The New Ghetto Medicine

...Harlem is able to offer little beyond the scant essentials of the most rapid and depersonalized service...

...Top doctors from the other institutions threatened to refuse to accept budget cuts, for they too were feeling pressures...

...Many of those concerned with ghetto medicine had been ambivalent about the change, fearing the public corporation would prove so autonomous that it would be largely immune from community pressures...

...Although about 50 of the hospital's beds are occupied by elderly patients who should be in the nonexistent chronic care centers, that particular social problem is minor compared with narcotics addiction...

...Very likely, this was inevitable...

...Some of the doctors are cynical about this, saying that addicts come primarily for free narcotics...

...This was to be Harlem's share of a 5 per cent cut in state aid to the city, and it would have sliced into the very vitals of the medical service...

...But the Black Revolution, the war on poverty, a new generation of doctors and socially conscious black nurses have filled those intervening years...

...Faced with this steady erosion of city and state funds...

...First appropriations for it were made 12 years ago...

...Harlem became associated with Columbia's College of Physicians and Surgeons, and in six years the level of staff professionalism has risen considerably...

...The police knew to bring the boy to the Harlem Hospital emergency operating room, for it is among the best in treating acute traumas such as knife and gunshot wounds...

...She says that she has a daughter and six grandchildren, but they won't take her in anymore...

...On this particular evening, a range of diseases and problems that most hospitals would not treat in a year paraded past a mere handful of doctors...

...It therefore seemed almost natural for the board to threaten to close the hospital if the budget cuts were not rescinded...

...Originally, a 900-bed hospital was planned, but because Medicare and Medicaid provisions stipulate semi-private accommodations, it will have only 800...

...But she has nowhere to go...

...Herbert Cave, a small black doctor in a long white coat, looked up over the throats of a dozen microphones and, speaking in a voice charged with emotion, announced that Harlem Hospital would close...

...As it is now, say an old lady comes in with a sprained ankle...

...Still, Harlem Hospital has remained a sad mirror of the ghetto it serves...

...With the emergence of the Black Revolution, they became natural focal points of change and conflict...

...The hospital will benefit, too, from a new hospital reorganization bill, the first major reform since the affiliation plan, that will transform the present unwieldy hospital bureaucracy into a public corporation this fall...

...So we check her blood pressure...

...After buttressing their own complaints with a general survey of on-duty staff conditions during the March 18 evening tour, they refused to work in intensive care...

...Ray E. Trussell, "injured and sick patients were sitting on benches because there were no beds...

...six were receiving intravenous liquids...

...among those who do not, of apathy and alienation...

...They come only at the last moment, driven by pain and wounds, or simply because there is no place else in the area where they have to be taken in...

...Early last March, for example, 18 nurses of Harlem's intensive care unit decided they could no longer tolerate their working conditions...

...1 am told, that not only have the physicians been so united and purposefully involved, but that the various community groups have been solidly behind us," said emergency ward director Forde...

...People will stand up and make more demands, both as receivers and deliverers of that care...

...And being the only comprehensive hospital available to the 350,000 residents of a community that is devoid of old people's homes, nursing homes, narcotic detoxification centers, family clinics, or psychological services, it is the "dumping ground" for all the social, psychological and medical problems of Harlem...

...and finally, no sleeping quarters have been provided for the medical staff...

...From my point of view—because of the inflation in the costs of medical care—we're right back where we were ten years ago...

...Harlem's stand bristled backs throughout the municipal hospital system...

...time and time again the opening day has been pushed back, and the rising tempo of demands for completion has helped unite the community leaders as nothing before...

...Charles A. Ragon, concedes...

...What you have is a conservative state legislature...

...You can't find a scapegoat," he added...

...ground was broken in 1962...

...The situation, moreover, was not much better throughout the municipal hospital system...

...Bernad, a husky black surgeon with round burning eyes and a rolling sailor's walk, was not exaggerating...

...On March 18, there were only seven registered nurses, 25 practical nurses and 38 nurse's aides on hand to care for 788 patients and a steady stream of emergencies off the street...

...There will be many new services, such as community psychiatry and health education, that will reach out into the ghetto...

...T. W. Roberts, director of pathology, interviewed just after he performed an autopsy on a 16-year-old girl who had died of an overdose of drugs, considers narcotics addiction, alcoholism and cirrhosis of the liver absolutely endemic to the area...

...As part of the overall decentralization compromise in Albany, however, a companion bill provides for the immediate establishment of Harlem Hospital as a separate operation, making it a major experiment in decentralization...

...Harlem's doctors might not be so expansive, and they may very well be wondering where their new activism will lead...

...The result was the Trussell affiliation plan, by which university medical schools were paid to staff the municipal system...

...We take an X-ray and we find out that there's no fracture...

...But even if one should want to attempt withdrawal, he would find himself out of luck...

...Medicine, then, is a class phenomenon as well as being a profession (even at Harlem, where more doctors come from relatively humble backgrounds), and if many doctors are much more than benevolent entrepreneurs, they are certainly far from civil rights activists...

...The decision to close was backed by ministers, politicians, community leaders, as well as by the hospital's house staff, nurses and nurses-in-training...

...More, they have started to become political animals, as indicated by the theme reiterated in the rallies and meetings during the closing crisis: The Harlem community was through being used politically...

...But the other doctors and paramedical staff were busy elsewhere...

...As Commissioner of Hospitals Joseph V. Teren-zio has pointed out, "Hopes and demands for health care have risen...

...Bob Wallace, director of health education services, offers one explanation: "People have to take too much bullshit...

...a new political role is being thrust upon ghetto hospitals...

...They had no legal right either, since Harlem is a municipal hospital and the doctors are merely employes...

...The pale blue structure looks like an exotic temple among the liquor stores, pawnshops, small groceries, and takeout food places along Lenox Avenue...

...George Goodman, chairman of the Citizens' Committee of 100 for the new hospital, feels these programs will fare well because "there is an esprit cle corps that there never was before...

...The hospital finally reopened on April 17, after assurances from the city that $1 million would be provided to hire personnel to staff the new building, that a freeze on hiring other new employes would be lifted, and that Bellevue Hospital would accept overflow patients...

...Patients were lying in beds with fractures five days old which had not been set...

...And yet we have only one social worker here in the ward—one social worker on a daytime shift...

...and one was attached to a cardiac monitor that the practical nurse did not know how to read...

...Poor health indices, such as an infant mortality rate three to four times that among whites, have not changed because the basic conditions of the community have remained constant...

...The last major reform of the hospital, almost a decade ago, did nothing to lessen community fears...

...If we were Presbyterian Hospital, we'd put an ace bandage on and send her home...

...Almost a quarter of those admitted died—not a surprising figure, since the poor have neither the time, money nor psychology to think of their bodies as precious mechanisms...

...Nevertheless, most of the patients we see are at the end stages of various diseases," observed Dr...

...Now do you see what I mean...

...New York's Methadone program has a long waiting list, and it takes at least a year before treatment can begin...

...Thus the medical board's decision to close was made by thoroughly middle-class men, and in making the announcement...

...The American Medical Association's own statistics show that in 1964 34 per cent of all physicians in the nation came from the top 3 per cent of the socio-economic strata, while only 12 per cent came from the bottom 54 per cent...

...Only 11 of them will be black, despite an attempt to contact all fourth-year Negro medical students in the country...

...Five were drug addicts...

...It costs $97 a day for the average patient here, and it's inconceivable why it can't be realized that it would be cheaper to have some chronic care centers...

...In fact, a remarkable rapport is growing between hospital staffs and community spokesmen...

...I just don't know the cause of drug addiction, alcoholism and overcrowding...

...For almost a month, Harlem's out-patient clinics remained unused, its emergency room and beds available only to the most acute cases...

...The obvious solution, almost everyone in the medical profession seemed to agree, was to tap that expertise...

...Unquestionably, it is the hospitals that foster this...

...See...

...Harlem has become a good place to become a good doctor...

...They're on the move...

...A message had just came from the city Department of Hospitals that $4.5 million would have to be pared off the hospital's proposed budget for the next fiscal year...

...In the old main building, where 25 of the 323 patients required intravenous liquids that could only be mixed by a registered nurse, none was on duty...

...Bernad called out, "Help, I need some help...

...Before, the community always talked of Harlem doctors as being part of the Establishment, but now everyone is together...

...At Harlem, one element of this new rapport has been the struggle surrounding the still unopened 18-story new main building that stands next to the old soot-stained complex...

...Patients get abused by clerks, elevator operators, everyone...

...According to the traditional ethic of medicine, the 20-mem-ber board and Cave, the chairman, had no moral right to turn away sick patients in a political ploy...

...Indeed, a decade ago they might have acquiesced, and the Harlem community would have known little of the situation...

...In addition, the voluntary agencies involved in non-drug-induced rehabilitation are contracting their programs because the state has cut their budgets by 25 per cent for the next fiscal year...

...At that time, according to the then Commissioner of Hospitals Dr...

...Canute Bernad said as he cleaned a deep wound in the arm of a man who sat in sleek green pants, a sheathed knife sticking from his side pocket, streams of blood gushing onto the floor...

...Until recently beds lined corridor walls in many wards...

...Bad as conditions were in the intensive care unit, though, the survey showed they were much worse in the wards...

...They have distressing social problems as well...

...For in the emergency room of New York's Harlem Hospital, all the raw nerve ends of America's foremost black community come together...

...Fifty-five of the patients in that same building were being attended to only by semiskilled nurse's aides...

...The conditions that so outrage Bernad and his colleagues have existed for years...

...One politician, at least, came away from an afternoon with area residents and medical professionals approving this new spirit...

...Its medical board, he said, was "no longer willing to assume the responsibility for trying to provide hospital care with inadequate facilities...

...Harlem Hospital and community spokesmen achieved unparalleled solidarity...

...Kenneth A. Forde, director of the emergency ward...

...Few have any outspoken commitment to community control or decentralization...

...Next year it will have 52 American-trained interns, the sole municipal hospital to achieve its full quota...

...With this prospect, added funds, and the new addition about to open, it might seem that a new era has arrived...

...Now Medicare and Medicaid have been cut back...

...Laurence Leamer, a previous contributor, graduated this year from the Columbia School of Journalism and is now on the staff of Newsweek...

...Al Hammerling, a young white former teacher who heads one of the drug education programs at the hospital, noted: "You could go to any one of the local high schools and take urine samples, and I wouldn't be surprised if 75 per cent of them came back dirty...

...Cave quoted not from Brother Malcolm or Brother Eldredge but from President John F. Kennedy ("the torch has been passed to a new generation...

...These included knife and gunshot wounds, a stump of a hand dripping puss, hysteria, pregnancies, a 100-year-old man with a minor complaint...

...Nevertheless, the new building can mean the beginning of better health care...

...Medical professionals and their patients, though, are learning that they have much in common...

...Politically, Harlem's poor remain largely anesthetized...

...the emergency room will have no area where patients can be temporarily observed and can change clothes...

...A couple of other girls had taken her into the bathroom and shot her up with their works...

...It was difficult," admitted Evelyn Thomas, a registered nurse, "but it seemed better to risk our professional careers and go out...

...The new generation of ghetto medical prac-ticioners is learning that if they are concerned about improving health care, it is not enough to be simply "doctors," "interns" or "nurses"?they must minister to social and political ills as well...

...Agenda for the Democrats?2...

...The staff itself has a new cohesion and self-respect, and the doctors have partially shed their traditional medical role...

...Still, most of the doctors, in their starchy white coats and rigid schedules, are rather reluctant revolutionaries...

...Last year the grimy red-brick complex that comprises the 865-bed hospital admitted over 5,000 patients while serving 127,000 in its emergency room (30,000 is considered a major emergency room by the Department of Health), and 239,000 in its out-patient clinic...

...There's just no sense of urgency...

...The community always feared the hospital, but now I'm optimistic about the kind of rapport that has grown up between the community and the professional staff...

...It's a recognition of political power, that just talking individually just doesn't get results...

...The new main building is inadequate...

...he yelled at me gruffly, his fierce eyes blazing until assistance finally arrived several minutes later...

...technology and medical demands have changed so in a decade that in many ways it was outmoded before completion...

...For the personnel, it is the most frustrating kind of medicine...

...Clearly, though, socially conscious medicine is a heady, stimulating business...

...Like the 19 other municipal hospitals—and unlike the nonprofit, "voluntary," university medical centers or the profit-making "proprietary institutions"—Harlem must treat everyone in its locale...

...He had been going down the steps of his tenement when someone knifed him...

...The patients themselves have long regarded the hospital as a "butcher shop," fearing and mistrusting the doctors...

...Because of added revenues from Medicare and Medicaid in the past four years, it has cut its hospital budget from $175 down to $135 million...

...Fortunately, medical personnel at Harlem and elsewhere have begun to realize that traditional medicine is not capable of meeting the needs of the black community...

...Two policemen hurriedly wheeled in a stretcher containing a thin 10-year-old boy in black-and-white sneakers, jeans and a T-shirt drenched in blood...

...This is the first time...

...The community support, in turn, came primarily from middle-class blacks who often go elsewhere for medical care, not from the masses of poor who—surly, sullen or subdued—wait in line for treatment at the hospital...

...It has also established a framework for the "new medicine," which is only in its nascence but has already led to several actions that in another era would have been seen as violations of the Hippo-cratic Oath...

...And to talk about how many patients you have, or how many doctors you have, is equally meaningless unless you talk about second-class citizens...

...In the postwar technocratic age, the innovators and first-rate doctors had been drawn to the great university medical centers and their voluntary hospitals...

...They've fully decided that they're not going to abide the things that can be corrected...

...As Dr...

...The telephone system still works so intermittently that sometimes it takes two hours to reach someone else in the hospital, and patients have died when doctors have been unable to use the phone...

...Hospitals and schools are the two main institutions that carry the flag of middle-class American life deep into the inner-city slums...

...A sense of urgency has been missing in the city government, too...

...The health care of this community can hardly be approached by health resources," the silvery-haired physician says...

...Thus, the hospital can be no more than a holding operation, as even its director of medicine...

...Just recently, we had a little 11-year-old girl brought in here from I. S. 201...

...I think it's extremely important," New York's junior Republican Senator, Charles Goodell, said while riding back downtown...

...As Cave said in his cramped office during the end of the crisis, "If anything comes out of this, a lot of professionals will take a second look at the dealing of hospital services to the poor...

...It's a little high, and we admit her...

...In 8K, a typical ward in the K building, one practical nurse and one nurse's aide cared for 39 patients...

...Actually, the struggle for decent medical care is just beginning...

...Of course you're going to have such rates...

...The blood bank is far too small...

...Phillip Stewart, director of the hospital's medical clinics, says in a voice far softer than his words: "When somebody talks about the tubercular rate or this rate or that rate, that man is either a fool or a hypocrite...

...Because there are practically no residential treatment centers for narcotics addiction in central Harlem, another 40-50 of the regular beds are usually filled with patients who are drug addicts...

...Statistics and poignant descriptions by themselves, however, serve little purpose...

...The nurses' decision acted as a catalyst for a protest of unprecedented proportions...

...On March 22, Dr...

...We are having to admit patients solely because of social problems," continued Forde, a black surgeon whose intensity is masked by an engaging openness...

...Among those who care, there is an air of perpetual crisis...

...When the doctors looked the girl over, they found that she had gonorrhea...