"First seen in this clinic by Dr. Jones when the mohter brought Timothy, age 5, in for a swelling under the arm. She also brought in Susan, 11, and Kathy, 7. Susan is a very intelligent girl and has been chosen for the Latin School Test from her school. She has failed the eye tests and should be wearing glasses. She has very little sight in her left eye. She was referred to the doctor for an eye examination. Kathy also has eye difficulty.
Kathy is a bed wetter and mother wondered if it was because of mental strain. It seems as though when mother was in the hospital having her last child, the father molested Kathy. She was very ashamed and has not yet talked to ther mother about it, but has told all the children in the neighborhood as well as her sister who in turn told her mother. It was said that the children have been exposed entirely too much to sex. The parents still have a great amount of sex attraction for each other and hide nothing from the children." 2. Mother has been known to have psychosomatic complaints and poor health care follow-up. Brutality to child in past, burn on girl's face.
Other cases, running all the way from extreme brutality to "routine" separations have convinced Dr. Salber and her staff that to attack ill health in a ghetto must involve an attack on the social problems that result in physical and mental difficulties.
The poor are crisis-oriented. They neglect preventive care, and often delay in seeking help when a serious problem arises. Too often the practitioners they select are the local subprofessional quacks who have infiltrated and won the confidence of the neighborhood because they are racially and socially no different than the poor. The middle class, white doctors and nurses are different: They don't live with the poor, they just make their living from them. Even when the care is free, the delicate problem of winning the acceptance of the community remains. Dr. Salber and her staff organized a propaganda program during the past summer. News of the facilities and available care was preached from pulpits and spread through leaflets.
Merely to tell the poor of the existence of the Center, though, was not enough. Some kind of clinic has existed in the area for forty years, but the number of patients seeking care was far below the potential limit. Like too many welfare programs, the clinic had been organized simply as a handout: "Here's the center. Now you take it or leave it." Little concern was shown for the dignity of individuals. Patients had to wait in line to see a doctor who might or might not be the same one as last time. Examinations might be carried out in an impersonal manner that seemed to indicate to the patient that the system regarded him as just another burden. It was that kind of attitude that turned the poor to the quacks who at least remembered their names and soothed their emotional if not their physical ills.
The handout syndrome still characterizes welfare programs and, in particular, some of the clinics organized by city hospitals. The personalization of service was one of Dr. Salber's first steps as Director of the Center. Each patient is now given an appointment with the doctor of his choice, and to insure that they'll continue to come to the Center, patients are given new appointments before they leave. An attitude of "We care" has resulted in a tenfold growth in the number of mothers and children being seen.
Still there remains the question: Is this enough? Dr. Salber and her staff say it isn't. But they're bucking decades of medical tradition. "Our funders, the Children's Bureau of the Office of Economic Opportunity and the Mass. Dept. of Public Health, still demand body counts: how many did you see?, what were the diagnoses?, etc. Nobody asks you what community activities you and your staff carried out. This interaction of the staff and the community right in their homes is much more important in getting to the roots of the problems than are the number of people each pediatrician sees," Dr. Salber said.
Medicaid, the much heralded medical plan of New York State, falls far short of humanitarian medical practice, as Dr. Salber explained. A cumbersome registration program with a humiliating and involved inquiry into family finances may turn away many, and those that persist will often find the kind of impersonal attention that Dr. Salber did away with at the Eliot Center. Only when physicians take time to explain problems in laymen's language, only when the patient is voluntarily involved in deciding what the proper treatment is, and only when social as well as medical assistance is provided will patients willingly follow through with medical care and reverse the common notion that the poor are unwilling to cooperate. To treat symptoms and then send a patient back into the environment that breeds these illnesses is inhumane folly.
Dr. Salber has been seeking an expansion of the Center that would permit it to serve everyone in a family, not just children and mothers. "We are community-oriented, but we
While social workers can get to the root causes of the social, mental, and physical disease faced by doctors of the poor, a medical approach to social work can make the ticklish problem of "getting into" a family easier. It's not respectable to be poor or unemployed, but it's respectable to be sick.