Thursday, January 3, 2013

Community and Health Centers

With all due respect to middle class hospital administrators, I wish to shake up a common misconception, a false assumption, about community health centers.

Here’s an image: if you take your magical chain saw, lop off a big corner of the hospital, big enough to have several rooms, then tie a giant rope around it and fly it off by magical helicopter and land it in the community, what do you have? A small hospital. Not a community health center.

When the city was about to make a “small hospital” error, they first had a public meeting. There the administrators found themselves confronted by people from an existing old community health center. (This is dimly remembered hearsay, from an Alexandra community health center nurse who was present) The first question stopped them in their tracks: “Is the board of directors going to be more than half members of the community?” After a few more questions the doctors admitted they didn’t know what a community health center was, and they went back to the drawing board, humbler and wiser.

As you know, such centers are often set up in the older, shabbier areas within walking distance of downtown. Here’s an image: One evening I was standing on the sidewalk along skid row, surrounded by other men, just outside a shabby bar that featured exotic dancers. One of the dancers was outside, protesting. It seems that, supposedly due to “fire regulations” she was not being allowed to perform her act. So she there she was, outside, along with an evening television news crew. As she juggled her flaming batons amidst the bright camera spotlight, something not unexpected occurred: The spotlight panned the crowd. Not everyone had an outstanding arrest warrant, and not everyone was avoiding a spouse, but everyone instinctively moved away, producing a tide of people moving backward.

The point is that although “all men are equal” these men were not merely “just like the middle class only with less money” No. These people experienced different daily concerns than the middle class did. About this time the doctors started up the “community” health clinic “at 8th and 8th” This was, unfortunately, before the aforementioned public forum. From viewing that clinic, I can almost guarantee that no one outside the hospital community was in on the planning. The doctors assumed they knew better. Not so.

Unfortunately, on entering the clinic, the first thing you see is a uniformed authority figure. I shake my head: What were they thinking? I can guarantee you that even minimum wage humble rent-a-cops won’t wear their uniforms into a skid row bar. After entering the clinic, if you are nervous about having a social disease, and you wish to use the washroom, you must go down and around a long hallway, on your very first visit when you don’t know your way around yet, get a key, and then make your way along a different long hall, past the guard, and find the washroom far away from the door. Again I ask: What were they thinking?

Some of the downtown people are aboriginal youth, and some of them are quite artistic. I like how their lines, unlike mine, vary in width. Well. Have any of them been invited to paint flowing lines and homey pictures on the walls? No. Instead the clinic has forbidding long barren white walls. Yes, these white walls are “home sweet home” to a doctor, and yes the walls would look nice and pretty to a middle class guy like Steve Jobs, who liked minimalism. But the inner city is where people like collecting sentimental stuff, where few can define minimalism—and many are fearful of hospitals… with white walls. Yet again I ask: What were they thinking?

Never mind the hospital-medical model. In a hospital, a patient’s number one priority is to get well. In a community served by a health center the folks have their own priorities for themselves and their community… Folks like my mother. While growing up, she was a typical talkative Irish girl. One day she stopped speaking… Luckily, others in the community noticed. The community health nurse, after finding sores in the girl’s mouth, then gave dietary support to the girl’s mamma. My Grandma didn’t know any better: This was a few years before the government publicized its wartime research into the four food groups.

Now I sit here at my shiny black desk, middle class and middle aged. I can still dimly remember the old Alexandra community health center. Alas, it has long been closed. (But it flung off two pieces) It’s been years since I lingered on skid row or entered that “new” 8th and 8th clinic. Maybe it has changed. And maybe people across America no longer assume they know what a community health center is.

Sean Crawford
West of the Mississippi river
December 2012
Footnote: I have a short funny version that I wrote by "free fall" archived in April 2015. 

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