good medical care. 7. Public health clinics are not in a position to provide A a d D high quality medical service to the poor. S. it is possible to provide first rate medical care in a A a d D public clinic setting. 94 SUMMER 1968 9. Physicians who work in public health'clinies really care A a d D about poor people and their health needs. 10. Health clinics for the poor can achieve only a very A a d D limited degree of excellence. II. Medical personnel who work in public clinics just can- A a d D not give the time that is necessary to adequately handle each patient. Scale IV 1. Those who accept charity lack dignity. A a d D 2. An unwed pregnant woman is to be respected. A a d D 3. Any unmarried mothers who have morp than two ille- A a d D gitimate children and are on public welfare, should be sterilized. 4. An individual cannot be judged from the amount of A a d D money he earns. 5. Forceful sterilization of the mentally retarded is an act A a d D in violation of the dignity of the individual. 6. The experimental use of potentially dangerous drugs A a d D in habitual criminals, against their will, is justifiable. 7. Despite all the problems involved, good health care can A a d D be provided to the poor. Scale V 1. The Mexican concept of manhood is based on the size A a d D of a man's family rather than the quality of his family. 2. Mem'can-Americans want to take care of themselves; A a d D they do not want help from others. 3. In the Mexican-American community, the people who A a d D achieve respect are the gang leaders and big drinkers. 4. One of the striking things about poverty people is the A a d D need they have for individual contact and the con- cern of others. 5. Poor people are content; they, are generally satisfied A a d D with their lot in life. 6. Poor people are generally receptive to efforts at being A a d D friendly and helpful. 7. The majority of poor people are concerned and inter- A a d D ested in improving themselves. 8. It is difncult to escape the conclusion that most poor A a d D people are apathetic about their situation. 95 COLORADO STUDENT HEALTH PROJECT 9. Poorpeopleoftentakeadvantageofthegovemrnent. A a d D 10. Mexican-Americans live for today and can see no pur- A a d D pose in worrying about tomorrow. Scale VI I. Many physicians stand to lose a fair amount of their A a d D practices if public health clinics are put into opera. tion. 2. Many physicians work very hard because they are A a d D compulsive people, not because they are altruistic (or have a desire to serve). 3. Many physicians are quite cold, aloof, and conde- A a d D sr-ending in their relationships with patients. 4. Many physicians are in practice just for the money. A a d D 5. A physician should determine his fee in part by pa- A a d D tients' ability to pay. 6. Physicians are generally not responsive to the health A a d D needs of poor people. 7. Many physicians feel that the health needs of the poor A a d D are being met by existing agencies and services. 8. A large number of physicians feel that the reason many A a d D people are poor is because they are lazy. 9. Physicians cannot afford to do charity work outside of A a d D the traditional organized "donations of time." Scale V/1 1. The public education received by most of the poor is SA A SLA SLD D SD generally equivalent to that received by most of the middle class. 2. Police brutality was a major reason for the riots in our SA A SLA SLD D SD, cities last summer. 3. With our Nation's great wealth, no form of poverty SA A SLA SLD D SD should be tolerated. 4. Minority groups are trying to move too fast in seekink SA A SLA SLD D SD reforms. 5. The poor feel degraded by our welfare system. SA A SLA SLD D SD 6. Conditions are so bad in our cities' ghettos that no S@ A SLA SLD DSD. Negro could be blamed for rioting. 7. Anyone can pull himself out of poverty in the United SA A SLA SLD DSD States who has the will to do so. 8. Welfare should not be paid to women who continue to SA A SLA SLD DSD have illegitimate children. 96 SUMMER 1968 9, The unemployed should not be blamed for turning SA A SLA SLD D SD down low paying menial jobs. 10. Poverty in America is the fault of society and not in- SA A SLA SLD D SD dividual lack of motivation. 11- ThePOvertYinAmericaisOneofmorediseomfortthan SA A SLA SLD D SD of real deprivation as other countries know it. 12. Few receive welfare who do not need it. SA A SLA SLD D SD Scale VIII 1. Medical care is a right not a Privilege. SA A SLk SLD D SD 2. A sizeable increase in the number of practicing phy- SA A SLA SLD D SD sicians would seriously threaten the economic well- being of the medical community. 3. Good medical care is generally not available to the poor SA A SLA SLD DSD in our country. 4. For all of @ problems this country's system of health SA A SLA SLD D SD care is the best in the world. 5. Need alone should be the criterion for the provision of SA A SLA SLD DSD medical care. 6. The physicians who treat the poor are generally of aSA A SLA SLD D SD lower quality than average. 7. Many of the poor are constantly in danger of losing SA A SLA SLD D SD their jobs because they cannot afford adequate medi- e-al care. 8. Considering the incomes of other segments of society, SA A SLA SLD D SD physicians earn more than enough already. 9. Far more physicians are needed in order. to satisfy na- SA A SLA SLD DSD tional health needs. 10. If community medical services are to be expanded, the SA A SLA SLD D SD government should play the major role in backing this expansion. Scale IX 1. Many of the poor have a stable, simple life with more SA A SLA SLD D SD happiness than they would know with a well-paying job and a middle class life. 2. Knowledge of family planning is generally absent SA A SLA SLD D SD among the poor. 3. Drinking is more of a cause than a symptom of many SA A SLA SLD D SD of the problems of the poor. 4. In general, the poor would prefer a modest immediate SA A SLA SLD D SD gratification to a larger, long-term success. 97 COLORADO STUDENT HEALTH PROJECT SA A SLA SLD D SD 5. Superstitions about matters of health by the poor still form a significant barrier to adequate health. 6. In many lower class families the wife has a greater earn- SA A SLA SLD D SD ing ability than does the husband. 7. In most cases the poor are concerned with curing pres- SA A SLA SLD DSD ent health problems but have little concern about prevention. 8. The poor generally accept death more easily than do SA A SLA SLD D SD members of the middle class. -9. Minority poor have significantly more children than do SA A SLA @'3LD DSD poor Anglos. 10. Defeats and frustrations cause fatalism on the part of SA A SLA SLD D SD the poor more often than they result from it. Scale X 1. In pursuing social change breaking the law is never SA A SLA SLD D SD justified. 2. Local governments and business communities would SA A SLA SLD D SD generally like to help work toward social improve- ment. 3. As a first step toward halting lawlessness in America, SA A SLA SLD D SD agitators like Stokely Carmichael should be locked up. 4. Notbing can be gotten from "white America" without SA A SLA SLD D SD violence to force the issue. 5. Most agencies that are designed to help the poor ham- SA A SLA SLD D SD per them as much as they help them. 6. Most liberals talk humanitarianism but are not willing SA A SLA SLD D SD to make the sacrifices. 7. Cooperation and process of subtle manipulation of in- SA A SLA SLD D SD fluential citizens is generally more effective than confrontation. 8. In the past decade, a good deal of progress has been SA A SLA SLD D SD made in improving the lot of the bottom one-fifth of our society. 9. Most Americans would be content to tolerate the most ;A A SLA SLD D SD severe injustices in their society unless prodded into action. 10. The system has a way of corrupting idealists who think SA A SLA SLD D SD they can work within it. 11. By soliciffying the conservative opposition to social SA A SLA SLD D SD change most demonstrations and protests probably do more harm than good. 98 SUMMER 1968 12. Demonstrations and protests are often a convenient SA A SLA SLD D SD way of avoiding the responsibility of going out and helping those in need. 13. Rich and impoverished segments of our society are now SA A SLA SLD D SD farther apart economically than they have ever been. 99 COLORADO STUDENT HEALTH PROJ.UCT Individual Evaluations Collected Throughout the Summer COLORADO SHP DAILY LOG Name Date Briefly fill out and turn in a log each day to Your area coordinator. (1) What important feedback did You receive from the Poor community or Power structure today? (2) What was the most significant experience of the day? (3) What was the most rewarding experience of the day? (4) What was the most frustrating experience of the day? (6) Other: Include any experience, idea, problem, et cetera. COLORADO SHP Community Medicine Questionnaire (1) Name (2) Descri e the present system of health care for the poor in your area. (3) What are the most pressing needs in the way of getting better health care for the poor in your area? (4) What bureaucratic difficulties hinder the usefulness of present facilities to the poor in your area? (5) What concrete proposals do you have for Programs that might bring'better health care to the poor in your area? (6) In what ways do the values or culture of the poor in your area present problems for ade- quate medical care? SUMMER 1968 Student Questionnaire-Final Evaluation Session HEALTH SCIENCE STUDENTS (1) In what ways was your suznmer a success or failure as a learning experience? (2) In what ways was your summer a success or failure as far as services to the poor were concerned? (3) Whatsuggestions could you make that might be implemented next summer in order to make the SHP more effective? (4) a. In what Ways was the summer successful or unsuccessful as a learning experience for the high school interns in your area? b. In what ways were they successful or unsuccessful in contributing to the program in your area? c. How could the intern program be set u'p more advantageously next summer? (5) a. How valuable was your orientation at the Oxford Hotel? b. How could it be improved? (6) a. What agencies did you work with in the field? b. What were the specific successful and unsuccessful experiences you had with each agency and why? c. What other agencies were available, but not utilized, and why? d. What agencies might be utilized advantageously n"t summer and why? (7) What are your short and long range career plans? HIGH SCHOOL INTERNS (1) Home town (2) a. Did you ave any career plans before the start of this program? If so, what were they? b. Has this program in any way changed your career plans? If so, in what way? (3) a. What kind of work did you do this summer? b. Do you feel that the program made the best use of your skills this summer? Why? c. How could the sldlls of the interns be employed better next summer? (4) a. What were the failures of the SHO program this summer?. b. What were its succesm? C. How could it be improved for next summer? *U.S. GOVERNMENT PRINTING OFFICE' 1970 0-3@= 101 e, U.S. C;OVERNMNT PRTNTING OFIIICE 1970 0355-230 I I I U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE Public Health Service