Academic journal article Human Organization

Power, Rhetoric, and Partnership: Primary Health Care and Pie in the Sky

Academic journal article Human Organization

Power, Rhetoric, and Partnership: Primary Health Care and Pie in the Sky

Article excerpt

Talk of "partnerships" between communities and primary health care professionals is widely recognized as a valuable selling point of programs competing for grant dollars and community sites. How the partnership manifests itself varies. Funded by a grant from the U.S. Department of Health and Human Services to a school of nursing, one such program was presented to a Chicago community as having two equal goals: delivery of primary health care to the community; and the education of nursing students. Community Health Advocates were hired to work in the center with a registered nurse to facilitate access to the local neighborhood. This core group maintains the daily functions of the center and are the first three authors of this paper. Nursing students and faculty from the university provide services at the site on the university's schedule to meet the university's goals. In this paper the core staff reflects on the experience and discusses the clash of professional and community standards, objectives, and perspectives, which results in fragmented service

Key words: community health advisors, primary health care, community participation, public health nursing, Chicago

Introduction

The disparity between institutional rhetoric and practice can lead to divergent expectations and objectives. Here we discuss a community health program, the Family Nursing Center on Chicago's Near West Side, that has been plagued not only by the distance between outlooks of biomedical individualism and community interdependence (Miewald 1997), but also snarled in the confusion of roles, objectives, and standards brought on by the distance between a rhetoric of participation and the realities of practice. In Sandy Smith-Nonini's (1997:364) felicitous phrasing, "`community participation'-remains a rhetorical staple of health development proposals with little reality in practice." This is reflected in the Family Nursing Center (FNC). This grant-funded project has the dual purpose of providing community-based health services for neighbors and community-level experiences for nursing students and faculty. A nursing school puts its interests first while using the rhetoric of "community partnership" to market its program. It employs community members as Community Health Advocates (CHAs) as a means of gaining entree into the neighborhood. The experience of the center shows how this role is fraught with contradictions.

This paper explores the rhetoric of community involvement juxtaposed against the daily realities of the people in the middle who are charged to make the center somehow work-the nurse manager of the clinic and the CHAs. We combine interviews and workers' written narratives so that each person is able to tell her own story. The history of the school and local area was obtained through interviews with neighbors. A community assessment, bibliographic research performed by the nurse manager, along with notes kept during her three years on the project, were other methods of data collection. The impetus for this paper came from a wideranging discussion among the clinic's nurse manager and CHAs, the project director from the university, and Paul Durrenberger, an anthropologist from Pennsylvania State University, as we sat around a table in the basement of the school where the center is located. As we discussed disparate points of view, the requirements for nursing students, the certification program for nurses, the family and class background of nursing students, the history of the center and its prospects for the future, the director suggested we collaborate on a paper to represent the various points of view, including the outside perspective that an anthropologist could bring. Smith-Nonini's (1997) discussion compares participatory versus hierarchic health care systems in El Salvador and places both in a global comparative perspective. Here, we present the view from one such local system in Chicago, equally subject to the ravages of poverty, from the perspectives of the director of a program and two of the CHAs. …

Search by... Author
Show... All Results Primary Sources Peer-reviewed

Oops!

An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.