so. yeah, yeah.

i know i lived in this neighborhood for about two years now and i'm used to the sound of the elevator train and of the streets. well, cars sit around in the gutter. i think the waking life, the kids. some people, i think and it's colorful. you know. but when you live here you call it something else because it's born of doesn't look good or smell good or being especially not you're sick and not your body hurt and you want to make it. well, it took a while, but we've got a good answer to sickness in this part of new york. it's part of a new idea that's going on in other cities. do you know all over the country here in the bronx, we call it the montefiore neighborhood

health center, where people from my neighborhood come to have their sickness treated and made well, you are entering a new world of health care. it draws upon the same science and uses the same instruments and equipment that health services traditionally do. but yet in it's philosophy and its practice, it is different in some startling and significant ways. here in new york's montefiore health center and in its counterparts in other american cities and towns, this concept of care has profoundly affected both the health professional and the patient. in york, a lot, though they never had a doctor before, at least not one who knew his name and, his medical history. he had much swelling in your legs. yeah, it's just adaptations in a way, to keep cool. that is so sad. would hope so. be that i don't run from it because my dad, mrs. skinner, is getting on in years and it never entered her mind that she'd

getting so much interest attention in a place devoted to medical care. so saying, don't kill me and don't. i thought, you know, have something to do with your heart. mrs. hitchcock complains about a lot of things, but she never thought complaining her medical care would make a difference. but it is if i took the pills. but every time i the pill instead of my arm and stop hurting it hurt. and then my chest would hurt up about. and just a few short months ago, it certainly occurred to many of these people that they'd be helping shape the entire in which their neighborhoods health care was to be offered. but they are and the medical people are listening. this is the story of, a new kind of comprehensive health and the way it is being offered in 36 american cities. and towns. it is the story of a unique and creative approach to the health of its consumers, which where they are, listens when they talk

answers, when they question and perhaps important of all, accepts their advice on how it can best serve needs. it is the story of a health care philosophy which could well apply not just to the poor, but to everyone and the whole approach of medicine in the future. right now, hundreds, thousands of americans are utilizing it every day through their neighborhood health center. i'm dr. roger achterberg dean of the university of southern california's school of medicine. this film describes a 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 poor has inadequate, for instance, hard to in personal fragmented in that kind of a setting quality, often suffered. and today are probably 30 million people who are not receive the kind of care we all deserve. now with people in their neighborhoods working together with professionals and, the planning and operation of these centers, there are some new ideas and new directions that we should all be of. so let's a closer look at some of the problems and what neighborhood health centers doing about them.

if you're poor, poverty poor and you live in places, these sickness can be a life long blanket, a kind of vicious circle described by physician who said the sick get poorer and the poor get sicker. if you're poor and sick there are some mighty discouraging barriers between you good medical care. barriers like transport. and standing out here for a half an hour waiting for the bus come along. if you one. no telling. how long you have to wait. and then you get to a hospital. you've got to wait for more. very hard. you get to hospital when you have to get your kids all dressed that. get yourself dressed and you very very sick. then you have to. so to bus.

so i never go until i'm nearly dead before i go. even before i the kids because it's difficult at long distances no predictable way to get there or get home later only the most serious illness can drag you out. about 2 hours. and once you are there what they're very. sure you have to be to go. physicians and other medical people have got a supremely difficult job under immense pressures in their countries. emergency rooms and clinics. but as so many physicians, emergency rooms just weren't for that job. well, emergency rooms were designed to handle catastrophes of all kinds. and when the medical or surgical need is of top urgency, they and their highly trained staff

function smoothly and efficiently. the team in emergency rooms all over the country functioned with supreme. and they're presented with the kind of emergencies for which this place was designed designed. but the role of the emergency room has changed over the years. and now people bring routine problems. if you had to take three busses to get here for a ten hour taxi ride, you're very likely to wait until you're really sick or $10 sick, as they used to say in one unfortunate they are being $10 sick, often not getting well very fast. as dr. achterberg knows, so. underlying all this is the inescapable fact that there are hardly enough doctors to go around as medicine now practiced in this country to add 30 million patients and 15 hours of

extra work each to every doctor's workload would throw the whole medical into chaos. the fact is, we need to explore new of delivering health care, health care to everybody, not just the poor. and this means using as many people as we can to extend the hands of the doctors. something that is being tried in neighborhood health centers. the health problems that plague the city ghettos, the migrant camps, the wherever they were concerned, physicians and health professionals, all over the country and exploration creative solutions was top. and with the of the office of economic opportunity. the surge became known as the health right programs. and so it began in the city ghettos and country towns.

something was happening. members of the health professions working closely with the ohio had begun to implement the idea of community medicine and action. the idea was to high quality, accessible. one door care where the whole family has health needs could be met. they called it the neighborhood health center. and the neighborhood was so involved in it that a little towns like lbc or california, they built it themselves. there's more just hammer and saw participation. this is a community because this group voluntarily building its own center has a unity of that can address other problems. and as they break for lunch,

they may well talk about things like housing and education, welfare, community worker tom you're adel puts it this way. through the experience of attacking a specific problem and with one another they've begun to the relationship of such things as health problems. the lack of housing lack of education and a lack of response by the institutions and the society that so dramatically affects 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 possibly to change some of the other areas of their life. so with the vigorous and necessary help of community workers like tom here are now dramatically deprived people of communities like l.b. so we're themselves. a health in this neighborhood? that's right. and it wasn't even, frankly, to resemble a chilly, impersonal

emergency room. this was going to be accessible. and if they had anything to say it, it was going to be given in the best looking building in town. the centers didn't have to be magnificent or even elaborate begin with. seven. francisco's first orders were in hospital growing up around this attractive courtyard. but they did have be convenient and comfortable and easy of access with pleasant waiting rooms, which neighborhood people would feel welcome and at home. i suppose people aren't so far outside the mainstream of medical that they don't want what other people want perhaps most dignified leave. they want what health professionals themselves want and i like my picture on it. they want private offices. now you tell me, is this comfortable? yeah. i should go and call. they want quiet examining room.

they are open at. why. they want a comfortable conference where a warm and lasting can be established between. health professionals and patients. when i sat a, they just say, look, don't go anywhere obstetrics. and without putting though, i find that in this doctor patient relationship we are able to establish is more than just the ordinary back to a patient relationship but rather that of a friendship in which we're not interested only in the pregnancy but on the whole. and i feel that centers as this should be only interested in providing health care, but also in raising the standard of living and giving hope for future generations to. you see. a fundamental and most important concept, the health center, is to offer patients, family care,

medical service through an approach with tremendous for the whole medical field. it's called team medicine, and it's offered by a highly group whose members respond to patient needs, both medical and social. the typical health team is made up of physicians, usually internist and pediatrician. though, including an obstetrician to a dentist, a public health nurse and, one or more new health specialists called family health workers. when a family registers at the center, it is assigned to a health team, which will be responsible for all of its health needs. so it's possible for an entire to come in at once and each member be seen the appropriate person on their team in order to protect your voice, you retain back on the table. guy and the extra right.

and while his father is getting attention down the hall, young, spunky, getting his pediatric workup as a member of. the team. the pediatric man has the unique opportunity to use his pediatric training. the best advantage he wind up spending half of his as a clerk or a record taker social worker as a nurse or receptionist. all of the members of the team can attribute as coach with their own specialized area of expertise. well, why don't we see in my particular case i've found over months that more and more i have to rely upon the other members of the team to do their part of the job. and so i've had time to concentrate what i can do best and how i want to help entire family and the patient in their

total medical care. then let me know and i'll get the social worker to talk to you and maybe give you some help because he's at a pretty rough age right now without a diet and, the diet may be a little bit too much for him to handle. i think as far as i can see from this picture, that's left for the team's position. not many centers offer that convenient advantage of in center specialist specialists. this gynecologist at the montefiore center who is available to consult specific patient problems. i wanted to refer a patient to a circumstance that requires that of your tummy. now, have you when have you had your last period. right. the 12th of last month. 12th of last month. have they been always regular your periods? yes. and how long do they last. you have five days to. from what? psychiatric consultations are also possible in the new york center and team physicians take advantage of the opportunity to talk over a specific case

problem, reinforce connection, and by following. that's right. okay. one of the most important team members at center is the dentist whose facilities are almost always busy and ensure we practice. we'll show you how. we brush our teeth. here at the center, care is an important aspect of family health care. our main consideration, of course, is clinical. however, feel it very important to begin a program of preventive dentistry with instructions and diet and nutrition. feel. we begin our preventive dentistry program with the basics and that instruction in home hygiene, home care. our assistants here are trained to continue the program by further instructing the families and the children especially upon each visit already to for us and doing through self care and put it off.

then don asked f j for instead of your own toothbrush, with your own name on it, or say, there you are, not take your toothbrush, jose, and take it home with you. and the family helped make the maximum use of physicians, dentists. each team also upon the nurse with public health skills who knows and is known by her in a very special way. this mother and i have built a tremendous relationship. i know our family. i've been to her home. she knows the doctors and the family health work where team hers alone. i mean it's people saying you're that special to us you know we're your special team and we're interested in you not only terms of the medical aspects, but how are your children doing in school this time? sun today is going to tell us how take an oral temperature while you're it. we said that it was fundamental to center philosophy to involve

people. the neighborhood in creative new health and certainly one of the most creative is the idea of the family health worker and the family health worker is typically a woman. so there are expanding opportunities, women in the role and always a person who lives in the neighborhood and understands it needs its people and its community resources. if the patient is unconscious, you never take an oral temperature. in the such health skills or care of the bed fasd. checking vital signs, first aid and elements of anatomy and passed some rigorous examinations to demonstrate their knowledge. these family health workers are integrated into the functioning health care team and come in sometime within the next couple of weeks consulting closely with the public health nurse who often serves as team coordinator. the family health worker has given her days assignments, which can include everything from visiting a bed past

coronary patient to visiting city hall to get action on a housing violation. i want to bill for family health workers like martinez in new york's bronx patient care often begins visiting in the home apartment tenement. there can check the entire family in home environment, not just mother who is pregnant, but also the children for whom she may well suggest things like diet changes or better oral hygiene. have have periodic get around the family worker, make an appointment for the family. the center here in health number three. this patient, her children, will be given all of the medical attention they require for the mother. that means the obstetrician who

think it's all right. the baby's in good and we'll probably expect her deliver towards the end of the month. and you need to get those baby to win. but also you pay. iraq a better place as ms. santana health has been feeling since the last time i saw her in the turkey. this american, the simplest physical, only thing i could give my name and billing. i'm going. to give my home and one brother here i'm how one and that's the way it's working it centers all across the country team medicine with the family 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 cultural bridge into the community and mr. beltran. and as you're walking now know listen in again the family health responds to the needs of a patient who happens also to be

a neighbor and a friend so it catches me right in you know right in there and then you go around i don't if one of my real owner of my the rest of this sick part of my shoulder. oh i don't want to go back to mike so i have never been no leave person in my life and i've come to this clinic and i ever went to a doctor in my life you don't gain from. it some of the patients come to their neighborhood health center. there aren't complicated eligibility requirements for the patients. no lengthy forms to fill out in cold and friendly environs once top priority goes, serving people and always patients are seen as people whose health needs are bound up with the other circumstances their lives. young salvadoran isn't just an injured wrist. he's a little boy whose mother

kept dangerous washing machine. and one of the first things the center did was to send someone out to his house to share some safety techniques. and he had went to a call senor gallardo. there isn't just a heart patient. his doctor knows that he's the head of a large family and it's important for him to have an income producing job and their factor which will be taken into account in his treatment known all the time, is sometimes if even mrs. hitchcock, who complains a lot is seen as a tired wife and a mother of five who must be listened to and respond to with attention and respect, not only because she needs to ventilate her feelings, but because it allows the center to see where they not be meeting patient need. i said, look, this is my body. so they listen to their patients both in the center and on the job. if a man can't off work to come to the center, a center worker will go to him.

even in the middle of a plowed tomato field. can we help you with? your family's health problems? well, that's what they want to know. on the job or at home, center workers go out where the patients are to tell them about the health services available. and they tell it in the of the people at that address. you looking for as on and being there for having sell enough so that when there's this hurricane in dallas the classic. but we're losing you than being middle class but if live too far to make the trip themselves, the center bus will go get them. the idea that the center must accessible was top priority

from, the beginning, and nobody is ever care because you lack transport, you. accessible medicine. it's as accessible as your backyard to this elderly couple. in king city, california, yes, they could come into the center for treatment, but oh, mrs. bernardi has always had a fear of hospital and injections of your own great barber aren't anywhere near threatening outreach, bringing medicine to the consumer, the community, academic to describe what really goes in the benighted backyard and their appreciation takes form sanctioned by tradition. call a carny at your peril. this gift is given with sincere in gratitude and is received the same way. you know good thing that good and where from the outset the health center idea was based on the concept of community participation that residents in

the neighborhood cared about the kind of they would have and that they must have an influential voice in determining the way in which care was delivered. we can't get poor center directors like dr. rodney powell and his staff in what community involvement means working with his health council, a management group made up of concerned community members selected by their neighbor head, an opportunity to work in clinics that met many of them. we know that this is i think one of the biggest problems is the lack understanding what the team really means and the person who has the plays a key role has not had the kind of training. but i think you'd prescribe for him initially. and that's the neighborhood health agent. oh, these are people who are serving in that interpretive communicative advocacy role. back to the teams. and no one pays any attention to him. he's still not accepting it. the doctors regard him as someone less than a professional and the people such as the

social and the public health nurses still accepted his role. that's because dealing from a position of no power. i think by that ability in dealing with powerless position. and that's why he's not recognized. well that that's the conflict let me identify right here the conflict that we can get people that who can do it in. my experience the community health council is one of the vital channels communication that serves our center you just can't get to the heart of things by using statistical surveys you've got to get the community itself to identify its health and once the consumer input is absolutely essential and it must be in the context full partnership we get consumer participation from the patients themselves. the employees at the center for our community and most the community residents who are members of the community health council, the board of directors who set program policy for the center. they find out about the supposed

be able to make contact with anybody regardless to the level of the first time we the implications for the future of this new kind of health care complicated and intriguing and all of their activities, whether medical, dental dental, pharmaceutical, consultation laboratory. the center's with a medical institution in. their area usually a medical teaching hospital, public health department or established in group practice. a new way to deliver health care. yes, in a great many important it is. and here in the center what their ties to the communities serve. they are training neighborhoods, people to take their part in it. the training programs include not only assistant family, health workers, laboratory technicians, x-ray technologist

and other specialists, but also key punch operators, switchboard operators, record specialist and when their training is complete, these people will be equipped to fill need that the center itself or go out into their community and, work in other facilities by new wage earners and neighborhood centers, or helping develop the financial health of the community as well as its physical health. this new and it's challenging and it's frustrating to because the problems aren't solved yet by any means. there are still patients whose needs aren't being entirely satisfied. still health workers, not entirely home with this new concept of care. the system is evolutionary and energy evolving is inevitably confronting tough and complicated issues such as recruitment and changing professional roles and others. but the neighborhood center idea

is well launched and its implications far reaching as a flexible system which, emphasizes full involvement of the himself. the health center principle may well be useful not just as medicine for the poor, but for medicine as a whole. doctor, my job in kings city, california, or the southern monterey county medical, operates the center. dr. len andrus and his colleagues have successfully improved the private group practice work closely with government agencies to fill gaps in health care, with new services and manpower manpower. we hope represent a real working partnership between private physicians and government. working the same goal and. so far we've had actually

relations with washington and, we've had real friends brilliance of bringing better medical to people. never before found adequate medical care in their lives. and the development of our program. we owe you encourage us to develop any innovations that we would capable of through our own initiative, imagination and. i feel that this grant ended tomorrow that we would never go back to practicing medicine exactly the same as we did prior to the grant. even with our private patients, because we've learned learned techniques and used of delivering medical care that that changed our our entire pattern of practice for the better. i'm convinced. it's a beginning and while it's far from perfect, it's light years away from what was there

before. let's the family health worker is an expert on that you have to live in this neighborhood you have to really be here to know what it was like and what a wonderful thing now has happened for the people's health. the center has not solved all the problems. our schools and houses and primary. but for friends and my neighbors and all the people who live here to them this center is a very great thing. i'm talking for me. it is a great thing to to. be on again, on. and when you built your center yourself as they did in lethal on opening day, you come with prayer and thanksgiving. oh, oh, no.

in my grown on the day and i have gone by all your. opening day. the of something important from this day the people of be so we'll have a health center of their home and it is home and the special way that anything you build your self belongs to you community action this entire health center is evidence that there is such a thing and that it can work. perhaps is more visible here and how be sold and in some other areas where the ideal may be more difficult to obtain, but it can done because they did it. so in future days when they come here to have their sickness treated and their hurts made well, you can understand it if they feel very much at home. that's part of what it means to

have a center center. calledwhen i first started to pn

this weekend, i came up with this theme, the information war. one of the attendees i was chatting me about spies and espionage and that kind of thing. and my ears perked up and i thought that would be an interesting topic. so i broaden that a bit to think t