By Robert McClory
At Saint Basil's Free People's Clinic in the decaying, underserviced Englewood neighborhood they're still practicing "slow medicine"--taking the time to get to know patients and not just their symptoms--just as they have for the past 15 years. At 7 PM on a cool summer evening 18 people are sitting in the waiting room watching the big overhead television, while five doctors, three dentists, and an assortment of medical assistants and volunteers quietly go about their duties. It's the same routine every Monday through Wednesday evenings--sometimes Thursday and Friday evenings too if enough volunteers are available.
Willa Harris, who's at her desk toward the rear of the facility registering dental patients, discovered the clinic a year ago. "Lord," she says, "it's good to be around caring, sweet people!" Harris, a 32-year-old lifelong Englewood resident who's raising an 11-year-old daughter on her own, works part-time with the state Department of Rehabilitation Services, cooking and cleaning for an elderly disabled woman who can barely move around her tiny apartment. "I have to help her a lot," says Harris. "She's quite heavy, maybe 300 pounds."
Harris herself has had serious dental problems since she was 12. "Lots of bleeding, loose teeth," she says. "A disease called pyorrhea." At Cook County Hospital a year ago a dentist told her there was nothing to do but "pull 'em out when they get bad enough," she recalls. He couldn't do anything for her at the time because her medicaid coverage qualified her only for emergency dental care. At a city health clinic she was told her teeth were indeed beyond repair, but even with a sliding-fee scale the extraction procedure was beyond her means, and the set of dentures would have run well over $1,000.
Then she came upon the clinic at Saint Basil's. Harris smiles, revealing her newly installed white dentures. "Free," she says. "Free! All I had to put out was $165 for the set. Can you imagine?" Now she volunteers at the clinic to pay back in part for what she received. "We're in tough times out here," she explains. "What we don't have a lot of is people who take their time, who really care about you."
By many measures Englewood, which runs from State to Racine and from 55th to 75th, is a community in deep distress. Between 1980 and 1990 it lost 18 percent of its population, and residents say the hemorrhaging continues unabated. The only age group to grow substantially in that decade was that of people 75 and older, many of whom live alone. There were notable increases in the proportion of the population on public aid (from 44 to 58 percent) and in households headed by single women with children under 18 (from 59 to 69 percent). Not surprisingly, the health of the residents has deteriorated. The number of deaths from 1992 to 1994 due to cancer, pneumonia, diabetes, and accidental injury all increased compared to a decade earlier. The homicide rate soared by 67 percent.
All this misery was accompanied by the steady disappearance of neighborhood health-care facilities. Once upon a time there were dozens of doctors and dentists in little storefront offices and a variety of clinics and hospitals. "About all we have now [besides Saint Basil's] is Saint Bernard Hospital, the city clinic at 63rd and Lowe, and another small clinic," says John Paul Jones, a community organizer who's lived in Englewood all his life. "Everyone else is gone."
The most recent blow to the community was the retirement earlier this year of Herbert Odom, a local dentist who was an activist and tireless supporter of Englewood economic development. Odom closed up shop and entered a nursing home. His departure, says Jones, served to further depress an already badly depressed population.
Jones, his wife, and five children have medical coverage through his job as director of community outreach for the Neighborhood Capital Budget Group, a citywide coalition seeking increased public spending in inner-city communities. But his policy doesn't include dental care, which is why his family takes advantage of the services at Saint Basil's Free People's Clinic.
"It's really almost impossible to get dental care in this area," says John Mosby, chief executive officer of the Englewood Community Health Organization. "You can't get foot care or eye care either. Just about every other person you meet on the street has some kind of untreated problem. Even people who work are uninsured or underinsured, so they wait until there's some kind of crisis before they get any help."
ECHO is a government-funded private agency that treats exclusively the mentally ill and those addicted to drugs or alcohol. Mosby sees an obvious link between the lack of good primary medical care and the wretched condition of the patients ECHO sees. "Maybe we're saving taxpayers some dollars at the front end nowadays," he says, "but then lots of folks are falling out at the back end. It's a very frustrating situation." Still, he doesn't blame medical practitioners for leaving Englewood and similar neighborhoods. "If you can't get paid for your services," he says, "how can you stay around?"
As a cost-saving measure, starting in July 1995, the Illinois Department of Public Aid cut $34 million a year in health-care services for the state's medicaid recipients 21 and older, an estimated 50,000 people. The bulk of the cuts, $22 million, affected dental care; also seriously affected were podiatric and optometric treatment. With pressure from the Illinois State Dental Society, emergency dental treatment was restored to recipients last February, but regular preventive care of teeth, feet, and eyes remains an unaffordable luxury for thousands in communities like Englewood where over 60 percent of the population is on public aid.
Illinois' new welfare system, which went into effect July 1, has no immediate effect on health care. But its provisions requiring most recipients to have a regular job within two years and limiting lifetime benefits to no more than five years will eventually make medical care even less accessible for some.
The Free People's Clinic opened in 1982 in the basement of the rectory at Saint Basil's Church, 1850 W. Garfield, and that's where it has stayed. At first it was staffed by four volunteer doctors and was open one night a week. Gradually the demand for care increased, and so did the number of volunteers. Today, as one of only two free clinics in the city, it's staffed by 15 physicians, 17 dentists, a full-time director, and 130 volunteers, including nurses, therapists, hygienists, and people from the community such as Willa Harris, who do everything from registering patients to sweeping the floor. Some veteran volunteers have gained enough skills at the clinic to move on to jobs elsewhere as nurses' aides or dental assistants. The staff maintains friendly relations with some 17 specialists in areas such as gerontology, dermatology, and optometry, who've agreed to treat occasional referrals from the clinic in their own offices free of charge.
The clinic is a clean, professional-looking operation, with fully equipped examining rooms, up-to-date dental equipment, and a well-stocked pharmacy. The only missing ingredient is a billing department. Funding for equipment, medical supplies, drugs, and other needs has come from a wide variety of private donors, including the Washington Square Health Foundation, Polk Brothers Foundation, and Chicago Community Trust. The clinic has never sought or received financial support from Saint Basil's parish or any public health agency.
Despite the pressure to handle 25 to 30 people an evening (4,500 patient visits a year is the current pace), the atmosphere at the clinic is calm and relaxed. Rodney Blaney, a 38-year-old dentist with a private practice in Chatham, says he feels no strain working at the Free People's Clinic after hours. "Actually, this is more relaxing than my own work," he says. "So many places practice a kind of assembly-line approach that there's pressure on all of us to operate that way." Maybe it's the absence of the profit motive, but Blaney says he feels free to take his time at the clinic, to treat patients like friends. He began volunteering three years ago after his mother heard about the clinic and told him he should offer his services. "She was right," he says, laughing. "I guess we all have a need to give back."
"Slow medicine is the only way to go," says Frances Pagan, a 50-year-old patient and volunteer almost from the day the clinic opened. "I've learned people don't need medicine as much as they need counseling, talking to, somebody to pay attention." Pagan worked full-time in adult day care until last May, when her agency downsized and laid her off. She's now managing on her unemployment benefits. Through her work at the clinic she's become a capable medical assistant, and she's taken nursing courses, which may help her find a new job.
Slow medicine also benefited 32-year-old Sandy Dunham, who worked as a bilingual clerk for an insurance company until she became disabled in 1995 and had to go on public aid. Medicaid paid for much of her treatment, but state cutbacks meant she no longer was eligible for dental care. "I needed work on my teeth," she says, "but what could I do?" Early this year she began coming to the clinic, and she's already made five visits to get her crumbling fillings replaced. When they discovered I needed a root canal they sent me to a specialist," she says. "He did the job, and he was free too!"
Many in the waiting room on any given night hold regular jobs and are not on welfare. They're the uninsured or underinsured, the working poor who can't afford to pay huge medical bills and are tempted to neglect health problems until they become catastrophic. Some, like John Paul Jones, lack only dental coverage; others, such as Marcus Lee, have no coverage at all.
Lee is a 19-year-old construction worker who makes $300 a week while taking engineering courses at Olive-Harvey College. An uncle lets him sleep in his house and helps him out with tuition, but otherwise Lee is on his own. "My mother moved to Arizona," he says, "and I don't really have any other relatives." His employer pays him in cash and provides no benefits, so Lee's serious allergy problem went untreated until a friend told him about the Free People's Clinic. "I didn't have anywhere else to turn," he says.
The unseen spirit who seems to inhabit the Free People's Clinic is that of the late Dr. Eric Kast, the founder and tireless advocate of slow medicine. Few who met him have forgotten this rotund, charismatic, eccentric physician. Kast was born in Vienna to Jewish parents who'd converted to Christianity. For years he wrestled with his religious and cultural identity, and during his medical career he developed a philosophy of life that was part Jewish, part Christian, part communist, and part Freudian. Plagued with Parkinson's disease in his later years, he nevertheless kept a vigorous Chicago private practice going. "If someone has a cold or flu," he told me several months before his death, "you don't prescribe a drug and send him home. You want to get to know the person. Illnesses are rarely only physical in origin. I'd be drained at the end of the day if I treated people mechanically. I'm usually refreshed because I've developed relationships with other human beings."
With equal conviction Kast despised the profit motive in all its manifestations--a characteristic that frequently left the billing aspects of his own practice in chaos. He viewed capitalism as diametrically opposed to the biblical admonition to love one another. So he paired Karl Marx with Jesus in a critique of the U.S. economic system and its two "ugly offspring": no-holds-barred competition and rampant consumerism.
In 1967 Kast was fired from his director's post at the city's Lawndale Mental Health Center. Among the complaints against him was that he distributed Marxist literature to patients. Kast contacted Fred Hampton, the young leader of the militant Black Panther Party, and under Panther sponsorship opened a free clinic on the west side in 1969. After Hampton was killed in the notorious police raid on his apartment, Kast kept the clinic open for two years, closing it down in 1971 when he thought--erroneously--that the government was going to increase health-care funding for the poor.
In 1982 Kast launched the free clinic at Saint Basil's when the pastor offered him space rent free in the rectory basement. (His original plan was to start the clinic in the even more ravaged Woodlawn area, but he said the local clergy group declined to cooperate with an acknowledged "Jewish-Christian communist.") Because of his long association with Michael Reese and other Chicago hospitals Kast was able to recruit a small coterie of physicians and volunteers who agreed with his policy of slow, free service.
Kast's death in 1988 at the age of 72 devastated the volunteer staff, and the clinic seemed unlikely to survive without his colorful presence. At the very least, people assumed, the personality of the place would change drastically. For a short time Jennifer Artis, the clinic director and Kast's right hand, held the operation together, but then she moved on.
The clinic's current director and only paid employee, Laura MiSweet Jones, didn't know Kast, but she clearly has his mind-set. The 37-year-old woman, who has spent her entire life in the community and has a master's degree in health-care administration, first heard of the clinic at a community meeting shortly after Kast's death. "There was all this talk that a free clinic would have to shut down, and I thought, what a shame!"
MiSweet Jones offered her services and has been director for seven years, adopting as her motto a simple distillation of the Kast message: "We should take care of one another." She says she was amazed by the dedication of the professional staff--doctors such as Edward Schaaf, David Freedman, Lori Soglin, and Richard Shapiro--and the people from the neighborhood who just wanted to help. "People saw the need, and they made things happen."
MiSweet Jones glides effortlessly around the facility, chatting with patients, checking schedules, settling misunderstandings before they flare up. "I don't think Dr. Kast ever imagined we would be here this long," she says. "I think he saw the clinic as a prop until people got a job or insurance. He didn't foresee what's happening to the poor in our cities."
Slow medicine has its downside, admits Schaaf, the clinic's dental director and acting chair of the board. "It means that for every patient we take, we have to turn away 15 or 20 others or put them on a waiting list. As it is, we're always concerned about being overwhelmed."
Schaaf, who is 65 and has practiced dentistry for 40 years in South Shore, is one of the early Kast volunteers. Even when not on duty, he can often be found circulating around the clinic, greeting patients by name.
The greatest threat to the clinic's survival, he says, was the 1995 cutoff of dental aid to medicaid recipients. "Before that we didn't take medicaid people because they were already covered. Then of course we had to make room for them." For a while the routine was chaotic and the waiting list longer than ever. Today almost half of the people treated at the clinic each year are dental patients.
To keep the demand under control, Schaaf and other clinic regulars enforce a kind of tough-love policy. "People have to take their treatment seriously," he says. "If a dental patient keeps his poor hygiene habits and won't brush or floss, we have to reject that patient, because he obviously needs a better relationship with his practitioner. If real healing doesn't occur, that person needs to go elsewhere." Missing appointments is also regarded as a serious offense: the guilty often wind up at the end of a long waiting list.
David Shapiro, a close friend and collaborator of Kast's, having worked with him at the Black Panther free clinic 28 years ago, has been a central figure at the clinic since it opened. Technically retired after 38 years in general surgery at Michael Reese, Shapiro is still committed to the clinic. He looks startled when asked why--as if the answer should be self-evident. "Why, I guess because it's the right thing to do," he says. "The reward, you see, is right there in the doing." He pauses. "Or maybe it's like what Mammy Yokum used to say: 'It's important to be nice, and it's nice to be important.'"
Schaaf says there's no guarantee the clinic will survive indefinitely. The prognosis for inner-city medical and dental care is bleak, and funding from the private sector, essential for operating expenses, is shrinking. "I guess we're always living on the edge," he says with a wry smile. "Just like the poor." o
Art accompanying story in printed newspaper (not available in this archive): uncredited photo by Lloyd DeGrane.