Views.
IOW I live in neighborhood for about two years now into an instant under the
elevated in of the story world class their own in the gutter
and available to play with the full license in
gullible little but when you live here.
The plot is on the Elf because blueness than the locals
or smell of the a girl.
Especially not when you're not wearing a body
or unlimited Well of course but we've got a good
and suspect in the heart of New York.
It's part of a new idea that's going on into you know all of the sick
and in the Bronx.
We call it a month old neighborhood health of people from my neighborhood
and come to have the sickness treated
and the hurt made well you are entering a new world of health care draws upon the
same science and uses the same instruments
and equipment the health services traditionally do but yet in its philosophy
and its practice it is different in some startling
and significant way here in New York Smadi the or a neighborhood help center
and its counterparts in other American cities
and towns this concept of care has profoundly affected both the help of Arsenal
and the patients. Your global there never had a doctor before
or at least not one knew his name
and his medical history so
Miskin as getting on in years and it never entered her mind
that he be getting so much interested and in a place to go to medical care.
Mrs Hitchcock complains about a lot of things
but she never thought complaining about her medical care would make a difference
but every time I heard it would hurt her
and just a few short months ago.
It certainly number occurred to many of these people
that they be helping to shape the entire way in which their neighborhoods health
care was to be what they are and the medical people are listening.
This is the story of a new kind of comprehensive health care
and the way it is being offered in thirty six American cities
and it is the story of a unique
and creative approach to help the needs of its consumers which goes where they are
answers when the question and perhaps most important of all accept their advice
and best serve there is
a story about health care in the life of a good well applied not just to the poor
but to everyone
and affects the whole approach of medicine the
Right now hundreds of thousands of Americans are utilizing it every day through
their neighborhood.
I'm Dr Roger Edgar Berg dean of the University of Southern California School of
Medicine. This film describes new ways of providing health care for the poor.
Whether they live in the country or the city.
By means of neighborhood health centers. In the past.
And in many places today. Health care for the bore has been inadequate.
For instance hard to obtain impersonal fragmented.
In that kind of a setting quality often suffered.
And today there are probably thirty million people
or not receiving the kind of care. We all deserve.
Now with people in their neighborhoods working together with professionals in the
planning an operation of these centers.
There are some new ideas and new directions that we should all be aware of.
So let's take a closer look at some of the problems.
And what neighborhood health centers are doing about them.
If you're poor
and you live in places like the sickness can be a life long blank kind of vicious
circle described by the physician who said the sick get poorer
and the poor get sick or if you're poor and sick.
There are some discouraging barriers between your medical.
Barriers like transportation.
If you mean one of the ways in any given hospital. You gotta wait.
Some are hard to get to the hospital
when you have to get the get the sand in you very very
black and white
but I never dull until I'm dead before you
can add long distances no predictable way to get there
or get home later
and only the most serious illness can drag you out the
rush
the physicians
and other medical people have got a supreme a difficult job under immense pressure
in the countries emergency rooms in place
but as so many physicians no emergency room just aren't designed for that.
Just let merge into rooms were designed to handle acute catastrophes of all kinds
and when the medical or surgical need is a top urgency.
They in their highly trained staff function smoothly
and efficiently the team in emergency rooms all over the country function with
supreme skill and are presented with the kind of emergencies or worse.
This place is
but the role of the emergency room has changed over the year
and now people are being a routine problem here
and he would take three buses to get here ten dollar tax.
You're very lucky to wait until you're really sick or ten dollars sick
but you say once I'm fortunate maybe.
Ten dollars off a map not getting well very fast.
Dr Egbert no underlying all of
this is the inescapable fact
that there are hardly enough doctors to go around as medicine is now practiced in
this country.
Thirty million patients and fifteen hours of extra work to every doctor's workload.
With the whole medical system in the chaos. The fact is.
We need to explore new ways of delivering health care.
Health care to everybody not just the border.
And this means using as many people as we can to extend the hands of the doctors
something that is being tried in the neighborhood health centers.
The health problems
that plague the city ghettos the migrant camps the poor wherever they were
concerned physicians and health professionals all over the country
and exploration for creative solutions was pop priority
and with the help of the Office of Economic Opportunity.
The search became known as the health program the end.
So it begins in the city ghettos in the town something was happening.
Members of the health profession working closely with
and began to implement the idea of Community Medicine in action.
The idea was to deliver high quality accessible comprehensive one
or care for the whole family.
They called it the neighborhood health center
and the neighborhood was sown about that a little towns like L.B. So California.
They built it themselves.
There's more than just hammer and saw participation here.
This is a community for to save because this group voluntarily building its home
center has a unity of springs that can address other problems too.
And as they break for lunch.
They may well talk about things like housing education
and welfare community worker time you're avails puts it this way through the
experience of attacking a specific problem and working with one another.
They begin to see the relationship of such things as health problems to the lack of
housing lack of education a lack of response by the institution in the society
that so dramatically affect their lives
and not only do they have at least some of them for the first time a positive image
of themselves.
But they're beginning to see ways
that they can move fast asleep to change some of the other areas of their life.
More so with the rigorous and necessary help of community worker like come here
and now. Medically deprived people of communities like L.B. Zero.
We're helping them sell health center in this neighborhood. That's right.
And it wasn't even sprayed the going to resemble a chili personal hospital
emergency room. This was going to be accessible
and if they had anything to say about it.
It was going to be given the best looking building in town the center
didn't have to be magnificent
or even a labyrinth to begin with San Francisco's first orders were in her face
grown up around this attractive courtyard.
But they did have to be convenient and comfortable and easy of access.
With pleasant waiting rooms in which neighborhood people would feel welcome
and it all.
Well people are so far outside the mainstream of medical care
that they don't want what other people want. Perhaps most significantly.
They want what health professionals and selves want
and they want private offices they tell me is is come
they want quiet examining rule.
They want comfortable conference areas where a warm
and lasting relationship can be established between health professionals
and patients.
But I satisfy you know what I just said the dignity with S.S.A.
that I find
that in this doctor patient relationship is the same as we're able to establish
more than just the ordinary doctor patient relationship but rather
that of a friendship in which we're not interested only in the pregnancy
but it on the whole family and I feel
that in this case is this should not be only interested in providing health care
about also and raising this kind of living
and given her for free through generation it becomes I mean this is the fundamental
and most important concept of the health center is to offer patients family care
medical services through an approach with tremendous implications for the whole
medical field.
It's called Team medicine
and it's offered by a highly organized group with members respond to patient needs
both medical
and social the typical help team is made up of physicians usually an internist
and pediatrician so frequently including an obstetrician to me there's a public
health nurse and one or more new help I said was called The Family Health worker.
When a family registers epicenter.
It is assigned to a health team which will be responsible for all of it
and help me. So it's possible for an entire family to come in at once
and each member be seen by the appropriate person on their team.
So I can protect your slowly so you know what's going on back and put it right.
And the next right.
And while his father is getting attention just down the hall young spankie is
getting his pediatric work up.
Thank you as a member of the team the pediatrician has the unique opportunity to
use his pediatric preening to best advantage.
He doesn't wind up spending half of his time as a clerk for already record take
your social worker or as a nurse
or receptionist all of the members of the team contribute as co-equals with their
own specialized area of expertise.
While getting in my particular case I've found over the months that more
and more I have learned to rely upon the other members of the team to do their part
of the job
and so I've had more time to concentrate on what I can do best to help
the entire family
and the pay for a lot in their total medical care die than let me know
and I'll get social worker to talk to you
and maybe give you some help because he's got a pretty rough age right now without
a diet and the diet may be a little bit too much for him
and post such things as funny as I can see from this picture
that the left for him is causing many centers offer the convenient methods in
centers by some of the specialists like this going to college at the money Fiore
center who is available to consult on a specific patient problem.
I worked there for a patient to.
Circumstances require me to have your hand
when have you had your last speedy at the trial of law.
My plans over last months have they been always Regular know your periods.
Yes And how long do they last.
You know not days just from what psychiatric consultations are also possible in the
New York Center.
And being physicians take full advantage of the opportunity to talk over a specific
case problem reinforce this connection.
By all that's OK.
One of the most important members at any center is a dentist too so some of these
are almost always busy.
OK on a short practice will show you how we brought here at this event dental care
is an important aspect of family health care.
Our main consideration of course is clinical dentistry.
However we feel very important to begin a program of preventive dentistry with
instructions and died in nutrition
and we begin our preventive dentistry program with the basics and
that is instruction in home hygiene and home care.
Our assistance here are trained to continue the program.
By further instructing the families
and the children especially upon each visit to frighten doing three south side can
put it out and then the it go
and say leave your own toothbrush with your own name on it.
There you are now take your tourist back shows a
and take it home with you on the family help to make a maximum use of physicians
and then each team also dog upon the nurse with the public's help skills knows
and is known by her patients in a very special way this mother
and I have built up a tremendously They say I know my family.
I've been to their home you know the doctors in the family help me. We're her team.
Alone.
I mean of people saying your dad's best and to why you know where your best
and teams and we're interested in you not only in terms of the medical aspect
but how are you telling Dorian go.
On today and tell us how to take on a world secretary doing it.
We said
that it was fundamental to center philosophy to involve people from the neighborhood
in creative new health roles
and certainly one of the most creative is the idea of the family health worker a
family health worker is typically a woman.
There are expanding opportunities for men the role.
And always a person who lives in the neighborhood
and understands it's me it's people and it's community resources.
If the patient is unconscious you never take an oral temperature the
room effect health skills of care the Betfair checking vital find first aid in
elements of a nap
and passed some rigorous examinations to demonstrate their nothing to the family
health workers had a greater than the functional health care to some time
consulting close to the public health nurse who often serves as a team board for a
family health worker was given her days assignment which can include everything
from building a bed bath coronary patient to visiting a city hall to get action on
a housing violation.
For family health workers like where Kilmartin in New York from patient care often
begins by visiting in the home apartment
or tenement.
There she can check the entire family in their home environment.
Not just the mother was pregnant.
But also the children for whom she may well cigs. Things like diet change.
Or better oral hygiene
periodic intervals a family health worker make an appointment for the family at the
center here
and help in a number three this place never children will be given all the medical
attention. The recliner the mother
that means the obstetrician The baby's in the position
and the power be expected to deliver tolling the end of the
Santana. He's been feeling the last time I saw him.
This is an old timer
and that's the way it's working.
It centers all across the country pain medicine with the family health worker
bringing the doctor what he's lost the ability to see patients in the context of
their home and family
and what he never had a culture bred into the community
and now.
Listen again to the family health worker responds to the needs of the patients who
happens also to be in the neighbor
and a friend to me read you know your read on
it read back to my dad never been a sickly
person in my life or this clinic more and I wear one for Dappy in my last year
and the
patients come to their neighborhood.
Complicated eligibility requirements for the patients knowing the forms to fill out
a cold on a friendly environment. Top priority go to serving people.
And always patients are seen as people whose god needs are bound up with the other
circumstances of their life young feller
that are there isn't just of interest is a little boy whose mother kept a dangerous
washing machine
and one of the first things the center did was to send someone out with House to
hear some safety techniques to get little holes in your Gallardo there isn't
justified nation. His doctor knows that he is the head of a large family
and it's important for him to have an income producing job is a factor which will
be taken into account and history is sometimes that even this is good.
Scott complains ally is seen as a tired wife
and a mother of five who must be listened to learn responded to with attention
and respect not only because he needs to a ventilator feeling.
But because it allows the center to see where they may not be meeting patients need.
I said look this is my body.
So they listen to their patients both in the center
and on the job as a man can't get on board to come to the center a center worker
will go to him. They were in the middle of allowed to meet over here
and we help you with your family's health problems.
That's what they want to know.
On the job at home center workers go out where the patients are could tell them
about the health services available
and they tell it in the language of the people that are here.
So we would all get her down on the.
Well you know they think they can get back
to mass media.
If they live too far to make the trip from the sale the center bus will go get the
idea that the center must be accessible with top priority from the beginning.
And nobody is ever denied care because he lacks transportation.
Accessible medicine. It is excessively your own backyard to this elderly couple
and King City California. Yes they could come into the center for treatment
but all Mrs Menotti is always had a fear of hospital injections Any own grey Barber
are anywhere near a strike out we bring medicine to the consumer to the community
academic word to describe what really goes on in the not in the backyard
and their appreciation takes a form sanctioned by tradition call a carnie at your
peril this gift is given my sincerity in gratitude
and it's received the same.
From the outset the health center idea was based on the concept of community
participation
that residents in the centers neighborhood cared about the kind of services they
would they must have an influential voice in determining the way in which care was
delivered for center director is like Dr Rodney Hall and his staff and watch.
Community involvement means working with his health council a management group made
up of concerned community members selected by their neighbor to work is a crime.
The net nanny and that we know this
but I think one of the biggest problems is the lack of understanding what the pain
really means that.
A person who plays a key role has not had the kind of training
but I think you prescribe for all nationally
and that's never unhealthy All these are people who are serving
and interpret things communicating the roll back to the team
and he's still not accepted the doctors regard him as someone that's in the
professional
and the people such as the social workers the public health nurses all have
accepted his rule that because of no power.
I may buy the policy position and that's why not.
Recognize that let me write here.
The conflict is
that we can get in my experience the Community Health Council is one of the vital
channels of communication that serves our center.
You just can't get to the heart of things by using statistical survey.
You've got to get the community itself to a dentist by itself needs
and wants the consumer input is absolutely essential
that it must be in the context of a full partnership we get consumer participation
from the patients themselves the employees at the Center for Community residents.
And most significantly the community residents who are members of the Community
Health Board of Directors was
that program policy for the center make contact
with the implications for the future of this new kind of health care are
complicated entries in all their activities whether medical
dental pharmaceutical consultation
or laboratory the center to work with a medical institution in their area during
the medical school teaching hospital public health department
or a spam list a group.
A new way to deliver health care.
Yes in a great many important ways it is
and here in the center with their ties to the communities they serve their training
neighborhood people to take their part in the training programs
and to not only dental assistants family health workers laboratory technician X.
Ray technologist and other health specialists
but also keep on job with switchboard operators records specialist
and Secretary when our training is complete.
These people will be equipped to fill needs of the center itself
or go out into their community
and work in other facilities by creating new agers neighborhood health centers
or helping develop the financial health of the community as well as its physical
health is News
and is challenging
and is frustrating too because the problems are all solved yet by any means there
are still patients whose needs aren't being internist
that is by Still health workers not entirely at home with this new concept the
system is revolutionary and it is evolving.
It is inevitably confronting tough and complicated issues such as recruitment
and changing professional role is another
but the Neighborhood Health Center idea is well law
and its implications are far reaching as a flexible system which emphasizes the
full involvement of the consumer himself the health center principle may well be
useful. Not just as medicine for the poor but for medicine as a whole.
In case of a California
or the Southern Monterey County Medical Group operates the center.
Dr Len his Andrus
and his colleagues have successfully proved a private group practice can work
closely with govern. Agencies to fill gaps in health care with new services
and manpower.
Whole represent the really long working partnership between private physicians
and government working towards a single
and so far we have excellent relations with the real
story.
And so bring them a good word of people who never had a good American peer in their
lines in the development of our program the Oleo encouraged to develop any new
innovations we were capable of through our own initiative imagination
and I feel that it's just grand ended tomorrow
that we would never go back to playing.
C.N.N.'s new exactly the same as we did prior to the ground even with our private
patients because we were learning the techniques
and new techniques of delivering medical care and that
that changed our entire pattern of practice for the better.
I'm convinced. It's a beginning.
And while it's far from perfect.
It's like years away from what was there before this family health worker is an
expert on back. You have to live in the neighborhood.
You have to really be here know what a way of life before
and what a wonderful thing. Now has happened for the people at the center
and the problems are now than freshly tagalong
for my friends and my neighbors
and all of the people who do you hear today on this center is a very great thing I
talking for me it is a great thing to.
The rules on what care about even your boat your center yourself
that they didn't L.B.
Saw on opening day you come with a special prayer Thanksgiving
or good with one night
or no on the on
opening day the beginning of something important from this day the people of L.B.
Soul will have a health center of their own
and it is their own in the special way this anything you build yourself belongs to
you. Community Action this entire health area that within
that there is an effect and that at hand were perhaps more visible here
and I'll be sold on in some other areas or the idea
or maybe more difficult to obtain but it can be done because they did it.
So in the future days when they come here to have their sickness treated
and their hurts made well you can understand that if they feel very much at home.
That's part of what it means to have a sense.