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African Americans and Health Care

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Hardy L. Brown
As the debate heats up about Health Care Reform, the African American community had better toss in its two cents on the issue because something is going to happen during this session of congress. Any time you get the American Medical Association which represents most of America’s doctors, the pharmaceutical companies the health care insurance companies the hospital association, a democratic house and senate that is in agreement with a president who wants change something is going to happen regardless of what the Republican party leadership says. To that end the Black  community must get engaged in this conversation as it relates to careers as providers, cost of health care coverage, access to health care institutions, access to treatment once seen by providers, choice of providers with the many chronic care issues facing our people.  When I went to work with Kaiser Permanente Health Care organization back in 1970, I was involved with a special federally funded community based Comprehensive Health Care Program for an indigent population of 500 families covering a seven mile radius of the Kaiser Hospital in Fontana. The objective was clear, enroll the family, provide better care at a cost at or below what they were currently receiving and expand the coverage to other Kaiser Medical if successful. I knew nothing about health but I knew how to organize my community. Needless to say we were successful because within four years the program was all over Kaiser Southern California Medical Centers.

Something we learned about poor people regardless of race was that they had low expectations of themselves and their health care providers. Two, was access to health care institutions for service, public transportation was not convenient and taxi service was expensive and most did not have reliable personal transportation. Third, these families had less education, earned less money, had larger families, and had more chronic diseases like hypertension, sugar diabetes and all the other things that come with them. We also learned they had more negative encounters with our education, legal, public utility and other public institutions. Even with all those things against them we tapped into their fighting spirit of survival and the desire to be good citizens. They only wanted to be treated with respect and given information they could trust. I remember community activists like Kitty Holloway of North Fontana and Eva Cruz of Bloomington telling Kaiser if you are only coming to offer us something for a couple of years so you can feel good, then don’t come.

Once they were enrolled into the program every family member was scheduled for a complete health evaluation and assigned a personal family doctor for follow-up. Thus Kaiser started a new member health evaluation for all its new members regardless of coverage.  As I mentioned earlier of the other issues we had to add support services to make it work. Services like Neighborhood Health Service Counselors, transportation to bring some in for appointments, baby sitting services, dietitians, and drug and alcohol counselors. I know you say why. We found that many appointments were being missed because of these issues. These are some reasons many people today do not keep medical appointments regardless of income.

Doctors would give special instructions for diets they wanted the member to follow but did not take into consideration that the member could not purchase the food. So our dietitians were assigned to visit the member’s home for an evaluation of the family’s eating habits and educated on substitute foods that would accomplish what the doctor had ordered.

The Neighborhood Counselors were trained by us on how to be advocates for our families in the doctor’s office, schools and help with any barrier that was preventing the family from receiving the health care we offered. You might say this is costly but not as costly as having a professional medical staff waiting around for patients that do not show for appointments or fail to follow doctors instructions ones they leave the office. Doctors set up exercise clinics in conference rooms and at community centers closer to the people. As members were diagnosed with chemical dependency problems alcohol and drug counselors were hired by the program, thus the current Chemical Dependency Program was established and is now a regular part of the entire Kaiser Medical Care System.  This service was so good that other members including doctors wanted it expanded to all members.  We met with the public transportation company to alter bus routes and times that would better accommodate a low income population. The same was done with the taxi services in the seven mile service area. We also established a transportation fund to pay for night emergency trips when public transportation was not in service.  By Kaiser enrolling this population it created the need for more people of color to be on staff for a better understanding of the population it served. Many people of color, who had Kaiser coverage from their employment during that period, were paying for care in the local community from people who looked like and understood their needs. This issue of choice is still a major problem with many of us who have some coverage but don’t like where we get care but cannot change.

The other reason for us to get involved in the discussion is for what the late Dr. Raymond Kay, our medical consultant would always say to the Kaiser medical staff, if you don’t provide care to a portion of this population eventually the government will tell you what to do. In other words if people need care those who have will have to care for those need. It is clear to me that some form of health care reform is going to be legislated this year with or with out your input. African Americans are in need of careers and care so let us let the discussions begin in our home, churches, neighborhoods, beauty salons, barber shops, sororities, fraternities and other organizations.

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