The Problems Facing Our Urban Communities: Community Organization and Urban Problems

self-evaluation

© 1998 John E. Perkins, III
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Date, Place and Time: December 17, 1994 at the Baltimore Urban League Headquarters, Baltimore, MD, 9 AM - 5 PM.

Convener: Odessa Dorkins

Peers: John Perkins (me), Pam Foster, Diane Weston, Lynda Firment, Larry Fields, and Jacqueline Rhoden-Trader.

Agenda:

Discussion: The life of Edgar Allen Poe compared to life in Today's Urban Community

Discussion: What do we mean by Community

Lynda Firment: Health Care Services and the Poor

John Perkins: Organizations and types of services available to urban families. What might these organizations be like in the 21st century.

Diane Weston: Aspects of integration of health education in the Urban setting (Harm Reduction Model)

Larry Fields: Creating a successful urban elementary school.

Odessa Dorkins: Addressing the problem of aging.

Pam Foster: The healing process in a drug treatment program.

Jacqueline Rhoden-Trader: Urban Schools - Integrating Community Involvement in the Education of Children

Odessa Dorkins organized an exceptional peer day, drawing participants from the Baltimore-Washington, DC area, North Carolina, New York, and Washington State. Each participant prepared well for our discussions.

When I first read the proposal and the suggestion that we read about the life of Edgar Allen Poe I thought, "Now I am beginning to get some real interdisciplinary learning." Actually, this worked out well, because Mr. Poe lived and died over 100 years ago, we have some distance culturally to look back on his life's circumstances and consider whether the experience of urban living has changed.

This idea might serve for an entire seminar or PDE; I will highlight some of the points raised in our conversation.

· Mr. Poe lived virtually his entire life in the urban environment. After his natural parents died before he turned three, he became the foster-child of a wealthy couple living in Richmond, VA. Many children today grow up in foster parenting situations. Because of drugs, we see the phenomena today of grandparents taking on the role primary care providers for their grandchildren.

· Poe never quite had enough financial resources. He left Richmond for Boston at the age of 16, after running up large gambling debts his foster-father refused to pay. He enlisted in the Army, a common means of escaping poverty still encouraged by the military today.

· Poe ends up in West Point, but without adequate financial resources (from his foster-father) to remain there. He gets himself kicked out. How often do urban youth translate troubles in one arena of their lives into misbehavior?

· Poe used alcohol and other drugs, perhaps as a means of self-medication during fits of depression or emotional instability. How many urban residents today use mood altering substances to help modulate internal and external sufferings?

· During his adult life Poe lived in Baltimore, Philadelphia and New York, dying at the age of 40 in Baltimore. How frequently do poor families move? In my work with poor families many move more times in 2 years than I have moved in my lifetime.

· Poe died while on a trip trying to persuade one of the widows he knew to marry him. His child-bride, Virginia Clemm, had died in the ninth year of their marriage. Also, Poe's death while searching for companionship illustrates his personal difficulties in relationships. Today, relationships within poor families often includes violence, drug abuse, neglect and abandonment. Hardly models of healthy relating.

After our general discussion of Poe and how we defined community, we each had turns highlighting aspects of urban living and facilitating the group's discussions.

Lynda Firment began with a discussion of the healthcare problems of the poor. Improving health care for the poor may not be as simple as having more doctors working in poor neighborhood hospitals. Poor people often wait until the last possible moment before seeking standard health care, this means that their primary provider is often the emergency room. For African American and Native American poor people racist health practices(such the Tuskegee Study of Syphilis and stories of forced, unapproved sterilizations) might make some understandably reluctant to go the hospital.

Here, I raise a fact that has puzzled me for years: "I would think that someone fearing hospitals and doctors would develop alternative health promoting practices. This generally hasn't been the case, and so the people who fear hospitals often live lives which increase their chances of needing them, that is, they eat improperly, use drugs and alcohol excessively, and/or associate with people known for their tendency towards violence."

I followed Lynda, discussing what organizations serving the urban family might look like in the 21st century. All of us there lived in, or very near, urban communities. The institutions of the future would come from people like ourselves having fresh ideas. My peers and myself could experience "new thinking" about institutions. I structured my time loosely around some techniques from Synectics.1 I suggested three stages for our experiment:

1. We each began with a common personal experience of a service or institution which support our living successfully in the urban environment. I asked them "What in your life makes your life function better. What services or tools do we use?"

2. I invited each participant to create a Book Title for their experience. A Book Title is a two word phrase which captures the essence of a paradox in a situation.2

3. After we discussed our personal choices in small groups, we returned to large group discussion to see how our own preferences might suggest new directions for services in health care. This is a technique called Force Fit.3 The following table offers a sample of our ideas. The suggestions listed under Force Fit could be used to develop creative new programs or institutional approaches to improving health care.

TABLE 1: Ideas for Improving Health Care Delivery
Personal Convenience BOOK TITLE FORCE FIT
Internet Worldwide Communication Net nodes in waiting rooms
distance learning
in libraries
Gas and Jaguar Peaceful Ride Ask how the "ride " (service) was.
backpack with needles shower coupon, lunch, for workers to carry while doing outreach

Diane Weston followed me with a description of her drug treatment program in New York which uses the harm reduction model. Since this peer day, my life partner attended a harm reduction conference held in Seattle. After reading some of the materials she gathered from the conference I have a better understanding of what is trying to be accomplished. As I understand it at the moment, when a service provider or outreach worker interacts with clients using the harm reduction model, their first priority is to listen to the client and follow the client's lead about what to address and when. This model began in England and has been used successfully there and in New York City and Seattle.4

Diane offered as an example the story of a client who exchanges sex for money. Many customers of sex industry workers prefer that no condoms be used, and are willing to pay extra to get what they want. In this example, this woman also knowingly carries the HIV virus. She may have had children to support, if I recall correctly, and the lower fees for safer sex might mean less food for the children. Diane asked the rhetorical question, "How can we insist that she use a condom in these circumstances, we don't have her family to support."

In the harm reduction model for reducing the spread of HIV/AIDS, the provider builds a relationship with the client, accepting the client's choices and seeking to help the client make gradual changes in the client's mode of living. Providers avoid direct challenges to behaviors and never call for complete abstinence, preferring to let the client chose for themselves how much is enough, safe, harmful, etc.

I know of some of the programs in Seattle which use the Harm Reduction model. I once worked for the People of Color Against AIDS Network which uses this model in its highly successful sex industry, gay/lesbian/bi-sexual and peer educator programs. My life partner has attended a conference on the subject on January 13, 1995 and returned with a packet of literature. Some of the examples Diane used and I have since read in some of the literature leave me with disquieting ethical and legal questions. I will read her packet of literature and continue to think about and discuss my concerns with people who use this model.

Larry Fields is the principal in an elementary school in Winston Salem, North Carolina. In two years at the helm, he has brought this school from the bottom of his district to the top. In the process he garnered a National School of Excellence Award from the Department of Education, the only one given in his state that year.

I listened with great care to Larry. He had three parts to this program: (1) look at the variables, (2) talk to the parents (3) change attitudes. The most important was his staff's attitude. When he started, their nasty attitude got expressed in the children's misbehavior and the lack of participation of the parents in school activities. He spent over $10,000 on workshops and trainings for his staff. Overtly racist staff (Mr. Fields is African American) soon had the opportunity to seek employment elsewhere. Eight staff members, out of 40, chose to pursue their careers at other schools or lines of work.

Larry threw out the curriculum because it had no meaning and little transference to the lives of the students in the school. He sends his kids to camps for training in leadership and conflict resolution.

He pointed out, that he spends money on the kids, not things. He compared the funding for education with that for prisons and other services. In Washington, DC it costs $7000 to pronounce someone dead and $21,000 for a "normal" emergency room visit. It costs us $13.5 billion a year nationally to operate emergency rooms.

Later in the day, Jacqueline Rhoden-Trader shared an article and led our discussion on integrating community involvement into education.

Odessa Dorkins read to us her written thoughts aging and living in urban environments. In summary she said, we will continue to see the realities of modern economic life take its toll on poor families. These families often find themselves in desperate circumstances. The migratory patterns of individuals from rural areas of the south to urban areas of the north often left men and women raising families without the social networks of relatives and friends willing to support them.

As men and women age their mobility gets more limited, both from their fears of harm when the venture out of doors, and from the physical decline of their bodies. Even their children who may live nearby often lead quite busy lives and many aging citizens chose to go without than impose on busy children to do minor errands with them. More social connections and inter-generational programs would begin to restore a world lost during the great migration.

Pam Foster shared her program for helping youthful offenders begin to make healthier choices. Her program in Washington, DC finds that music, dance and art helps youth reduce their drug use. Her program uses the 4 principles of Bantu Philosophy: live in harmony and at peace, live in balance, be your authentic self, recognize your interconnection with others and all of life.

The youth are lead through five phases designed to help them incorporate the principles into their living: harmony, awareness, alignment (working past grief, death, loss, disappointments), actualization (skills for a new life) and synthesis.

References

1 George M. Prince, The Practice of Creativity, New York: Collier Books, 1970. Also, William J. J. Gordon, Synectics: The Development of Creative Capacity, Collier Books, 1961.
2 Prince, p. 95.
3 Ibid., p. 57.
4 Edith Springer, "Counseling Chemically Dependent People with HIV Illness," Journal of Chemical Dependency Treatment, 1991, 4:2:141-157.