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Davis documented a wide disparity of immigrant satisfaction with the dispensaries and similar urban health care clinics. Ukrainians in Davis’s study reported feeling “very strange and lost” in these institutions, while the Jewish immigrants “flocked” to the dispensaries, knowing that “they will receive the care of a specialist, a professor, and they are only too glad to avail themselves of the opportunity.” Similarly, a citywide study of the dispensaries of New York, conducted by the New York Academy of Medicine in 1919, revealed a wide disparity of satisfaction with the care provided for immigrants and the urban poor.36 Imperfect institutions though they were, the dispensaries were the “birthplace” of the well baby examination, the training ground for two or more generations of American pediatricians, an integral part in the movement to provide clean, fresh, and cheap milk for poor infants, and the primary site of medical care for the majority of first-generation immigrant children in American cities during the Progressive Era.37 Conclusion Americans as a society are particularly prone to relegating valuable lessons from the past to the overflowing dustbin of history. This is an unfortunate national trait as consideration is begun for the needs of immigrant children living in the United States, today. Indeed, there is much to be gleaned from the social activism and sense of community responsibility that spawned the health efforts described in this essay. And while there were conflicts and cultural disparities that played themselves out daily between foreign-born patients (and parents) and American health professionals , from the viewpoint of a century later, these health care efforts were remarkably successful. Infant mortality rates dramatically decreased during the course of the twentieth century; the catechism of scientific motherhood was preached to native-born American mothers and their immigrant counterparts across a huge spectrum of socio-economic classes; the health of students and the health conditions in American public schools were significantly improved by medical inspections; health care and nutrition were delivered regularly to millions of impoverished and immigrant children in the form of dispensaries, neighbourhood health centres, and school clinics; and a legion of health care professionals, ranging from pediatricians and nurses to social workers and bacteriologists , obtained impeccable training within these community settings. In the current era of anti-immigrant sentiment, social and economic scapegoating has returned, as well as a distressing potential for punitive laws directed at immigrants wanting access to health care. There also exists a morass of confusion and misguided finger-pointing by many Americans over the distinction between legal and illegal immigrants. 220 HOWARD MARKEL In a social milieu where federal, state, and municipal welfare support systems are being markedly altered or scrapped altogether, it obliges those who are concerned with the needs of this diverse patient population to reconsider the vital partnerships that once existed among philanthropic social agencies, public health and medical professionals, schoolteachers, social workers, the immigrant communities, and the government. All of these historical actors and social institutions played integral roles in improving the physical, mental, and social welfare of the newcomer. Yet these efforts did not fulfil a utopian version of “how things ought to be.” Volunteer community efforts, then as today, often combine diverse groups with markedly different goals and agendas. Such efforts are as fragile as a powerful engine whose parts are held together with chewing gum. There are “engineers” who can pull off such a feat, but only with back-breaking work and constant attention. Many of today’s immigrant health care issues, including the barriers of language, education, and culture, would be very familiar to the health worker of a century ago. As a result of abrupt and chaotic human migration patterns, however, a number of new paradigms have emerged. For example, the new immigrant groups of the 1980s and 1990s have had difficulty creating social support networks de novo when compared to their predecessors of a century ago. Further, many immigrants from Africa, Eastern Europe, the Middle East, and other politically unstable areas are currently fleeing from their native lands to seek political asylum ; a large percentage of these immigrants have experienced some form of physical torture or abuse. Another challenging group are the illegal immigrants who smuggle themselves across our borders and, thanks to an international trade in counterfeit passport and identification dossiers, through our major airports. Undocumented by definition, these immigrants have little, if any, access to health care. The potential for significant health problems, including epidemic disease, that can result from such an...

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