Keeping Neighborhoods Healthy

Ten years ago a small group of North Cambridge residents decided they were fed up with the lack of health care services in their area of the city. They were tired of having only one doctor in the area, who charged $20 for house calls and would not accept Medicaid, and lacking nearby public transportation to the Cambridge Hospital. They were angry that it often took all day for elderly people to travel to the hospital to get their blood pressure checked and that the hospital would often overbook its schedule, forcing people to come back the next day.

They were mostly working-class people, and many of them lived in the Jefferson Park Housing Project. They had to live with the knowledge that large numbers of physicians lived and practiced in Cambridge, and they did not have access to those doctors and their isolated corner of the city was medically underserved.

So, in 1969 they decided to act. With the encouragement of Cambridge Hospital officials and other social service agencies, they formally requested the hospital to open a neighborhood health clinic in North Cambridge.

For the next ten years they followed up their application with persistent community pressure. In 1972 they obtained a certificate of need from the city. They struggled with the Cambridge Housing Authority for space to house the clinic in Jefferson Park. They raised money and applied for grants to renovate the rooms that the Housing Authority finally gave them. And, finally, the residents made the hospital live up to its commitment to install a full-service family clinic.

The North Cambridge Health Clinic opened in the Fall of 1977. It is now expanding its services to include pediatric care, capping the community's long effort to bring a full range of health services into the area.

Although the North Cambridge clinic may be one of the most conspicuous successes of grass-roots community organizing for health care in the city, it is only one of ten neighborhood health centers now operating in Cambridge (see box.)

The Cambridge Health Centers act as neighborhood branches of the Cambridge Hospital. They are staffed by teams of physicians, nurse practitioners, health aides, nutritionists, family planning counselors, social workers, psychiatrists, financial counselors and receptionists.

These health care teams provide a wide range of medical services. The North Cambridge Clinic, for example, offers physical examinations, obstetrics, gynecology, family planning, nutritional and psychiatric counseling, as well as pediatric services.

The Cambridge Department of Health and Hospitals supports the clinics, which also receive other public and private agencies.

The goal of the system is to offer quality health care in a neighborhood setting. It specifically attempts to bring services to the areas of the city which a recent Department of Health, Education and Welfare study found to be medically underserved--North Cambridge and the area between Central Square and MIT along Main St.

Dr. Hilary Worthen, medical director of the Cambridge Hospital's ambulatory care unit, says that "we have a special responsibility to the people in these areas" and the top priority is to provide greater access to services. Thus, besides being conveniently located, the clinics feature payment plans based on people's ability to pay, and provide interpreters for those whose who do not speak English.

The emphasis in the clinics is on quality, personalized care. The clinics' small size enables the community residents and the staff to meet in a friendly, non-threatening atmosphere. Many basic services are available right in the clinics, and only when necessary are patients referred to Cambridge Hospital for special care. In this way the clinics ensure that people get the care they need when they need it. The idea, as Worthen says, is to respond to people instead of automatically plugging them into the predetermined slots of a large institution.

The personalized nature of the clinics' health care is apparent in the thoroughness of the physical examinations. For example, Mary Ellen McConaghay, the nurse practitioner at the North Cambridge Clinic, stresses the importance of examining the whole person during a physical. She takes time to study not only the patient's physical health, but also examines social and psychological factors that may affect his physical well-being.

After taking basic bodily measures like blood pressure, weight and height, and doing urinalysis and blood tests, she talks to people about their medical, family and social histories, and tries to discover stressful situations that might be influencing their health. If she suspects that a bad family situation could be causing problems, she may then refer the person to one of the counselors or psychologists on the clinic's health care team. She then finishes the physical with a complete review of bodily systems.

The personalized nature of physical examinations points out something else the clinics stress: health maintenance. By encouraging simple, routine check-ups and by charging only what people can pay, the clinics hope to break people of the costly habit of seeking medical attention only when their illnesses require extensive care.

Through check-ups and other counseling programs, the clinic staffs are trying to help community residents understand how to prevent illness and stay healthy, as well as providing treatment for people once they become ill.

The Cambridge Neighborhood Health Centers are not without problems. Most important, many of them are severely underutilized. The clinics are a relatively new phenomenon and many neighborhood residents still think they must go to a hospital for good health care. Other residents believe the clinics are only for the poor. To combat these false beliefs, the clinics and community groups are starting publicity campaigns to spread the word about the available services to all Cambridge residents.

Besides being a new phenomenon, Cambridge's small, neighborhood-based health clinics are important in another way. The clinic system bucks the medical industry's tendency to create large, capital-intensive hospital centers.

Adult and Pediatric Health Clinics Neighborhood Family Care Center 105 Windsor Street

M.E. Fitzgerald Health Center 70 Rindge Avenue

North Cambridge Health & Social Services, Inc. Jefferson Park

Adult Health Clinics Riverside Clinic 5 Callender Street

Cambridgeport Clinic 150 Erie Street

Mary Castriotta Clinic 663 Cambridge Street

Pediatric Health Clinics King School Health Center 100 Putnam Avenue

Kennedy School Health Center 158 Spring Street

Harrington School Health Center 850 Cambridge Street

High School Health Center 1700 Cambridge Street

As one doctor at Cambridge Hospital said recently, the neighborhood health clinics, with their decentralized locations, personal atmospheres and emphasis on low-cost health maintenance, are places where those who believe in socialized medicine can gain a foothold.