"YOU know every resident is supposed to take some responsibility as part of the contract in public housing, but it doesn't work out. There's a lot of work that's unattractive." Dr. Eva J. Salber, the Director of the Martha May Eliot Family Health Center in Bromley-Heath, one of Boston's housing projects, stopped to dig out an article on the Center. A coworker took up the conversation. "Yes, there's rubbish in the halls, and it's not uncommon to find vomit on the steps or urine in the elevators."

Dr. Salber found the report, "A Community Child-Care Program," which outlined the history and goals of the Center.

Community health clinics originated in Boston in the early 1920's with "well child conferences," weekly treatment centers run by a voluntary nursing agency. Authority for these centers, whose practice was limited to preventive treatment of children, was transferred to the Boston Municipal Health Center by the end of the decade, and in 1929 each of the city's three medical schools took responsibility for some of the clinics. At Harvard this job was delegated to the Professor of Maternal and Child Health of the School of Public Health, and he continued to organize the informal weekly treatment centers for thirty years.

When Dr. Martha Eliot was named to this Professorship in 1957, she saw that one of the centers could serve as a demonstration unit for the testing of new public health concepts. She picked out the Bromley-Heath Clinic because of its proximity to the Harvard Medical School. After her death, a grant from the Office of Economic Opportunity in 1966 led to the expansion of the center's activities from weekly sessions for treatment of children to care of children and mothers five days a week.

With a full-time staff of doctors, nurses, dentists, and social workers, the Clinic needed a full-time director. Dr. Salber, who was then a Senior Research Associate in Epidemiology at the School of Public Health and a Scholar of the Radcliffe Institute, said she "wanted to get back into the social realm of medicine." She laughed and added, "I don't ever remember saying, 'Yes, I'll take it.' But somehow I found I had the job, and by August 1967, I was working there full-time."

Dr. Salber had had previous experience with public health. She was born and raised in Capetown, South Africa. After graduation from Capetown University Medical School, now made famous by Dr. Christian Barnaard, she and her husband went to work in a demonstration health center in Durban on the east coast of the country. These federally-operated clinics had been founded in 1945 by Henry Gluckman, a Cabinet Minister in the moderate United Party government. (The United Party is today strongly pro-apartheid.)

Durban was divided into sections for whites, Indians, coloreds, and Bantus (Negroes), and Dr. Salber and her husband, also a doctor, were working in the Bantu township. Though facilities were good and the work "terribly exciting," apartheid raised moral problems. Just outside the township was a settlement of 6000 Bantu men on contract labor, brought in from all around the country. Mothers complained to Dr. Salber that their daughters were being threatened, and malnutrition was a problem among the huge colony of men. Yet to complain to the government from a medical and humanitarian point of view inevitably led to a criticism of South African politics. Dr. Salber recalled, "There just wasn't very much you could do about health without getting involved in politics. It was very difficult to do this kind of work and live with yourself at the same time. Even in the United States, medicine is very much bound up with politics, but you feel that the federal government is progressive."

In 1948 the United Party fell and the Nationalist Party, with a rigid policy of total apartheid, came into power. Increasingly repressive laws, disguised as "Suppression of Communism Acts," silenced opposition and further limited what doctors like Dr. Salber could do for the native and mulatto population. Most white South Africans, Dr. Salber explained, were "shocked, but then they accepted the laws. Who wants to go to jail without a trial? We could see that it was going to be increasingly difficult for people who thought differently than the government. If you didn't agree, you had to shut up and live with it or leave." Then she added, "And the majority live very comfortably."

Neither Dr. Salber or her husband could live comfortably, though, and they were particularly anxious that their four children not grow up in such an atmosphere. When the Harvard School of Public Health offered Dr. Salber's husband a position in 1956, they were able to get their visa and move to the States. A few years after they left the clinic in Durban collapsed.

The Martha Eliot Health Center serves an area of four and a half census districts--that is, about 17,000 people in Jamaica Plain and a small part of Roxbury. Because restricted funding has limited care to mothers and children under 21, only approximately 8000 residents are potential patients. The Bromley-Heath housing project, where the center is located, is nearly all Negro, with a smattering of Cubans and Puerto Ricans. The dilapidated homes around the project belong to Negroes, Cubans, Puerto Ricans, Greeks, and some old Boston Irish-Catholics. Many of these old Irish families are unwilling to come for medical care into the housing project where they'd have to associate with minority groups. Though the area covered by the center does include some well-to-do middle class homes, like the high rise Jamaica Towers luxury apartments, most of the people are chronically poor.

The Bromley-Heath project is run by the Boston Housing Authority, a federally-financed state agency. To qualify for housing a family has to have a certain low level of income, and once this income ceiling is passed, a resident of the project has to move out. Thus, the project houses a reservoir of families who are incapable of independently earning a living. Over half of the 1200 families in the project have no male head, and sometimes the three or four children in the family are fathered by different men. About 50 per cent of the families in the project are on welfare.

Their apartments do provide a steady supply of heat and clean water, while instances of lead poisoning from faulty pipes are fairly routine

Like too many welfare programs, the clinic had been organized simply as a handout. Little concern was shown for the dignity of individuals. It was that kind of attitude that turned the poor to quacks who at least remembered their names and soothed their emotional if not their physical needs. in houses just outside the project. But fewer families in these homes--one-third of them--are without a father. And fewer of the women running these houses are on welfare: 75 per cent of them as compared with nearly 100 per cent in the housing project.

The malaise of poverty is pervasive, restricting opportunities before they even arise. Some of the kids in the area around the Center have never even been into central Boston, though it's just a trolley ride away. Poverty also has been linked to disease. Federal statistics show that for a person under 45 with an income of $10,000 or more the average number of visits to a physician is 5.0 per year. When the income level drops to under $3,000 visits drop to 3.2 per year. Even with free medical programs this discrepancy remains. In England after fifteen years experience with the National Health Service, it's the higher income groups that make better use of the program. And at the Martha Eliot Center, Dr. Salber said, the children have many more minor ailments than normally: colds, respiratory ailments, chronic coughs. "We wonder if they get their medicine," she said.

Beyond this lack of care, the stigma of poverty inevitably leads to more physical and mental damage. For example, two reports of the center's social workers illustrate the kind of "disease" that doesn't occur in middle-class families: