For People, Not For Profit: A History of Fenway Health's First Forty Years
356
For People, Not For Profit: A History of Fenway Health's First Forty Years
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Product Details
| ISBN-13: | 9781477216996 |
|---|---|
| Publisher: | AuthorHouse |
| Publication date: | 06/12/2012 |
| Sold by: | Barnes & Noble |
| Format: | eBook |
| Pages: | 356 |
| File size: | 8 MB |
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FOR PEOPLE, NOT FOR PROFIT
A History of Fenway Health's First Forty YearsBy Thomas Martorelli
AuthorHouse
Copyright © 2012 Fenway HealthAll right reserved.
ISBN: 978-1-4772-1701-6
Chapter One
THE 1970S
"The Health Center didn't have one parent, or one anything. It's like the Mississippi River. It had a lot of different people doing a I of different things all over the place, which ended up being a river. But the river has a lot of tributaries from places you really would never expect, exactly." —David Scondras, a Fenway Community Health Center founder
In its earliest days, Fenway Health was more a project than an organization. A group of Fenway residents, students, medical professionals, political activists, and a Catholic nun were in charge. Today we might call them the original Board of Directors, if only to help us impose a sense of orderly progress on a time when no such structure existed or was even desired. Beginning in the late 1960s, this group, almost all of them under the age of 25, volunteered to take on the task of creating a local response to a number of local residents' needs, looking for problems that demanded solutions, and injustices that cried out for remedies. Consistent with a national rebellion against authority that was then called "the movement," they created a neighborhood safety net to change things for the better. They were innocent enough to believe that they could accomplish their goals through their own collective action. They saw the struggle for social change as a battle against the establishment," which they defined as anyone over 30, and believed that poverty, hunger, war, and sickness were caused as much by oppression as anything else. By their logic, if the neighborhood's, or the country's problems all had a common cause, the challenge of solving them would be a common struggle. Solving things one at time was missing the point. Collective action was their method of choice, and collective decision-making was the way they governed themselves.
They formed FIG, or the Fenway Interagency Group, as an umbrella organization where collective decision-making could be made, with representation of the many smaller groups that were active in the neighborhood at the time. These organizations included: the Tenants Action Group (TAG) to fight for tenants' rights and affordable rent; the Fenway Civic Association (FCA), to clean local streets, maintain parks, and protect residents from crime; the Edgerly Street Playground Association, to build and manage this resource for local children; The Fenway Free Life, a community newspaper; the Boston Center for Older Americans (BCOA), to improve the lives of older neighbors; and a local chapter of the American Friends Service (AFS), a national Quaker organization open to people of all faiths devoted to service, development, and peace programs throughout the world." The Fenway Community Health Center, as a member of FIG, had roots in the neighborhood while it was also affiliated with the fledgling social movements of gay liberation and feminism.
Many of the same individual community activists were involved in all of these organizations. They would simply meet and move from one project to the next, planning and then acting on their plans. Initially, there was no selection process for service. Once someone showed up for three meetings, he or she was a member, and could participate fully in governance. But showing up meant more than just debating and brainstorming. The same people who planned the playground went out and brought in sand, swings, and slides. After they decided to start the food coop, they staffed it, buying and distributing canned goods and staples to their neighbors. Some of these individuals also provided lunches to the elderly through the BCOA's Meals on Wheels program.
Together, the Fenway Interagency Group started and re-started a food cooperative, succeeding on the third try, and launched a newspaper, The Fenway Free Life, which took only two. They formed a tenants' rights organization and opened a playground on a vacant lot across the street from the Health Center's second location at 16 Haviland Street. On weekend evenings, they hung sheets from an adjacent wall to show children's movies they checked out from the Boston Public Library. They hosted social programs for seniors at the Boston Center for Older Americans (BCOA), whose 236A Huntington Avenue headquarters were located in office space rented from the Christian Science Church. They held many of their meetings in the Westland Avenue Community Center, a neighborhood haven for the movement. There, in 1970, Fenway neighborhood activists began a medical referral program using the Center's telephones. They collaborated with the fledgling Homophile Community Health Services, perhaps Boston's first gay health organization, and with the Boston Women's Health Book Collective, which had produced a mimeographed health education program called Our Bodies, Ourselves. When they determined that local residents were experiencing roadblocks to health care, such as gay people seeking respectful, confidential care; young college women seeking medical services without the risk of having it reported to their parents; or the elderly having difficulty navigating the streets to get to one of the city's hospitals, they launched a free medical clinic. Across the city of Boston, other community health centers were forming in response to their own issues regarding access to care, whether they were language barriers, cultural mores, the mental health needs of people in the neighborhood, or the problem of drugs on the streets.
When it came to the Health Center, Fenway's volunteers solicited equipment from an elderly doctor in the Back Bay, who willed the contents of his office to them when he died, and moved it into the clinic's original location at the BCOA's 236A Huntington Avenue offices in 1971. They recruited volunteer doctors and nurses to staff the clinic one night per week (on Thursdays) and served without pay as intake workers. Fenway Health's founders acquired the clinic's 16 Haviland Street location shortly thereafter, readying it for its opening in 1973 by volunteering their own labor to construct a number of features-the flooring, front door, and raised basement window bars—that still exist today. The clinic's waiting area was furnished with seats salvaged from the old Fenway Theater on Boylston Street, an historic movie theater that had fallen on hard times and had been purchased by the Berklee School of Music to become today's Berklee Performance Center.
Technically, both before its incorporation in 1972 and throughout the 1970s, Fenway Community Health Center was not only a sub-group of Fenway's larger collective of neighborhood volunteers; it was also a loose confederation of three of its own internal collectives. The Women's Health Collective, Gay Health Collective, and the Elderly Health Collective were autonomous, volunteer units operating out of the Fenway center," as Ronald Vachon, a Physician Assistant and one of Fenway Health's first paid employees, stated in a Boston Globe article about the organization in February of 1978. Each Collective took one night per week to operate a free walk-in clinic, and each of them met independently to plan programs, recruit volunteers, and debate policy and management issues. Each had ties to other organizations in Boston growing from the nascent social movements sweeping the country, which brought talented people and vibrant ideas to Fenway's Board of Directors. Their sense of independence from each other and allegiance to broader political ideals from outside the neighborhood eventually caused problems as the center grew and choices had to be made on behalf of Fenway Community Health Center as a whole. This was particularly true when one of these decisions went against the interests of another collective. But in the early days, everyone went to everyone else's meetings, so the only real impact was the time it took for any individual meeting to end.
Many other tributaries, from near and far away, brought big ideas and opportunities to Fenway's founders. Some were national trends that swept Fenway along in changes to America's health care system, like health care free clinics and women's self-help. Others were city government innovations designed to decentralize city services and health care delivery in Boston. There were advances in education—medicine and music—that opened doors for its founders to create Fenway's role as a health center in Boston's system of care, and in the neighborhood. Through it all, in the early days, there were politics, lots and lots of politics. Sometimes Fenway Community Health Center's founders would side with fellow neighborhood activists, and sometimes they would side with the establishment. Sharing patients' names or medical information with government funding sources would remain a political challenge throughout the 1970s and even into the 1980s, as organizers grappled with demands from the gay and women's liberation movements for the right to anonymous care, while placating the establishment's demands for uniformity of care and record-keeping. Ironically, the experiences of these early struggles and decisions prepared Fenway for its future leadership role in HIV/AIDS research and clinical care. Its work on issues of self-help, privacy, and anonymity (i.e. no named medical records at all, just aggregated information) vs. confidentiality (keeping physical records but not revealing names to outside organizations) enabled Boston's smallest community health center to guide the city's large hospitals and government agencies in developing protective patient care systems for those with secrets.
In 1970, an organization called the Boston Women's Health Book Collective, published Women and Their Bodies, a 193-page stapled course booklet that was republished a year later by the New England Free Press as the first edition of Our Bodies, Ourselves, to advance its beliefs that:
Women, as informed health consumers, are catalysts for social change.
"Women can become their own health experts, particularly through discussing issues of health and sexuality with each other.
"Health consumers have a right to know about controversies surrounding medical practices and about where consensus among medical experts maybe forming.
"Women comprise the largest segment of health workers, health consumers, and health decision-makers for their families and communities, but are underrepresented in positions of influence and policy making.
"A pathology/disease approach to normal life events (birthing, menopause, aging, death) is not an effective way in which to consider health or structure a health system."
The idea that women ought to be in control of their own health care was new and inspiring at the time, as was the emphasis on education and prevention in health care, the demand for increased dialogue with "medical experts," and the challenge to the prevailing health system.
There are many anecdotes but little written documentation of Fenway's philosophical struggles in its evolution from a free clinic to a licensed community health center. But an analogy can be made from The Cambridge Women's Community Health Center (CWCHC), which was incorporated in 1974 as "a feminist institution which seeks radical social change by implementing the concept of self-help; the sharing of skills and information so that women can regain control of our health and our lives." This organization was founded in 1971 by feminist women, who occupied Harvard's Architectural Technology Workshop, at 888 Memorial Drive, on International Women's Day, March 6, 1971. The CWCHC began offering the same type of self-help health education programs and gynecological services that Fenway's Women's Health Collective provided, including education of paramedics, lesbian health groups, natural birth control, and information on herbal self help therapies. By 1975, the Cambridge Women's Community Health Center was performing first trimester abortions, a service Fenway never offered. Consistent with the values of the Boston Women's Health Book Collaborative and Fenway, CWCHC provided patients with printed information on women's health topics. Its staff gave presentations on "well-woman healthcare" and slide presentations on the components of a good gynecological exam and women-controlled abortions. In 1976, the center operated a pelvic teaching program for the Harvard Medical School in which CWCHC staff acted as instructors and patients for medical students learning to perform gynecological exams. The program broke down, however, because CWCHC staff felt that they were only valued by the medical school in their role as informed patients while their ideas on self-help and women-controlled exams were being ignored. Ultimately, the Cambridge Women's Health Center ceased operations in 1981 and the medical records of its patients were incorporated into Fenway Community Health Center that same year.
Following is a section from the April, 1978, edition of On Our Way, the newsletter published by the Cambridge Women's Community Health Center, providing an insight into the struggles of an organization trying to remain true to its founders' original mission while grappling with the requirements of clinic licensure:
Dear Sisters,
"The Massachusetts Department of Public Health (DPH) has issued an ultimatum to Women's Community Health, the state's only feminist health center offering abortion care. In a letter dated March 2, the DPH threatened to deny the Center's application for a clinic license and take legal action to close Women's Community Health, if various certificates pertaining to clinic licensure are not in the hands of DPH officials by May 31, 1978.
Women's Community Health, which offers a variety of health care services under physicians' licenses as well as educational self-help programs, is currently renovating office space in Central Square in order to satisfy extensive physical plant requirements for clinic licensure. The DPH has notified the Center that 'relocating' before obtaining a clinic license will be considered a criminal offense. All of the required certificates, however, must be obtained for new location before licensure. Again it is unclear what the DPH is requiring of Women's Community Health (WCH). WCH is investigating the meaning of the seeming 'catch 22s.'
"... Specific attempts to harass abortion providers, especially Women's Community Health, have been escalating since Nov., when State Representative Flynn persuaded the Post Audit Committee of the legislature to ask the Attorney General to rule on the legality of health facilities operating while in process of obtaining a clinic license.
Although the Attorney General decided it would be improper to make a ruling on the specific questions posed by the Committee, he has pressured the DPH to take action against unlicensed facilities, especially abortion facilities. The DPH has responded by reversing their policies to operate while in process of becoming licensed. In the future, any facility seeking clinic licensure will be required to obtain the license before offering health care services. This is a severe blow to all small, community or consumer based groups. Only those with access to large amounts of money will be able to open clinics, making it even harder for people to have control over their own health care.
Women at WCH see the campaign to deny abortion rights as a spearhead in a much broader political movement against women, Black and other Third World people, homosexuals, and other oppressed groups who have been organizing to take more control over their lives."
"... It is vital that women demonstrate our determination to fight for our right to control our own bodies and our health care. We must not allow the state to close feminist health centers like Women's Community Health!"
Several insights into the state of community health services in Boston in 1978 can be found in this letter. First of all, there is the fact that, until the late 1970s, a practicing health center could continue to provide medical services without its own license, using the individual credentials of its professional medical staff. Fenway Community Health Center did so for nearly ten years, until its application for a license as a medical clinic was submitted in 1978 and ultimately approved in 1981. The Massachusetts Department of Public Health would charge Fenway and CWCHC with operating an unlicensed health center, but chose to allow them to apply for a license instead of shutting them down. Note that, like Fenway, CWCHC provided "a variety of health care services under physicians' licenses as well as educational self-help programs." It's likely from the wording of this sentence that CWCHC, like Fenway, provided educational self-help programs using volunteers without medical credentials, a major hurdle in the way of licensure. Without that license, health clinics like Fenway or CWCHC could not directly bill insurance companies, Medicare, or Medicaid, and they could not claim to provide medical care as part of their self-help services.
(Continues...)
Excerpted from FOR PEOPLE, NOT FOR PROFIT by Thomas Martorelli Copyright © 2012 by Fenway Health. Excerpted by permission of AuthorHouse. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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Table of Contents
Contents
DEDICATION....................IV ACKNOWLEDGMENTS....................VI FOREWORD....................IX INTRODUCTION....................XIOverview....................2
Care....................26
Education....................44
Advocacy....................51
Leadership....................60
Overview....................68
Care....................92
Research....................123
Education....................146
Advocacy....................160
Leadership....................171
Overview....................204
Care....................214
Research....................238
Education....................256
Advocacy....................265
Leadership....................276
CONCLUSION....................288
END NOTES....................293
APPENDIX....................303