More Than Medicine. Jennifer Nelson
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disagreed as to whether OEO-supported NHCs were the proper vehicles with which to meet their common goal of creating a health care system that no longer neglected the poor. Levy argued that storefront clinics provided by groups such as the Black Panthers were better examples of reformed medical institutions for the poor because they were funded and operated entirely by black activists (although they also employed white medical professionals from entities such as the Student Health Organization to staff the clinics and raised funds from white supporters). Geiger countered that these were patchwork measures and largely ineffective because their services were so limited. He believed that federal dollars linked to an established medical delivery system in the form of hospitals, medical schools, and local departments of public health could be effectively utilized by local health care activists to achieve successful health reform.128
Most examples of SHO and Black Panther attempts to provide clinics for the poor confirmed Geiger’s criticism. White volunteer medical students who provided medical support in SHO summer clinics (which did receive federal funding through OEO) in poor urban areas and in Black Panther clinics often found that they garnered important educational experience from the work but did little to change overall medical provision for the poor over the long term. A handful of clinics set up to serve the poor, most of which, like SHO summer projects, were also temporary, could do little to transform a medical system that failed to provide for the vast majority of the poor in both large cities and rural areas. SHO disbanded its summer clinics for this reason.129
Levy’s critique of and Geiger’s support for the NHCs hinged on what each meant by community control and, specifically, on whether they thought that involvement by the “establishment” negated community control. Did community control necessarily mean that white professionals and federal government support needed to be absent? Geiger insisted that the resources held by professionals, medical institutions, and the federal government were too important to reject. He wrote,
Those resources are now in the hands of the Establishment institutions—the medical schools, the hospitals, and all the rest—and the funds needed to operate significant health services must come from the Establishment, and overwhelmingly from government itself. These institutions are now, properly, damned for their racism, their elitism, their indifference and hostility to the community, their exploitation of the poor, and their refusal to surrender even a share of their control to community/worker groups. But what if they are dragged by the community, or the workers, or the students, or some of their own professional staff into primary care and community action and community service, or even into new institution-building under community control?130
If we accept Geiger’s assertion that the presence of the “established” medical and government institutions did not by itself hinder health care reform, did NHC programs foster a real partnership between traditional medical providers—public health administrators and medical professionals—and local poor residents and consumers of health care? From evidence gathered for this chapter, it appears that the NHCs were mostly successful in their effort to involve the community in health care provision and in broadening the meaning of health care to better serve the real needs of poor communities. Much of that success, however, depended on the quality of community representation at a particular NHC. Hatch explained that “OEO programs were often planned as if poor communities had no viable social organization or structure. They, therefore, sought to create or sanction new structures rather than to conduct a hard analysis of what existed.”131 Geiger agreed with Hatch that community boards at NHCs could be more or less effective depending on how representative board members were of the local community. He also asserted that community worker involvement in the clinics impacted medical delivery much more consistently than did community board involvement. Medical administrators reported that community outreach workers often improved contact with and design of programs within a particular neighborhood. Maximum utilization of community workers, however, also required adequate training programs, which were also unevenly operated at the NHCs. In some of the more successful cases community workers were hired for nonprofessional reasons such as their intimate knowledge of the community but then trained to develop new career tracks as professional employees.132
It is very unlikely that such an extensive program of health care reform could have been realized or even minimally successful without strong federal support and some help from established medical providers.133 The program required both money and medical expertise ideally guided by those who most needed and used the resources but provided in dialogue with professionals who delivered technical expertise and services at least until community workers could be trained to deliver services themselves. A less successful (and much smaller) health care reform effort that took place in 1970 at Lincoln Hospital in the South Bronx, a city-run hospital affiliated with Albert Einstein College of Medicine, lacked both federal funding and broad support from the medical administration. This program’s failure to establish lasting reform lends credence to Geiger’s contention that some federal money and established medical involvement combined with community input were essential for any real sustained change.134
The Young Lords, a Puerto Rican nationalist organization modeled on the Black Panthers, and other activists involved in Lincoln Hospital reform efforts shared the goal of improving health care and its delivery within a very poor community with multiple socioeconomic problems that deeply affected health. Originally built in the nineteenth century for use by freedmen and women, Lincoln Hospital had long been considered a woefully inadequate provider of charity health care to the mostly black and Puerto Rican residents of the South Bronx. The vast majority of health care providers and staff at the hospital lived outside of the South Bronx community and did not use the services of the hospital. By the mid-1960s, senior medical staff, residents, and interns at Lincoln hospital became affiliated with Einstein Medical College, improving medical care somewhat. Yet, Einstein interns and residents who rotated through Lincoln to complete their medical educations had little commitment to the Bronx community. Most of the young physicians were foreigners from outside of the United States who were only in the South Bronx to complete their medical training. Furthermore, senior medical staff on the faculty at Einstein Medical College utilized the patient population for instructional purposes, often with little or no sense of obligation to the community.135
Health care reform activists contended that community involvement needed to be at the center of any reform effort so that Lincoln would serve the health needs of the neighborhood. Several protests occurring in 1969 and 1970 involving Young Lords and other community activists attempted to further this goal. In the first protest in July 1969, community workers who had been trained in the Lincoln Community Mental Health Program, operated out of an old nurses’ residence at the hospital, focused on gaining more community-worker control over the mental health services. Cleo Silvers, one of the staff protesters, recalled that they demanded that psychologists consider that poor people had very specific problems that could not be solved by middle-class theories of mental health care. They called for the replacement of the two psychiatrists who ran the program and for a section of the mental health unit to be devoted to welfare and poverty issues. After the protest, the worker/activists became more involved with local branches of the Young Lords and Black Panther Party.136
Nearly a year later, in June 1970, at Lincoln Hospital, another health care reform effort was organized by workers, community members, and the Young Lords. This diverse group called themselves Think Lincoln. To illustrate their demands for more community-worker input into hospital policy and health care delivery, activists staffed community complaint tables in the lobby of Lincoln Hospital. As health care reform activist Fitzhugh Mullan recalled, “The complaint table was intended as a mechanism to stimulate patient awareness and participation in the hospital.” Those who staffed the complaint table handed out leaflets and pamphlets about patient rights and community control. Signs placed near the table instructed patients to lodge grievances about the hospital at the table because it was “their hospital.”137
In many instances, activists at the table also acted as patient advocates. If a patient had complaints or questions that could be directed to a particular staff member, a Think Lincoln activist would help the patient locate the appropriate hospital worker or workers to find the answers. Often this system worked and many patients viewed the complaint table as a positive benefit that demonstrated that someone in the community cared enough to improve patient care at Lincoln. Some staff, however, felt under attack