Volume XV, No.1 \,J'LI/ILJ'I\...4 Power Community Healthcare Berlin CarSharing Interviews Building For Pedestrians $5.00
In this issue ... There is no secret to making the pieces of a sustainable community. You can find variants of the recipe in every succesful grassroots project. Look at health care; the examples of the White Bird Clinic in Eugene, Oregon and the Westside Clinic in Santa Cruz, California. They organized volunteers, raised funds, bought property, obtained committments from medical practitioners, and creatively tackled some of their cities' most difficult health issues. They have become indispensible in a relatively short time in the life of two communities. People put tremendous energy into such projects, and in return these projects offer them the opportunity to solve local problems. Creating opportunities for community-minded work and economic relationships: this was the intent of the Rochdale Co-op on the outskirts of newly industrial Manchester. They helped fix the exploitative exchange of goods in their day. Whether one considers oneself an activist, a community-organizer, an environmental business person, or just someone trying to point out better ways of doing things, the key to success always lies in the oportunities you give people to make change for the better. Santa Cruz' People Power bike group has created a transport center so cyclists can help to make their dreams come true. STAITAUTO, Berlin's car-sharing group featured in the last issue of RAIN, has helped thousands of their fellow urbanites to live without owning a private automobile. The founders, who have helped create nearly 100 car-sharing groups in other cities, have some well-seasoned advice for people trying to create car co-ops and reduce a city's dependence on automobiles. Front Cover Photo A man holding a bike around 1910. Notice the fender on the back wheel, but not on the front. This must have made for a dirty ride. Photo slightly cropped: Oregon Historical Society, Orhi 72470 # 1060. Back Cover Photo This adventurous women, named Murielle, set out to see the United States by bike and rail. Probably didn't need to get a permit to take her bike along! Oregon Historical Society, Orhi 27044 # 1060. RAIN Volume XV, Number 1 Summer 1996 Above, Jim Denevan delivers organic produce by bike from Santa Cruz Farms to the farmer's market. See page 15. 2 White Bird Clinic 6 12 13 19 This community-supported health clinic is run as a collective, with lots of volunteers. Find out some of the tricks for keeping clinics open. Westside Clinic Teaching people how to look after their own health is the key to low-cost heathcare. This clinic passes along preventative information in a way that everyone understands, while taking care of the sick. The Hub Bring together all the different kinds of bicycle organizations (recreational, racing, way-of-life) in a city under one roof and you can greatly magnify each group's resources and political clout. People Power Good weather alone won't make a great bicycling and pedestrian city. What counts is the action of many neighbors to create their vision of paradise, step-by-step. Here's one group's story. The Bike Column Transportation innovation is what's needed to overcome health-sapping pollution and nerve wracking congestion. Find out how to recover the 40-60% of land in American cities dedicated to parking lots. Things can be done to change these wastelands and create instead beautiful mixed-use areas, where the birds sing, neighbors socialize and the kids can walk to school safely. The Column has examples of projects that are working.
26 Pedestrian Action 28 Explore the ways walkers are creating coalitions to gain influence and make changes at the street level. From Walking Buses to traffic calming, find the resources to make your town more walkable. Walking feeds the heart with joy! Transit Advocacy & Bike Sources Experience Portland, Oregon's fantastic downtown transit. Discover how cities can make the best use of existing railway tracks for lightrail and street cars. Also, uncover unusual publications you can use to convey to those around you your enthusiasm for diverse transportation choices. 32 Rochdale 36 44 56 Cooperation for a better society is not just a modern phenomenon. People have been doing it forever to make their lives easier. Find out about the power of working with your neighbors to gain more control over your quality of life. Time Underground Rube and Fydor Cartoon Travel with your favorite cartoon dogs through time travel tunnels to Salzburg, Austria in 1526. The head muckity-muck, the Archbishop, is sent back to his castle. The town's canines have decided to run their own affairs. CarSharing Interviews Interviews with Carsten Petersen and Markus Petersen, founders of Europe's largest carsharing firm, STATTAUTO Berlin. Find answers to questions that came up after we published the article in RAIN, Volume 14, No.4 on carsharing in Berlin. Learn how to make it work in your town. CarSharing Resources Most information about carsharing is in German, except for here in RAIN Magazine, where you can order many useful resources for your quest to create an alternative to private car ownership. Don't forget to get a copy of RAIN, Volume 14, No.4, if you haven't read much of anything on the subject. $5 per magazine. 57 Order Form I Distributors Get a gift subscription or back issues for yourself, or for your public library. You'll be spreading the tools for a cleaner, better tommorrow. 58 61 61 61 Back Issues List RAIN Magazine publishes information that is useful forever. Gain insight into how to make your body healthier and your home safer. Learn how to galvanize your community into action for the next generation's future. Writer's Guidelines We spend much time looking for brilliant and inspiring projects that make a positive difference. Let us know if there is something we should describe to our eager readers. Better yet, try your hand at explaining it in your own words. See the contributor's guidelines as a reference. Credits All the wonderful people who have helped. Raindrops A note to librarians. Next Issue ! Community Architecture: what is needed to help architects and planners become sensitive to both ecology and community? Articles on programs, institutions and principles of community-directed design. Auto-free development: real projects aiming to develop land with barely any realtionship to cars. Eco-Mongolia: a revolutionary new set of environmental laws in Mongolia may change the destructive habits of third-world development. Food and Aprovecho: a first-world research institute practices what it preaches to developing regions. RAIN Summer 1996 Volume XV, Number 1 Page 1
By Marc Bouvier American politicians need to keep working on national health care. Forty million Americans, one-third of them children, have no health insurance and this number is increasing by more than a million each year. Further, the inefficiency in the health care industry results in nearly a quarter of the cost going to administration. Even if Congress agreed tomorrow to create a complete health care system, one where no one would be neglected, it would take years to implement. But it's not impossible. A small clinic in Oregon has demonstrated for twenty-five years that low cost, high-quality health care can be made available to even the most economically disenfranchised. White Bird Clinic opened in February, 1970 when two University of Oregon graduate psychology students saw people on the streets of Eugene who needed mental and medical care. By the end of the first year, with close to 100 volunteers and a small paid staff, they created a crisis line, a drop-in center for people who had bad drug experiences, and a clinic where doctors saw walk-ins once a week. White Bird began like many other free clinics founded around the nation during the late '60s and early '70s. Many of these clinics have folded, others have ceased to rely on volunteers, and some, like the famed Haight Ashbury clinic, have survived by providing very specialized services. Few remaining clinics manage the diversity of services that White Bird does. White Bird offers free 24-hour crisis intervention counseling, and help in finding the appropriate assistance from the wide variety of agencies and programs in the County. White Bird has become known in the community for providing low-cost and free medical treatment, includPage 2 RAIN Summer 1996 Volume XV, Number 1 li ic ing exams, medication and lab testing. The clinic also was the first to offer anonymous AIDS testing in the County. In an effort to improve services for lower income residents, White Bird has opened a new, inexpensive dental treatment center. Low-cost counseling is available through White Bird for individuals and couples. Recently the agency has begun an outpatient chemical dependency program that includes both acupuncture treatments and counseling sessions. Many of the people who provide White Bird's services are volunteers who have been trained in White Bird's own School of Human Service. Nearly everyone involved with White Bird spends time on the crisis line. Most new trainees tend to want to solve the caller's problem. Although they may resolve the immediate issue, they may not address what put the caller in crisis. One White Bird trainer says, "We want our volunteers to learn that it's not enough to just patch a person up and send them back out. We have to assist each person calling to develop tools to deal with the problem in its larger context." Beyond this basic philosophy, the counseling or medical approach is as unique as the particular practitioner. White Bird has conventional and naturopathic physicians on staff and some do nutrition counseling. Some counselors apply rather more esoteric practices such as tarot or astrology in their work.
Most are political activists, in that they recognize how socio-cultural issues relate to individual troubles. It's a continual challenge, but this diverse group of 250 volunteers and the small paid staff continue to work together as a collective. Although White Bird began with a more conventional hierarchical structure, during all these years of consensus decision-making the members don't recall any serious deadlock. That's because collective members allow themselves to fully discuss issues, taking the necessary hours to decide as a group whether to serve coffee or apply for a particular grant. For example, a few members wanted a Christmas tree for the lobby. Some believed that in a secular institution, religious symbols had no place. Those involved compromised by putting up a small tree with no religious symbols and a sign that said the tree was not a religious symbol. In many large, hierarchical organizations, employees lack negotiation skills to resolve disputes amongst themselves. They often find themselves calling upon a supervisor for guidance. At White Bird everyone is urged to work with each other to settle disagreements and training is provided to assist this process. If one-to-one discussions do not work, disputers may meet with a facilitator. Beyond that, a dispute may go to the departments involved, then a community meeting, or at last resort the board of directors. Most problems, however, are quickly resolved in the first or second step, Left, White Bird is managed and run through a relaxed collective decision-making process that involves paid staff and volunteers. Right top, a beautiful Clinic building that provides space for the outpatient drug treatment program and case management offices for the homeless program. Right below, the rear of the building which connects to a yurt meeting room. This locally-made, lowcost, easy-to-install yurt is nestled beneath several shadeproviding trees. It adjoins a small, garden space with carefully placed benches where patients and workers come for a little health-giving relaxation and serenity. RAIN Summer 1996 Volume XV, Number 1 Page 3
Above, White Bird's CAHOOTS van workers can provide transport to detox and referrals, on-the-spot counseling, and help to domestic violence victims after the perpetrator has been removed by the police. Page 4 RAIN Summer 1996 Volume XV, Number 1 now that there are many old-timers experienced in settling issues. Despite its success, White Bird occasionally suffers because of its collective status. Unfortunately, despite its success, White Bird has occasionally suffered because of its collective status. One of the United States' largest and most well-known charitable agencies, United Way, refused_to fund White Bird for years because it wanted a single authority figure to deal with. White Bird members would respond, "Well, we have a Wednesday evening meeting you can attend." United Way finally dropped its requirement because of White Bird's excellent reputation and funded the medical clinic, one of the least controversial of White Bird's programs, and eventually it gave additional funding. Despite its counterculture origins, White Bird is increasingly gaining recognition from local government officials and other human service agencies because of their good quality work with difficult clients. Also, having trained a couple thousand people in its school, nearly three quarters of all local social service providers employ former White Bird volunteers or staff members. Many are impressed that White Bird also provides medical care in such diverse environments as rock concerts, university football games and the Oregon Country Fair (See RAIN, Volume 14, No.3). White Bird is working with an increasing number of unemployed and homeless people, yvho are often economic refugees from the declining timber industry. White Bird continues to survive financially through local government contracts, small client fees, and a little bit of luck. Because it also continues to rely on a large volunteer staff, only 10% of White Bird's budget goes to
administration. Further, in 1980, the members decided that future funding must be from an ethical source and for the kind of activities that they could all agree the collective should provide. White Bird has the good fortune of owning some of the buildings it uses. The original founders had the foresight to buy the present property with its two buildings when the agency was barely a year old. The arrangement at the time of purchase was that White Bird would make payments for seven years, then one large balloon payment. In a story fit for fiction, the widow who owned the property refinanced White Bird's mortgage to spite the real estate group that wouldn't return her calls when she first wanted to sell the property in the thirties. Longtime collective member Bob Dritz believes that White Bird continues to thrive because of such luck, and because it has continued to adapt to changing times. But most significantly, White Bird thrives because of the dedication and insights of the ever-changing volunteers. "Old time radicals can become the status quo," he warns. For those who want to repeat what White Bird has done in their community, Dritz recommends "Look at what's around you. We designed the clinic around the people, rather than creating a model clinic and putting it around the people. It isn't a chain store." In an era when most conventional medical and mental health practices remain expensive and lacking in individualized care, White Bird is a beautiful and viable alternative, rooted firmly in an understanding of its local community. White Bird Clinic's main offices are located at 341 East 12th Avenue, Eugene, Oregon 97401. (505) 342-8255. Marc Bouvier is an experienced community activist, a non-profit consultant and a chemical dependency counselor. Left, White Bird's low-income dental clinic at 1400 Mill Street. Right, the streets near the old Clinic are lined with majestic old trees, with bike and bus routes that provide access to a diversity of clientele. RAIN Summer 1996 Volume XV, Number 1 Page 5
Westside Clinic :~ . Page 6 RAIN Summer 1996 Volume XV, Number 1 By Eric Bellfort A week after "La Migra" raided El Barrio for suspected illegal aliens, the streets were peaceful with the bruised, hollow quiet that follows a violent storm. This same uneasy calm pervaded the waiting room of Santa Cruz's Westside Community Health Center. The clinic was busy that afternoon, but mostly with routine problems: a few cases of flu, kids with ear infections, and an older man complaining of chest pains. The medical assistants and practitioners seemed guardedly relieved, knowing that this peace should be savored as long as possible. Guillermo Vasquez, the Mexican gentleman complaining of chest pains, was put through priority registration so as to get him monitored ASAP. Guillermo's practitioner, Morgan Stryker, states: "He knows he has diabetes, knows he has hypertension, but he quit taking his medication months ago because he couldn't afford it." As Morgan preps the EKG, the medical assistant takes the man's vital signs; his blood pressure reading is 210 over 180. The patient should have been rushed straight to the hospital. But in light of the recent INS raids, and the fact that the Vasquez family is illegal and uninsured, they not only came to the people they trust, but also to the only "not-forprofit" family practicehealth center in northern Santa Cruz County. Guillermo is accompanied by his daughter, Maria De La Cruz-Vasquez, another regular patient of ours whom w.e saw through nine months of pregnancy, and who still brings her children here for check-ups and sick care. A large, stout woman with a broad, sweet face, she was the emissary for a large crowd of relatives waiting outside. Her face is distressed as she takes her father's hand. He is lying flat on his back, an oxygen mask clasped over his nose and mouth, his face disgruntled in pain. With his tee-shirt hiked up above his shoulders, his chest looks shrunken, knotted and exposed. As the medical a.ssistant slips out the door to call for an ambulance, Morgan whispers reassuringly in Spanish to Maria as she turns her liquid eyes on him, smiling forcedly, her face attentive and hopeful. She didn't notice,or couldn't read the lurching lines of her father's EKG. Above and below, the clinic (now a Planned Parenthood project) provides low-income families with inexpensive preventative care, education and medical treatment.
At some point in life, all of us experience what the Vasquez family faced that afternoon: the sudden threat of severe illness or death to ourselves or our loved ones, and the desperate hope that somehow the medical system can pull off a miracle. Like the Vasquez family, we depend on highly trained specialists - who understand the mysterious workings of the body - to know what to do. Similarly, we are dependent on a health care system that is confusing and seriously compromised. Instead of waiting for a national cure for our health care system's ailments, the Santa Cruz Westside Community Health Center ("Westside") takes matters into its own hands. Today. The Santa Cruz Westside Community Health Center is a grassroots, community-based organization, committed to providing affordable and accessible, high quality health care, regardless of the patient's social' status (income, age, ethnicity, citizenship, religion, sexual orientation, etc.). The clinic has the following special commitments: • To provide services for those who might otherwise have difficulty receiving adequate care, especially those who are low income, pregnant, or have limited access due to language, physical or cultural barriers. • To emphasize a wholistic approach to communityoriented primary care that includes prevention, education and involvement of people in decisions about their own health care. • To advocate for affordable, quality health care for all people by promoting change in the current health care system. Westside has designed its services and programs based upon the community's need for increased access to primary . care. Its administrators and board of directors take a look at families such as the Vasquezes, and assess their greater health care needs. Guillermo needs regular monitoring for his high blood pressure and diabetes that he can actually afford. Maria needed prenatal care that culturally and linguistically catered to her as a monolingual Latin American woman. Her children need pediatric development exams, immunizations, nutrition assessments, anemia screenings, and readily available sick care for common childhood maladies (ear infections, flu, sore throats, etc.). Maribel Cuervo, Medical Assistant and Health Educator, listed Westside's services as "...promoting proper nutrition, basic sanitation, maternal and child health care, family planning, and immunizations against major infectious diseases. This also includes prevention, control and treatment of common diseases, injuries and provision of essential medications." Westside's services are the first level of contact between the community and the health care system, providing support to peripheral services (such as radiology and/or specialists) by means of referral. The clinic's commitment to the community's lowincome families increases access for people who are traditionally underserved. Christy Hawley, Family Nurse Practitioner, states: "We are a safety net between preventable illness and emergency medicine. By making basic primary care more easily available, we can diagnose illness earlier, and treat the person before minor ailments become emergencies." The health center is not a free clinic, but provides affordable care and also serves MediCal recipients (California's version of Medicaid). In Santa Cruz County, only 7% of physicians accept MediCal because they are reimbursed by the state so poorly, at roughly 30% of what it t~kes to actually provide care. Guillermo, who does not qualify for MediCal and is completely uninsured, pays at a rate that is adjusted according to how much he earns a month and how many people are dependent upon his income. Our sliding scale is the lowest in Santa Cruz. The majority of the Health Center's funding comes from providing services, paid for by MediCal, MediCare, . \ private insurance and cash. 18% of the annual budget comes from a Community Grant from the City of Santa Cruz. In the past years, the clinic had a variety of State contracts which made up about 13% of total revenues and were primarily Prop 99 funds (the Tobacco and Alcohol Tax initiative). Westside is also recognized as an Expanded Access to Primary Care (EAPC) provider. This qualifies the clinic to receiv~ additional funds to supplement the State's inadequate MediCal/MediCare reimbursements. The director has also begun the Federally Qualified Health Center (FQHC) application process which would bring in additional funding, as does the EAPC program. Although the funding is put to good use, it is not sufficient. The only way to comprehensively increase RAIN Summer 1996 Volume XV, Number 1 Page 7
Above, Westside clinic's migrantfarmworker outreach. This pinata says "Malburro (bad donkey), purely wicked smoke, 20 cigarettes that will make you sick with cancer and will kill you." On the other side, it says, "what the makers don't tell you is that cigarettes are an addictive drug. " access to primary care is to reallocate health care funding. And even though health care reform was one of the Administration's top priorities, Latin American people's health care needs are often purposely overlooked. Politicians need not cater to this group of people that often do not or cannot vote. As far more than half of the patients are monolingual Spanish-speaking families, it is part of the clinic's mission to provide services in an environment of cultural sensitivity. Services are offered in a supportive environment that fosters participation and awareness among client groups. Almost all staff who have direct contact with patients are fully bilingual. Health education materials and registration forms are provided in both Spanish and English, at a literacy level that may be easily understood. Marcy Lopez, administrative assistant, says that, Page 8 RAIN Summer 1996 Volume XV, Number 1 "...getting care Westside style means that you are absolutely not a faceless number in a cold, sterile, costly, wasteful 'health factory.' Our patients are treated as guests would be in our own homes: with respect. All you have to do is walk in that front door: La Salsa blares from the radio; you can see the color; feel the warmth. We want our patients to feel at home, that's why we provide culturally sensitive health education in a multilingual environment. It comforts our patients, it ensures that they will leave the clinic understanding exactly what's going on with their bodies." Westside's health education department helps people help themselves. Their three focus areas are tobacco, prenatal care, and HIV education. These are three of the most important public health issues of the day because the best remedy for cancer or AIDS is prevention. Likewise, the key to a healthy pregnancy is a vast array of information that can prevent death and disability for both mother and child. Because many of Westside's patients suffer from smoking-related illness and disease, the clinic has received a variety of Tobacco Tax monies to provide tobacco education including on-site and outreach services for tobacco education and cessation counseling. The anti-tobacco program teaches the risks involved with both smoking and being exposed to second-hand smoke. Morgan Stryker, Physician Assistant, describes how Guillermo came to the clinic as a two-and a-half-pack-a-day smoker. "Before he began receiving care at Westside, he simply was never informed of the direct relationship between hypertension, heart disease and tobacco. I told him that if he didn't stop playing with his life as if it were a crap-shoot, he'd end up a statistic." After three months of intensive counseling, Guillermo is finally tobacco free... although he is still paying the price. Before he began receiving care at Westside, he simply was never informed of the direct relationship between hypertension, heart disease and tobacco. The Outreach Program identifies populations at risk (current smokers, pregnant women, mothers with young children, farmworkers, ethnic minorities, and out-of-school teens) and where they can be reached most effectively; finds community resources and potential locations where cessation counseling and education can take place; and designs community health education plans integrating materials, resources and efforts of other agencies involved in tobacco education. Outreach workers make contact with the community in El Barrio (the neighborhood), in ESL
classes (English as a Second Language), at migrant farm worker camps or by making individual house calls. These programs are conducted in conjunction with the Tri-County Community Clinics Coalition and the County Health Services Agency. The outreach encourages target populations to avoid risky behavior by providing culturally appropriate cessation tactics and lots of moral support. In October 1990, the clinic was approved by the State as a Comprehensive Perinatal Service Program (CPSP) provider. Through this program, the clinic is able to thoroughly assess a pregnant client's potential risks (such as low-iron diet, exposure to secondhand smoke, drug and alcohol use, etc.) and share with them the tools for improved health. Shauna McCosh, Bilingual Perinatal Educator, explained that, ".-..Maria De La Cruz-Vasquez gave birth to a healthy bouncing baby boy because in the course of her care at Westside, we speedily diagnosed and treated her for gestational diabetes. If she hadn't been screened and her diabetes had gone undetected, the end result could have been a highly complicated pregnancy, a stillborn baby, birth defects or Sudden Infant Death Syndrome (SIDS)." In spite of difficulties in tracking down the grants to fund HIV education, Westside is continuing their programs of HIV risk screening, pre-test counseling, HIV testing, post-test counseling, one-on-one HIV education,.educational materials and referrals. The HIV educators work closely with a number of community agencies including the County Health Services Agency, Santa Cruz AIDS Project and Salud Para La Gente (our sister-clinic in southern Santa Cruz County). From the moment a patient steps through the front door, they are involved in their own health decisions. This ranges from a plaque which hangs ove~ the reception Left, this Cinco de Mayo celebration table at Wa'tsonville Plaza is one of the clinic's preventative . health education forums. Outreach health workers develop trust, educate, and spread the word about the clinic's low-cost health services in the neighborhood, in ESL classes, at migrant farmworker camps and by making individual house calls. window announcing: "Your community health center needs you! We are looking for patients to serve on the Board of Directors," to the informative manner in which the practitioners perform exams, to the clinic's commitment to maintaining a health education department. Not only is health education about helping people help themselves, it influences us to do the right thing for our loved ones as well. Guillermo recalls, "I quit smoking because I don't want to end up a statistic, I have a family to think of too. I get so scared with my chest so heavy all the time, I don't want them to suffer if I ever get too sick." The staff at the Westside Community Health Center thinks it is a crime when people like Guillermo suffer from completely preventable illnesses. Barbara Garcia, Westside's very first Executive Director, agrees that "...the health center has always proved to be a model example of community medicine. Our neighbors, those who have traditionally gone without medical care, are getting what they need because we are out there, on the front lines, looking out for the community's broader interests." Barbara describes the Santa Cruz Westside Community Health Center as the product of a grassroots organizing effort by the Westside Neighborhood Association to provide a comprehensive medical facility on the west side of Santa Cruz. She recalls that, "...as the political climate began to shift away from the 'social consciousness' of the '60s and '70s, local community activists mobilized to meet the growing needs 6f their medically underserved populations." After eight years of research, planning, support-gathering, fundraising and recruiting, the health center opened its doors in June 1983. For many years the clinic remained quite small, serving the local neighborhood's most immediate needs. At that RAIN Summer 1996 Volume XV, Number 1 Page 9
time, the percentage of people on MediCal was much lower, and the county's Community Hospital could provide adequate care for the medically indigent. As social service reservoirs began drying up, the health care crisis spread in epidemic proportions, causing tremendous growth in patient volume, the number of staff employed and services provided. "Westside" no longer exclusively serves the west side. The health center is also committed to providing services for people commuting from as far north as the migrant farmworker camps in Pescadero (southern San Mateo County), and as far south as the Pajaro Valley (northern Monterey County). A satellite clinic has been added for well-child care, serving the families who live in remote areas of the Santa Cruz mountains. Jody Peugh, Lab Manager and Westside's oldest staff member, says that, "...what began as a neighborhood advocacy group's dream for a funky little neighborhood clinic unfolded into north county's major player in community medicine." The past few years, the health center's most important role in advocating for increased access is ensuring that Westside services expand. The clinic moved into a larger, better equipped facility at a more central location to handle a 78% increase in the number of clients receiving care at the health center. From 1990 to 1991, the percentage of MediCal patients increased from about 33% to 52% of all visits. In these times of recession, layoffs, AFDC cuts, decreasing employer-sponsored health benefits, and minimal numbers of MediCal providers in Santa Cruz County, the demand for Westside's services by low-income clients continues to increase. The clinic is advocating for local primary care expansion through a massive capital campaign by stressing the importance of the people's needs, how they are being met, and the evaluation of services in lifting the burden of disability and improving health. Michael Walker, ChairperPage 10 RAIN Summer 1996 Volume XV, Number 1 son of the Board of Directors, explains that, ".. .local advocacy for community medicine has turned into somewhat of an epidemiological nightmare. In this ball park, advocating for sociomedical reform is all about approaching City Hall and a vast array of private foundations, with well prepared data that explicitly reveals the local community's barriers to primary care, the socioeconomic groups which are at greater risk for untreated illness, and how the county's public health system eventually pays the price of prenatal care that is not given, immunizations that are not provided, cancers that are not detected, diabetes and hypertension that are not monitored, and mental illness that is not discovered." This is why the health center has included advocating for further recognition and development for communitybased medicine at the local level. One of the ways the clinic advocates for support is by developing its Community Involvement Campaign. The staff scout for people representative of the populations served, and train them as health aides and community health care advocates. The active participation of community members validates the health center as a community-based medical clinic. The Board and clinic personnel network within existing social, political and production-related organizations to secure the health center's future. It is at these local institutional levels that the community can rally a collective voice to effectively push for local support. Westside has put together a volunteer Medical Assistant staff and seeks further patient representation on the Board of Directors. This entails community outreach, education materials, training and project coordination. In the past, Westside has had volunteers and board members trickle in and out, but with both State and federal programs cut, the clinic has no choice but to seek further community support in the form of hands-on participation both in the clinic and for their Capital Campaign. The purpose is to put the word out on t~e streets that there is a network of locallybased health centers, and that we can all get actively involved in looking out for the community's basic right to health care. At Santa Cruz's Westside Community Health Center, the staff continues to serve the community under strained working conditions', low wages, and minimal benefits, because they believe that a health care system which neglects the basic human needs of its members puts the community as a whole at risk. Morgan Stryker, Physician Assistant, advocates that, " ...to the degree that the greater 'for-profit' medical system isolates itself from America's
crisis in health care, to perceive this crisis as insignificant or inevitable...to this extent the nation is living in denial that the crisis in health care will bankrupt us socially, as well as economically." The defenders of private medicine refuse to acknowledge that our health care system is no better than the least well-served of its citizens. We in the United States currently support a health care system which provides inadequate or no care for more than 20% of our population. The rest of us receive a graded level of provision based on our ability to pay. The medically indigent become the recipients of a compromised public health system, cared for by a small handful of grassroots community health care workers, advocates and institutions which receive little support, assistance or recognition from Capitol Hill. We live in a nation where the medical needs of the community are not provided for, and the right to health care is not respected. To the extent that we have all turned a blind eye upon the health care needs of our own citizens ...to this extent has our humanity diminished. However, there are now over 800 community health centers nation-wide refusing to look the other way. When asked why he stayed with community-based medicine for all these years, Morgan responded, "Well, I. guess you could call it an honest day's work...simply because it's the right thing to do." With a stronger community, less people fall through the safety net and more people will see a healthier tomorrow. Westside Clinic (now called Planned Parenthood) is located in Santa Cruz, California. Phone (408) 426-1994. Eric Bellfort is a Santa Cruz community activist. Resources -Books Connor, Eileen. Community Oriented Primary Care. Washington, DC: National Academy, 1983. Perhaps this is one of the all-time important works having to do with the theory behind community medicine. Connor clearly spells out why there is a need for increased recognition for community oriented primary care. Kark, Sidney. The Practice of Community Oriented Primary Health Care. New York: Appleton-Century-Crofts, 1981. This is the "how to" manual of implementing community oriented primary care. What is so useful in this text is the wide variety of models Kark uses, so that the reader can apply whatever context works best for their local community. Knox, E.G. Epidemiology in Health Care Planning. Oxford, England: Oxford University, 1979. Never underestimate the importance of epidemiology in creating community medicine with and for the local population. Traditionally defined, epidemiology is the study of trends in disease. Knox found this definition to be too limiting for COJTimunity-oriented primary care. He advocates for epidemiology to include the study of the health care system itself, as well as the barriers to care for local populations. Churchill, Larry. Rationing Health Care in America. Notre Dame, IN: University of Notre Dame, 1987. Churchill brings up some very challenging ethical questions for both health care planners and providers alike. How are needs defined? Who should define them? And should they be prioritized? He questions (and in the end praises) the existence of community health centers, and asks us if indeed they are not slapping a bandaid on one of America's greater social illnesses. Articles Bigelow, Victoria and Carolyn B. Trees. "A Model for Primary Care Delivery to a Widely Dispersed Medically Indigent Population." JAMA 266.4 (24/31 July 1991 ): 563-564. This is a piece similar to the article on the Westside . 1 Community Health Center, except that it applies more to an innercity environment. Bigelow's approach to increasing primary care for low-income inner city people is to create a partnership between private and public institutions. "Primary Health Care: The Chinese Experience." Report of an inter-regional seminar, World Health Organization, Geneva: 1983. Don't miss the Chinese Experience! This report is one of my favorites because it draws many comparisons between China's Barefoot Doctors and the Mid-Level Practitioners (Physician Assistants and Nurse Practitioners). Slater, Giuseppi R. "Reflections on Curative Health Care in Nicaragua." American Journal of Public Health 5 (May 1989): 648. This article reflects upon preventative medicine within an international perspective. It covers a lot of what community-based clinics similarly do here in the US, but in the context of a socialized medi~al system. Siegler, Mark. "A Physician's Perspective on a Right to Health Care." JAMA 244 (October 3, 1980): 1591-1596. RAIN Summer 1996 Volume XV, Number 1 Page 11
TnEHun For Sustainable Transportation By Micah Posner In March of 1995, the bicycle advocates in Santa Cruz, California, put aside for a few minutes their specific organizations and arguments, pooled their resources and started leasing a building downtown which was dubbed the Hub (no acronym, please) for Sustainable Transportation. Within a few weeks, we had our furniture donated and moved in (all by bicycle of course). Since then we have used our Hubhouse for generating plans and income, as a warehouse for bicycle deliveries, a space to sell trailers, fix bikes, and teach people how to fix bikes, endless meetings (ranging from entirely practical to entirely revolutionary in nature), a place for free food, and quite a few large parties. The organizations that spoke the Hub are: the Santa Cruz County Cycling Club (recreational riding and community projects), Bike to Work Week, People Power (see article), Pedaler's Express (the human-powered delivery coop), and Growing Cycles (youth outreach and education through rides and bike mechanics). Come visit us at 2048 N. Pacific, in downtown Santa Cruz, California or call People Power! at (408) 425-0665 for more information. Top left and right, March 3, 1995, a group of volunteers used bike trailers to.haul file cabinets, computers, desks, bookcases and everything else to the new Hubhouse. Left bottom, the inside of the bustling bike advocacy center. Right bottom, to leave the bike center you of course must pass through a "bike door". Bikes have limitless uses. Page 12 RAIN Summer 1996 Volume XV, Number 1
Bike Activ(sm in Santa Cruz, California By John Welch Bordered by redwood-covered mountains, sweeping agricultural lands, and a breathtaking bay, Santa Cruz is a pleasant setting for bicycling. It has a mild climate, clean air, natural beauty, and a fair number of bike lanes. The University community and the laid-back surfing scene make the city friendly toward alternatives like bicycling. Yet only 6% of the population commutes by bike, even though the average commute distance is short. Bicycles have a longer history in Santa Cruz than autos. During the nationwide bicycle boom in the 1890s, bikes were a popular way to get around the city. With the coming of Henry Ford's mass-produced machines early this century, cars began to outnumber bikes on Santa Cruz streets. Post-World War II prosperity brought more cars and suburban sprawl, and bicycles got squeezed out. It wasn't until the 1970s and the new environmental movement that the idea of bicycling for transportation was reborn in Santa Cruz and across the country. A new critical mass of bicyclists finally came in 1991 with the Gulf War. People seeing the ·connections between automobiles, war, environmental destruction,· and community breakdown came together once again. Local activists Jessica and Jim Denevan organized a mass pedal-powered protest on the morning of January 13, 1991. Three hundred cyclists took over the streets, protestiog the war, and affirming a transportation solution. There were students, parents pulling kids in trailers, senior citizens, etc., some with expensive bikes, others riding old cruisers with pets in the baskets. It was the explosive beginning of the modern bicycle movement in Santa Cruz. Jessica and Jim formed a group called cyclists, many of whom had never ridden past the city limits, made the 2-day trip up the coast. They made a strong , statement both at the protest and along the highway. A week later, 40 more riders went to the second San Francisco protest joining over three hundred San Francisco cyclists for a truly impressive and inspiring event. People Power soon turned its attention to the local scene. Building a model bicycling community turned out to be a lot harder than organizing protests, and People Power had its work cut out for it. Local government has been resistant to change, harboring economic concerns that limit transportation innovation. The city has focused narrowly on revenue generation since most of the downtown commercial district was destroyed in the earthquake of 1989. Many local politicians and business people feel that decreased auto-use limits consumer spending. Santa Cruz depends on tourism for a large part of its income, and politicians assume that tourists won't walk or take public transit. A city ordinance prohibiting a pedal-powered taxi service helps maintain the status quo. The city tries to bolster the economy with short-sighted auto facilities, even if this brings more congestion and pollution. Also, the majority of Santa Cruzans are not in other college towns. demanding bike infrastructure. It's a Catch-22: politicians won't improve bicycling facilities until there are more bicyclists but many people won't ride bikes until riding becomes safer and more convenient. The location of the Despite the obstacles, the local bike movement is growing. People Power's events and public outreach have RAIN Summer 1996 Volume XV, Number 1 Page 13
started to make an impact on the community. Mass rides and rallies are especially effective, usually organized around particular issues such as putting bike lanes on a certain street. Through speeches and discussions before these rides, hundreds are thinking more about cycling and the broad ramifications of automobiles. Politicians who see and read about these events realize how many concerned cyclists there really are. Discussion around cars and bikes is heightened throughout the community for several weeks after a ride. People Power information booths at fairs and rallies further help promote cycling. Regular bicyclists also benefit from these events. Susie Bradshaw put it this way, "I always know that I have a right to be on the streets with all the cars, but it feels like I'm the only one who knows it. ~- . <.)o),. ' ...... ~- Left, by installing bike racks on buses, and below, providing good bike parking at this Santa Cruz transit station, bus stops can be spaced further apart and serve more people. On People Power rides, we all know it, together, and I can imagine the day when everyone rides their bikes everywhere." The organization's work unites many diverse groups into a strong alliance for bicycling. Local environmentalists have turned more attention toward bicycling, and organize events in conjunction with People Power. The Environmental Council of Santa Cruz and the Santa Cruz Greens have both helped People Power with an educational bike·tour of several properties the city was consideri'ng acquiring for nature preserves. The increased political fervor around bicycling has also given a boost to existing bicycle organizations, such as the County Cycling Club and the Regional Transportation Commission's Bike Committee. The political experience of these organizations combines powerfully with People Power's radical idealism and grassroots support. The movement has slowly begun to see some representation in local government. The City Traffic Commission recently declared its support for alternative transportation, and changed its name to the Transportation Commission. The Regional Transportation Commission and the City Parks and Recreation Department work closely with People Power to organize successful annual Bike To Work Day events. A couple of bikefriendly candidates endorsed by People Power were also elected to the City Council. Officials now often seek out People Power's opinion when making decisions affecting bicyclists. Local politics has become a very important though often frustrating part of People Power's work. People like me, who are new to the political world, find it difficult just to keep track of all the acronyms. Fortunately, other members of the group have much more experience with the local bureaucracy. By keeping up on all the political goings on, Page 14 RAIN Summer 1996 Volume XV, Number 1
Above, Jim Denevan delivers organic produce by bike, from Santa Cruz Farms to the farmer's market. People Power can ensure that bicyclists' voices are heard throughout the decision-making process. We also find out which grants are available for bike projects and make sure local agencies apply for them, and use them wisely. Some of People Power's main political goals are: (1) to develop a continuous bikeway system that serves the entire County of Santa Cruz; (2) to change local parking requirements in order to ensure ample bike parking and allow for the conversion of car parking to bike parking; (3) to improve bicycle access to buses going to neighboring cities; (4) to make traffic lights sensitive to bicycles; (5) to implement disincentives to automobile use, such as a gas tax, increased parking fees; and (6) to remove as much onstreet auto parking as possible to make roads safer for bikes and discourage auto use. While most of these specific goals are still a ways off, we've had several political successes. One of People Power's first experiences with city politics was participating in the redesign process for the earthquake-destroyed One business is trying to create a cross-country, car-free bike trail called the National Bicycle Greenway. downtown. Don Pong submitted a set of detailed recommendations, called the "People Power Plan For a BikeFriendly Downtown." Despite opposition from planners and merchants, the hard work by Don and others resulted in many provisions for bicyclists in the Downtown Plan. As People Power picked up more political experience, the successes got bigger. A huge victory came when People Power and local residents convinced the city not to build a four-lane car bridge through the middle of the greenbelt area. The city took People Power's suggestion and redesigned the bridge, which would have carried 50,000 auto trips per day, into a bicycle- and pedestrian-only facility. Another hard-fought battle resulted in the removal of on-street parking from a busy downtown street to make space for bike lanes. Important parts of that battle included a petition drive, a letter-writing campaign, a huge ride through town ending up at City Hall, and lots of speaking at public hearings. One People Power volunteer, J.B. Harrington, came up with the idea of putting notices on bikes all over town a few days before the important public hearings. This helped ensure that hearings were packed with cyclists, many of whom wore their helmets inside to identify themselves. The bike-friendly General Plan adopted by the city is another success story. People Power involved itself in the planning process to ensure adequate provisions for alternative transportation. The Plan endorsed the idea of contraflow bike lanes on one-way streets. It gave a high priority to the construction of many new bike lanes and it prohibited the city from removing any bike lanes in order to make more room for cars. The Plan also required developers to provide covered bike parking at certain types of new and existing buildings. Also, thanks to the efforts of People Power's Ron Goodman, the city wrote an ordinance to improve bicycle parking requirements, and allow businesses to convert car spaces to bike spaces, even if this put them under the normal car parking requirement. While spending much of its energy in the often dry political arena, People Power's radical, grassroots events help make cycling fun. Grassroots changes in the community are even more noticeable and inspiring than the political victories to date. One now sees more families leaving their cars at home or even getting rid of them altogether. Parents pulling kids around in bike trailers or families doing their shopping by bike are no longer an unfamiliar sight. Paul and Margie Manners decided to use bikes as much as possible with their two sons, 7-year-old Lowell and 3-year-old LioneL Lowell has his own bike and Lionel rides in a trailer. Lowell says, "I like riding bikes a lot better than being in the car. Riding bikes, you can see more things, and you can stop more." Paul says, "When we go out for breakfast together on Saturday mornings, we I RAIN Summer 1996 Volume XV, Number 1 Page 15
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