Community Health Centers: A Movement and the People Who Made It Happen

Chapter 7: The Health Center Legacy

Paula Gomez’s advice to the young volunteers is a perfect introduction to this final chapter. We are constantly admonished to learn from history, but as I have traveled around the country I’ve also seen a jarring disconnect between the rich, emotional legacy of health centers and their need to compete in a modern marketplace as sophisticated providers. Daily life is a constant struggle with the bottom line, and conference schedules are crowded with management techniques , financing strategies, and sales pitches. And yet the health centers’ remarkable story not only enhances their worth in today’s world, it also inspires an ongoing commitment to their survival. Like all things of great value, the centers are enriched by their provenance—the telling and retelling of how they came to be created and who has touched and changed them along the way. Bridging the Gap between History and Reality What can we learn from the history of health centers and their heroes, especially the up-close-and-personal stories in this book? Despite widely varying circumstances, there are more commonalities than differences, and some important lessons for the future. Origins Some centers started with an outside “instigator”—Jack Geiger in the Mississippi Delta and Columbia Point, Paul Torrens in New York, and Dan Hawkins in Texas. These three had a vision and supportive institutions to help make it come true. For others—the Boston centers originally organized by the city 135 Chapter 7 The Health Center Legacy government—the instigator, Jim Hooley, was a native son. The centers in South Carolina and Jackson, Mississippi, were started by local activists Tom Barnwell and Aaron Shirley, respectively, who had a history of challenging the establishment on their home turf. While the outsiders were no less dedicated than the natives, they had less at stake in their daily lives and had to face issues of trust and sometimes race, being white in minority communities. Leadership Scratch some of the most sophisticated leaders and you find simpler beginnings—people not originally groomed for leadership. Jay Bellber in New York says he was “a loser in school” and didn’t start to develop management skills until a supervisor “thought I had half a brain” and took him in hand. Neither he nor Tom Barnwell was a college graduate. Tris Blake at Boston’s South End was a high school dropout. Like others in his neighborhood, Jim Hunt took a job in city government right out of high school, and finished college on what he calls the “ten year plan.” L. C. Dorsey started as a sharecropper, and Barbra Minch was a single mother, on food stamps for a while. People in Boston talk about how the health center movement “raised them up,” paying for training or yielding on-the-job experience they could never get in school. While some federal officials fought the ascendancy of “uncredentialed” leaders, others, like Richard Boone of the Office of Economic Opportunity (OEO), emphasized the importance of street smarts and peer recognition. Interestingly, the first generation of health center leaders I interviewed were all men—perhaps in keeping with prevailing custom of the early sixties. Some even said it was their wives who got them involved, then stepped back and let them assume the leadership role. In many cases, the second- or thirdgeneration leaders of the same centers were women who came into their own but still agonized over their salary requirements and sometimes had to accept lower pay than men in the same positions. Where these innovative leaders go when they leave their centers and how they manage the transition is another issue. In two places I visited—New York and Jackson, Mississippi—inherent conflicts came to the fore when successful center directors moved up to the network level. Other early leaders left the health center world for government, advocacy, hospital management, or academia . Current directors of centers in Texas, South Carolina, and Boston are content to grow their operations within the same structure. All of these executives are nearing retirement age, although only Roland Gardner made a point of noting that he is grooming a successor. 136 Community Health Centers Governance Community governance has been essential to the program’s survival, but no one ever said it was easy. Rogue boards in some places have fired excellent center directors or even manipulated resources for personal gain, as they did on New York’s Lower...