Introduction

The Dream

When El Rio was conceived, people allowed their imaginations free rein and cherished a host of joyous dreams. How wonderful it could be if the full meaning of "community health" materialized; if all those things that adversely affected health could be mended and all those things beneficial to health could be enhanced. Poverty, one of health's persistent enemies, could be defeated and aging, playing its nasty role in the break down of health, could be slowed and even mended.

Hope encompassed notions about the people who worked toward these goals. Many of these people, if not most, came from the very neighborhood which emerged from the darkness of persistent poverty to the light of economic comfort. Training meant more than bringing ephemeral skills. It opened the door to a multitude of possibilities and opportunities. The community could look toward a real shot at determining the policies of their clinic. The community expected highly trained people to be sensitive to the cultural differences of the other employees and of their patients. When the clinic began, and for many years afterwards, a time of great hope dreams existed.

The Reality

But it is one thing to optimistically strive to attain an ideal, and another to confront harsh realities. Conflicts that might occur any place became elevated and fueled by a few local people who seemed to believe leadership consisted of absolute control and bullying. This leadership hired administrators lacking independent judgement and with insufficient experience or skills.

To deal with the problems, the employees joined together and formed a union. The union too had its ideals and its dream. For many, the union emulated the original hopes of the clinic. But like all hopes, disappointments occurred. The ideal broke down barriers between people of different ethnicity, skills, educations. A few employees, caught up in "we verses they" strategies, again undermined the ideal.

While generally not obvious, the harshest reality involved political decisions made in Washington, D.C. As our nation's capital turned more conservative, a conservatism which had no bright vision of the future except to return to an idealized but unreal versions of the past, the dream of El Rio became more profoundly mutilated. None of the local problems, and many existed, could compete with the devastation of the paternalistic and mean spirited decisions in the Nixon and Reagan years that moved government wealth from the poor to subsidize the wealthy. Those new directions served to further divide people.

Although much never materialized, still the El Rio concept and the people who bought into this concept did achieve an amazing part of their dream. The community did become a better place, people whose health had been neglected received humane treatments for their illnesses and many local residents found productive employment and at times expanded their job opportunities.

The Book

The story of El Rio is worthy of telling as it reveals unique experiences. It placed a health center in the middle of a community that had poor access to professional health services and it staffed the center with many people from that community. El Rio had a broader view of public health than most, a view that understood that poverty, itself, acted as an adversary to good health.

Community boards abounded and like many places El Rio's board suffered serious problems. But community boards also offer potentials that are worth some struggle. Unfortunately, it was ultimately so much easier to return to the conventional board. Democracy is also not simple. It can be exceedingly frustrating. It is easy to think about doing away with democratic forms and going to fewer complex, autocratic models. Fortunately, most Americans deal with the messiness of democracy but unfortunately, too many people are not ready to overcome the problems of community boards. They are essentially the same problem with some vastly different dimensions.

When problems arose, the employees at El Rio, like so many employees at other work sites, looked toward a union for protection and advocacy. The El Rio union mirrored the uniqueness of the health center it served. Everyone, who could be in a collective bargaining unit, joined just one union. That meant that accounting clerks and physicians, along with the other employees, entry level to professional all joined one union. For the entry level employees who recognized it, they gained enormous protection not ordinarily possessed. For the professionals, this union offered the possibility of tearing down walls that divided people while encouraging a cohesive community for all. Again, this constituted the ideal and the ideal is rarely fully realized.

Writing this Book

So we started gathering material for our book. To write this book we drew upon many resources. We used newspaper accounts, some publications, newsletters, minutes, memos, employee interviews, our own memories and other resources. Some information about the clinic came from newspaper accounts, which provide insights into some of the more dramatic events and these proved to be substantial aids. Publications by the clinic and union added another dimension. When the employees first united under the title "Neighborhood Health Center Employee Organization," they established an employee newsletter. That newsletter provided valuable information about the employees' organization and the direction it took. The union newsletters reported on negotiations, elections of union officers, some actions of the board of directors, some grievances and the general affairs of the union. Minutes of meetings from the union, management/staff, and the board of directors provided valuable data. Minutes of committee meetings also extended our understanding. Interoffice memos from management to the staff or from union officers to management broadened our knowledge. A cross section sample of employees involved with the history and the unionizing activities gave valuable insights. In this process of interviewing people, we came to more fully appreciate the great depth and variety of views held by different employees.

We hope that by telling the El Rio story, the readers can see where we went wrong but also where we went right. Although our dreams fell short in the light of reality, we accomplished much. The neighborhood around El Rio became a better place because of the clinic. We believe the El Rio experience profoundly affected many employees.

Thanks to All Whom Helped

Fortunately friends, willing and able, supported our work in developing this book. Several friends simply showed an interest in what we wrote while others took a more pro-active role and discussed or criticized, in a helpful manner, various aspects of the writing.

Thanks need to go to Kay Sothier for her helpful suggestions that enabled us to move forward in a more productive way.

We are profoundly grateful to all the people we interviewed and want to thank Isabel Abalos, Virginia Alvarez, Virginia Bishop, FNP, Ed Celaya, P.Rh , Yolanda Coronado, LPN, Dolores Elenez, Alice Gallardo, Fernando Gaxiola, JD, Gloria Gonzales, Shirlee Greason, RN, Josie Guerena, Pat Morris, Pat Patton, Jessie Reece, Alicia Tovar, Herlinda Valenzuela, Barbara Warren, MD and Ava Wolfe, MD.

We owe a special thanks to Herb Abrams, MD. He not only played a central role in developing the original plans for El Rio, he provided help by discussing the origins of the clinic and in supplying us with insightful documentation and speeches.

As employees at El Rio, we have been very fortunate in having caring mentors. Ethel Larsen is especially thankful to Shirley Fish (a.k.a. Sr. Baptista) and Barbara Warren, MD for the direction and insight they provided. Mary Lou Gonzales is especially thankful to Zora Zemsky, FNP for her support as a mentor.

We are thankful for the time and work that Eileen Asher, Ph.D. put into reviewing some of the chapters.

Ultimately, this book could not have been completed without the support of our families. A special thanks needs to go to them for providing support throughout the whole process. Mary Lou Gonzales' family especially Patty Freeman and Danny Leitner lent a sympathetic listening ear. Most of all, husband Frances Leitner, relinquished part of many weekends while his wife went off ". . . to work on the book" and he did it in good humor and with support. We are also thankful for Frances Leitner's photographs. Many of the photographs in this book came from his work. Likewise, Ethel Larsen received an abundance of supported and encouraged from her family. Golda Velez, JoAnn Groh and Ken Larsen reviewed the manuscript and offered helpful criticisms. Larsen's brother, Harris Bernstein, Ph.D. and his wife Carol Bernstein, Ph.D., shared their experiences in both writing and then publishing their book. Those discussions, while being insightful in themselves, helped make the process seem less alien. The Bernsteins also shared their experiences in dealing with conflict between facility and administrators at the University of Arizona. Astonishingly, when dealing with conflicts many similarities existed between events at the University and events at a multi-ethnic neighborhood clinic. Arno Larsen helped make the book possible by always being there at the difficult times and offering appropriate support when most needed. Both of our families provided continuing support over several years and did this with good humor and insightful suggestions. That support essentially lightened the work.

To all the people who helped make this book a reality, we extend our profound appreciation and thanks.