Introduction
Today, Frances Nelson Health Center (FNHC) provides comprehensive services to residents of the Champaign-Urbana North End as well as others who travel to the Center to receive healthcare. The facility currently located at 819 Bloomington Road in Champaign includes well-equipped exam and treatment rooms, comfortable waiting spaces as well as offices and meeting space.
On a recent visit to the center other assets became apparent, most notably the dedicated and diverse professional staff committed to the health and well-being of patients. The commitment went beyond the immediate physical health of those who sought care to encompass a comprehensive approach in meeting their needs. In addition to medical care, patients received mental health care from psychiatrists on staff, comprehensive dental care and social services committed to assisting them in other areas whether it is help with utility bills, housing, and transportation or to address whatever concerns discovered. The extent of these efforts was evidenced by the immediate availability of free food bags for anyone who was hungry to take with them until they were in touch with the local food bank.
The impressive array of services provided by the FNHC, FQHC (Federally Qualified Health Center) now reaches 11,500 patients annually, amassing over 70,000 visits per year. The success enjoyed today did not happen overnight. The Center began on a much smaller scale and with significant opposition.
Beginnings: The North End Health Center
In the late 1960s there was robust controversy surrounding the delivery of healthcare to uninsured populations. On the left were proponents of free universal health care available to all citizens, appalled that the United States was one of the few developed nations without it. On the right were free market advocates who viewed universal access as “socialized medicine” and believed the existing system addressed the needs of the uninsured poor through programs including Aid to Dependent Children initially enacted as part of the Social Security Act of 1935 later becoming Aid to Families with Dependent Children, and charity care provisions in the Hill Burton Act of 1946 compensating hospitals for such services.
The African American population in the twin cities of Champaign and Urbana increased dramatically in the early 1900s with the in-migration of blacks fleeing the South primarily along the Illinois Central Railroad in search of jobs and opportunity. The majority of these newcomers settled in the Champaign North End as it came to be known and to this day it remains predominantly racially segregated.
The tenuous and troubled relationship between the North End and the Champaign-Urbana medical establishment is the stuff of folklore, cases corroborated by firsthand accounts of young unmarried black women who after giving birth returned home sterilized, fair-skin light-eyed Negroes discharged from segregated facilities when their race became known, and brain operations on a number of its residents by an area physician who was not certified to perform surgery. There was no clamor to question medical necessity or review informed consent. It was a different time that pre-dated patients’ rights legislation and malpractice litigation for poor people and racial minorities. Word spread within the community and North End residents were cautioned to steer clear of these unscrupulous providers.
Another aspect of segregation and prejudice became the unlikely source of tension between the North End and the local medical community. Prior to the Civil Rights Era blacks were deemed ineligible to obtain a conventional mortgage. Those wishing to buy a home were only able to do so under a land contract purchase which allowed them to pay over a specified period of time, most often monthly payments for 30 years, with the caveat that the home could revert to the lender if a single payment was missed. The purchaser did not accrue equity in the property. Few people had medical insurance and in some cases incurred medical expenses they were unable to pay, but some were able to remove their debt by transferring their land contract to a nefarious physician. Patient and family usually remained in the home as renters, but the physician now owned it. As a result, an inordinate number of doctors became absentee landlords and families were now reliant on the good graces of the new owner for the care and upkeep of their property.
As with most social change it is difficult to pinpoint a single pivotal event as the impetus. It is rather the convergence of several significant developments occurring in close proximity as was the beginning of the FNHC. In this case, four contributing factors can be identified: findings from local public health research conducted by a graduate student at the University of Illinois, disclosure of financial decisions made by the Champaign County Public Health Department, development plans announced as a part of Urban Renewal in the Champaign North End, and crucially the activism of local African American men who came together to form a group called SOUL, the acronym for Security, Opportunity, Unity and Love.
Research conducted by the U of I graduate student addressed the topic of health disparities for minority populations. As was the case in other communities in the country, his findings at the time confirmed that the black population of Champaign County fared poorer than the white population on a number of indices, notably infant mortality which was almost twice as high. In the timeframe of the publication of his report another disclosure came to light. As part of its responsibilities the Champaign County Public Health Department provided services for low income women and children, including prenatal and postnatal care and childhood immunizations. Taxes were levied by the county to support these services; however the department made the financial decision to invest rather than spend a portion of its revenue. The revelation of over a hundred thousand dollars in certificates of deposit held by the department appeared unconscionable in light of the indices of health disparities and implications for unmet needs.
Once uncovered these circumstances became a topic for discussion at meetings of SOUL. The association of predominantly young black men had established an activist agenda focused on bringing about improvements in the black community. An offshoot of the Black Coalition, a loose federation of a number of existing black organizations, SOUL attracted a broader spectrum of participants with differing opinions on how to bring about change. The conversation escalated when a member of SOUL relayed his experience at a local hospital emergency room where it became apparent that the intake staff was more interested in how he would pay for care than initiating his treatment. The issue broadened to include a more comprehensive view of unmet health needs and ways to improve access to timely and compassionate medical services.
In this milieu, the men of SOUL turned their attention to strategies to better meet the healthcare needs of North End residents. Ultimately it became obvious that something along the lines of a free community based health center might help address these problems. Discussion led to the belief that it was not only possible, but plausible. One of SOUL’s members, Vernon Barkstall, served as director of the Champaign County Urban League and in that capacity was actively engaged in the Urban Renewal project underway in the North End. Several houses in the zone had been vacated and would remain unoccupied until a later project phase, providing a potential location for the proposed health center in the short run. Barkstall’s wife Carol, a registered nurse, became interested in the plan and believed others in the medical field would be willing to participate.
Another member of SOUL, William Smith, was a native of the North End and U of I law student with university contacts. Ruth Heifetz, M.D., a visiting professor in the U of I Department of Urban Planning, taught health policy and planning. When Smith spoke with her about the possibilities of a center, she expressed excitement and her wish to become involved. Her expertise and insight became invaluable in identifying basic staffing needs, a physician, nurse and lab tech, to deliver the envisioned array of clinical services: intake, screening, immediate treatment and recommendations and referral for follow up. Dr. Heifetz went on to become one of the first physician volunteers.
In addition to Carol Barkstall, Capitola Stanley, RN, a public health nurse acquainted with SOUL’s efforts to create a community health center, became interested and brought another public health nurse on board, Sharon Trantina, RN. In their capacity with the public health department both women were aware of unmet needs in the North End. Another community activist, Elsie Easley, LPN, joined the growing list of volunteers as did Johanna DeVreis, RN. As well as being a nurse, DeVreis directed the Adolf Meyer Zone Center of the Illinois Department of Mental Health where SOUL member Smith was employed part-time as a community mental health worker. DeVreis saw a community based health center as a way for the Adolf Meyer Zone Center to carry out its community mental health mandate and ultimately committed Zone Center resources for that purpose. Similarly, Sue Ellen Jacobs Ph.D. of the U of I Urban Affairs Institute supported the effort by assigning graduate students who carried out staff functions for the new facility.
James Keasling, M.D., a community practitioner who had previously served as a physician in the armed services, joined Dr. Heifetz and Elsie Fields, M.D. as volunteer doctors and along with these nurses and Dave Dorm, a lab tech at the public health department, completed the initial volunteer clinical staff.
The vacant home selected for the initial site of the clinic was on the southeast corner of 5th and Eureka in Champaign. The two bedroom house was furnished and equipped with donated medical supplies and equipment in the fall of 1968 began operations, opening its doors one night a week, Thursdays from 7pm to 10pm. In advance of the opening, flyers were posted in churches, grocery stores, the community center at Douglas Park and other venues where word might spread.
Thus began the North End Health Center. Patient needs soon exceeded capacity and volunteer availability allowed the clinic to extend hours to include Tuesdays as well. The patient base quickly expanded beyond North End residents to other low income blacks and whites from outside areas such as Wilbur Heights, as well as married student families from the university. As receptive as patients were, the local medical establishment took a negative view of the clinic, seeing it as an infringement on the traditional health delivery system. The vast majority did not volunteer and reportedly actively discouraged the participation of other medical professions. A few doctors whose association was short- lived volunteered long enough to investigate whether or not they were losing their ADC (Aid to Dependent Children) patients to the free clinic.
The Evolution of Frances Nelson Health Center
The North End Health Center continued to provide medical care from its initial location for over a year and until urban renewal required that the site be vacated in advance of the next phase of development. Again Vern Barkstall took the lead in identifying alternative facilities, entering into discussions with the Optimists Club, builders and owners of a vacated children’s home in the Carver Park subdivision of Champaign. For many years the home served as the Frances Nelson Home for Children, so named for the woman who cared for black orphans barred by the racially segregated Champaign County Children’s Home. She had housed them in her own home until the Optimists became aware of limitations she faced and as a charitable act built the new Carver Park facility. Following passage of civil rights legislation prohibiting racial discrimination, the County Children’s Home desegregated and the Frances Nelson Home closed its doors, appointing Charles Phillips, longtime resident and community leader, as caretaker of the building. Phillips served as intermediary in negotiations and ultimately the Optimists agreed to transfer ownership, relinquishing it for the sum total of one dollar with the proviso the Frances Nelson name be retained, and in 1969 the FNHC came into being.
The new location was a two story building with two to three times the square footage of its predecessor. The first floor doubled the space available for clinical services with administrative office space available on the second floor. Volunteers worked tirelessly to get the facility ready. It had been vacant for several years and considerable clean up and refurbishing were needed. Special mention in this effort goes to those who devoted countless hours to prepare the building for occupancy the Mitchell Family, Eugene and Ora and three of their sons (Howard, Melvin and Alonzo), William Smith, James Culp, William Harris and to the women of the community who joined the initiative begun by members of SOUL, Elsie Easley, Joanne Dorsey, Christine Washington and Burnell Biggers.
By the time of preparations for the move the reputation of the health center was well established. The new had worn off and the cadre of volunteers had become regulars, their numbers more than enough to cover the hours of service. In addition, the mental health component expanded from one to as many as five community mental health workers on the payroll of the Adolf Meyer Zone Center. One worker and local activist Elsie Easley LPN also served as first paid Director, the role previously filled on a part- time voluntary basis by Carol Barkstall, RN. Momie Ruckes served as receptionist and in her intake role provided warmth, understanding and acceptance to all patients, for some a major departure from their experience with other area healthcare providers.
Although funding was never considered the main preoccupation, efforts were undertaken to identify support for the ongoing program. William Smith wrote the first secured grant to the Peoria Archdiocese of the Catholic Church for equipment and supplies. Tom Brown, community member and graduate student in Urban Planning also made significant contributions in the early years and succeeded Easley as director. Under his leadership more resources were identified through grants as government programs responding to civil rights and social justice movements came on line to support community health initiatives designed to improve access to affordable, quality health care for minorities and low income people. In 1975 Health Centers were first authorized under Sections 329 and 330 of the Public Health Service Act; in 1977 President Jimmy Carter called for the first major Health Center expansion as part of his Rural Health Initiative; in1981 Congress enacted Primary Care Block Grant legislation consolidating Health Center funding; in 1985 Congress repealed Block Grants returning Health Centers to local control with federal support; and in 1989 Congress defined guaranteed “Federally Qualified Health Center” services.1
The goals and objectives of new federal programs were squarely aligned with the mission of the FNHC. These government programs changed the caché of community health centers. Traditional health providers slowly began to take a second look. The local Champaign-Urbana medical establishment, aware of these federal initiatives and associated funding, reconsidered their relationship with the FNHC. For the first time, advantages of collaboration and possible affiliation were perceived and enlightened self-interest gave rise to discussion. The pariah initially dubbed “socialized medicine” earned a seat at the table and an opportunity emerged to forge mutually beneficial health care programs.
Legacy of Frances Nelson Health Center
The FNHC story is a microcosm of social struggles in the country over the past fifty years and still playing out on the national scene as evidenced by the 2010 Affordable Care Act and subsequent legislation proposed and defeated in 2017 to repeal and replace it. It is a success story demonstrating that affordable, comprehensive and respectful healthcare can be available to all. As a rule the medical profession is highly respected, but it was not held in high esteem by those abused and neglected by it in Champaign-Urbana more than seventy years ago.2 The beauty of the FNHC story is that those most underserved by the established medical community were instrumental in its birth. Ultimately the grassroots movement and the establishment worked together, benefiting the people.
1 Community Health Centers Past, Present, and Future: Building on 50 Years of Success, National Association of Community Health Centers Policy Report March 17, 2015, http://www.nachc.com.
2 This essay is informed by William Smith whose immediate family experienced abusive treatment from the medical community. He kept faith by using the experience to help bring about meaningful and lasting change.
Promise Healthcare is dedicated to improving the health of the community through treatment, prevention, and education. We seek to be the premier healthcare provider for all regardless of ability to pay by exceeding patient expectations and improving the health of our community.
We deliver primary medical, behavioral health, and dental services to the underserved. Promise Healthcare provides over 44,000 patient visits and cares for over 12,000 patients annually through Frances Nelson, our SmileHealthy dental programs, satellites on Walnut at Rosecrance, the OSF Healthcare Heart of Mary Community Resource Center, the Urbana School Based Health Center and our mobile clinics. www.promisehealth.org
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