PHILADELPHIA REFLECTIONS
Musings of a Philadelphia Physician who has served the community for six decades

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Subcultures
E pluribus unum refers to thirteen colonies peacefully becoming a single nation. But it applies to Philadelphia in a different sense. Philadelphia is a city of neighborhoods.

North of Market
The term once referred to the Quaker district along Arch Street, and then to a larger district that had its heyday after the Civil War, industrialized, declined, and is now our worst urban problem area.

Philadelphia Physicians
Philadelphia dominated the medical profession so long that it's hard to distinguish between local traditions and national ones. The distinctive feature is that in Philadelphia you must be a real doctor before you become a mere specialist.

Volunteerism
The characteristic American behavior called volunteerism got its start with Benjamin Franklin's Junto, and has been a source of comment by foreign visitors ever since. It's still a very active force.

Indigents
With a long history of welcoming and assisting the poor, Philadelphia has always risked swamping the lifeboat by attracting more of them than it can handle.

Block Captains

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Ed Asner

A block captain is not a ward leader, at least not most of the time. The block leaders of Philadelphia are mostly self-appointed, de facto captains, and yes, they are mostly middle-aged black ladies. Their attitude is that politicians are there to serve the community, not the other way around. At a recent meeting, the leader of the Block Captain's Association called out to the nodding, approving group, "Call your councilman. We elect those people, put 'em to work!"

This enthusiastic group of several hundred grass-roots leaders meets several times a year in, of all places, the hallowed auditorium of the Philadelphia County Medical Society, but doctors are not running this show. Nor is the City Health Department, nor the Department of Streets, nor the various mental health and social service agencies that send representatives. The federal government expressed considerable gratitude in being able to address this group, because their new Medicare prescription card was so terribly hard to explain (i.e. it was terribly hard to understand). The genius of the block captain movement is that it appoints leaders to understand what the establishment is trying to say, and then figures out a way to say it. You can make free flu shots available, even take them to the home or workplace, but most people won't accept them unless it is explained by someone they trust. Dead birds don't spread disease, mosquitoes do, but that really sounds a little unlikely. To believe that, you first need the word of a respected local leader. The U.S. Army is built around its sergeants, in the same way. That's in fact how things work at every social level, but in Philadelphia's block communities, it is finally becoming organized. For example, they like pamphlets. Pamphlets are what give sergeants credibility back in the neighborhood.

Success has a thousand fathers, failure is an orphan, so it's now hard to know who started this. Eve Asner, the sister of Ed Asner the movie star, can claim credit for starting a group called Philadelphia More Beautiful, dedicated to cleaning up the messes of the slums, and applying social pressures of a loud and effective sort to irresponsible neighbors. And then, along came the Deputy Health Commissioner Larry Robinson with HEAT. During a hot summer, it was possible for a hundred children and old folks to die of heat prostration because they were confused by dehydration and did things which made matters worse for themselves. The block captains were ideally situated to know who was in danger, who hadn't appeared outside in a day or two, and thus who might need to be forced to drink water or go to an air conditioned movie. Training the block captains to recognize the signs of trouble fit nicely into the Health Department's ability to measure results with computers. Last year, only seven people died of heat prostration, and everybody knows whose block they lived in.

The Medical Society pays for everybody's lunch at the block captain's meeting, and it is a calculated policy. Every doctor knows how useless it is to talk in terms of calories, carbohydrates, high unsaturated fat content, and water-soluble vitamins. Pamphlets help, but what really works is to serve the block captains a lunch and tell them, now this is what we're talking about. Heaven only knows how that gets translated back in the neighborhood, but surely the first step is to give the block captain an unmistakable message. The Medicare bureaucrat looked visibly relieved when her painfully convoluted explanation of the Medicare prescription card was reduced to about two sentences by questioners in the audience: If you have Medicaid coverage, forget it. If you don't, that card's worth about $600. And this here pamphlet proves I know what I'm talking about.

There did not seem to be a scrap of ideology or power hunger or self-serving -- the usual hallmarks of politics as we commonly observe it. The over-riding principle on which these highly disparate groups are operating together is, pick a problem, and solve it.

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