Light on the Hill, Volume II
COLUMBIA POINT AND MOUND BAYOU. The Tufts School of Medicine embarked in 1965 on a pioneer venture into community health which brought national recognition to the institution (as well as a host of problems). After Leonard Mead became acting president in 1966 he described it as "one of the most exciting and socially significant experiments" ever undertaken. It was financed initially with a grant of $1,168,000 from the federal government through the Office of Economic Opportunity (OEO), but the administrative responsibility resided at first entirely in Tufts' hands. The program was part of the national "War on Poverty" with which the presidency of Lyndon Johnson was associated. It was known locally and officially as the Tufts Community Health Action Program and was located in the Division of Community Health, part of the Department of Preventive Medicine of the medical school.
Two sites were selected, one to "crack the poverty cycle" in a Northern urban setting and one to accomplish the same end in a rural setting in the South. The first was located in Boston in what was known as the Columbia Point Housing Development, and the one in the South, in impoverished Bolivar County in Mississippi and centered in the rural community of Mound Bayou. The publicly financed urban housing project in Boston, consisting of twenty-six high-rise brick buildings, was located on a peninsula jutting out into Dorchester Bay, on the site of a former sanitary land-fill. The development provided subsidized low-income housing, the largest of its kind in New England, for a population of more than 6,ooo, about half of them Blacks. No medical services of any kind were provided until Tufts became involved. Nearly 70 percent of the families received public assistance of some kind, with a high proportion of the population consisting of the very young and the elderly. Mound Bayou was an all-black community of about 2,000 which had been settled initially in 1887 by ex-slaves and incorporated as a city in 1898. It boasted two small and inadequate hospitals, both operated
|by black fraternal organizations. The Tufts plan was not to confine its activities in Mississippi to Mound Bayou alone but to include the Northern part of the county, about 500 square miles, with a population of 14,000, of whom 12,000 were Blacks. They earned an average annual income of less than $1,000 and had an unemployment rate of 75 percent, due in large part to the mechanization of cotton growing and processing.|
The aim in both Massachusetts and Mississippi was to establish a health center to provide direct medical care, preventive services, and health education. Both programs were intended to actively involve the poor themselves by helping them organize health care through community action programs. It was hoped that the two projects could provide some guidance in breaking the cycle of poverty, ill health, unemployment, and illiteracy by bringing about social and economic changes related to health. The entire project was envisioned as a pilot program which might serve as a model for other universities, medical schools, and health agencies. In each health center a core group of family physicians and specialists were to work together with public health nurses and others in the community health team. They would, in turn, seek out and train local citizens to carry the program directly into the community through local "health improvement associations." The responsibility for initiating these two ambitious programs was undertaken by Count D. Gibson, Jr., professor and chairman of the Department of Preventive Medicine, in charge at first of directing both the entire project and the Northern program. The Associate Director (later Co-director and then General Director) of the Mississippi project was H. Jack Geiger, who joined the medical faculty from the Harvard School of Public Health in 1965 as Associate Professor of Preventive Medicine. He and Gibson were already well acquainted, having in 1964 set up a small health center in the South to treat individuals injured in the civil rights movement, which had frequently proved violent. Their clinic had lasted for one year. Geiger had had previous experience in social medicine in the Union of South Africa, where he worked among the Zulu at both urban and rural health centers affiliated with the University of Natal Medical School. The plan was ultimately to have Geiger supervise both projects as director of a proposed Division of Community Health within the Department of Medicine. An additional function of both health centers was to provide a training ground for medical students from Tufts and elsewhere as well as nursing students. As the two programs developed, the clinical training of medical students was actually carried out only in Mississippi and even then to a very limited extent.
|The contract to conduct the two projects was signed with the OEO in the summer of 1966 and contracts were also negotiated in Boston by Tufts with the Visiting Nurses Association and other agencies to provide various auxiliary services.|
The Columbia Point Health Center was dedicated on 11 December 1965 in premises leased for five years from the Boston Housing Authority which was responsible for the housing project. The center started as a medical outpatient clinic for ambulatory patients which by 1966 had broadened into a full-fledged community health operation. Complete dental services were provided by the Tufts School of Dental Medicine, beginning in 1967-68. On the occasion of the Center's first anniversary in 1966, Massachusetts Senator Edward M. Kennedy was the principal speaker. He was a strong supporter of a national health policy whose efforts had made possible the establishment of a national neighborhood health center program of which Columbia Point and Mound Bayou were a part.
The Columbia Point program was immediately utilized by the residents and only two years after it opened it was handling 200 visits a day, with a staff of 120, of whom 45 were residents. The clinic by 1970 was operating around the clock, seven days a week. An ad hoc citizens' committee had been organized in the summer of 1965 to work with the Tufts medical and dental staffs. It was chartered in 1967 as the Columbia Point Health Association.
Both the Massachusetts and Mississippi programs were financed mainly from annual OEO grants totalling more than $4 million, supplemented at Columbia Point by payments for services to patients under Medicaid when eligible; state welfare medical assistance; and a grant from the United States Public Health Service. However, the university also obligated itself to an annual expenditure of about $1oo,ooo, which increased steadily as both programs expanded and as federal funds diminished.
An administrative tangle had developed by 1968 in both the financing and administration of the Health Center at Columbia Point. A local politically oriented anti-poverty agency, Action for Boston Community Development (ABCD), had become increasingly involved in Columbia Point affairs. It insisted that, in line with the neighborhood concept stressed by the OEO, it should take over the negotiation for federal grants and that they should be channelled through it rather than assigned directly to Tufts. What amounted to a power struggle betweeen ABCD and Tufts ensued over the financing and administration of the Health Center. As a consequence, contractual arrangements and financing through OEO had broken down almost completely by the summer of 1969. Tufts lost some $1 million in
|attempts to keep the Center operating without federal funding, and was able to recoup eventually only part of its total expenditures.|
Considerable friction also developed between the officials in the Tufts-operated Health Center and the Health Association. The latter complained that they had insufficient input into policy making and that the Center was being conducted in an autocratic fashion. The Health Association attempted to take over from Tufts not only the authority to negotiate grants from the OEO but to approve all proposals, programs, and research projects submitted by the university to OEO, all to gain greater community control. Tufts thus found itself in the unenviable position of involvement in a serious jurisdictional dispute with two other agencies.
Rumors began to circulate in 1970, aided and abetted by the mass media, that Tufts was abandoning the sponsorship of the community health project at Columbia Point - rumors which produced great alarm among the residents. The dean of the medical school vigorously denied that such was the case but did verify the fact that the Department of Community Health and Social Medicine (previously known as the Department of Preventive Medicine) was being disbanded as part of a reorganization occasioned by Geiger's impending departure from Tufts. He did in fact resign as Project Director in the summer of 1971 and the dean himself took over temporarily.
Instead of closing the Health Center, ABCD took over the overall administrative responsibility early in 1971, with the understanding that Tufts would continue to provide doctors and dentists for medical care, and be paid $200,000 a year for its services. The principal reason for the institution's withdrawal was a conflict over, as well as a reduction in, government funding that made the cost to Tufts prohibitive. Additional factors explaining Tufts' withdrawal were tensions with both the Health Association and ABCD, a marked deterioration of Columbia Point as a community, with neglected housing, vandalism, rapid turnover of a declining population, and an ominous increase in drug use and crime among the inhabitants. Although direct responsibility for Columbia Point was transferred from Tufts to other hands, a greatly reduced affiliation was continued, and an Associate Dean for Community Affairs was appointed. Tufts personnel associated with the project had been forced to the conclusion that medical care could not alone solve all problems.