Community Health in Inner-City Cleveland

By Barbara Ruben

Rows of blocky brick public housing apartment buildings line the snow-covered streets of an inner-city Cleveland neighborhood. But instead of the atmosphere of decay and fear that pervades many public housing developments, there is a sense of accomplishment and hope. Here in what is called Miracle Village, drug-dependent women and their families work to start a new life through substance abuse treatment programs, job training and counseling for both parents and children.

A joint program of MetroHealth System's community health center and the county housing authority, Miracle Village offers intensive 24-hour treatment in renovated public housing for three months. Then families are moved to nearby apartments for up to 21 months of support. It is the first project of its kind in the United States to link family substance abuse treatment, health care housing and employment support for residents of public housing.

"In our experience, for most women who get sober, the lack of information on parenting, budgeting and jobs, not to mention plain old fear, drives them right back to using drugs. Here we treat not just chemical dependency, but the whole person," said Anne Sowell, project director for Miracle Village. "And if we can educate the kids that there are alternatives to stress and pain, maybe they won't abuse drugs themselves."

Seventy-five percent of the women treated in 1993 remained drug and alcohol free during the course of the year. During that year, 11 babies were born drug-free to mothers fighting substance abuse problems, and 26 children, previously cared for by other relatives or in foster homes, were reunited with their mothers.

Miracle Village, which has served 121 families since it opened in 1992, is one of a number of MetroHealth System's community health programs that the partners from Turcianske Teplice visited. They also toured MetroHealth's Clement Center, which offers many types of care--from family practice to geriatrics to dentistry--to a predominantly African-American population on Cleveland's east side.

"Rather than waiting for diseases to manifest themselves, this center reaches out to the community at the earliest opportunity possible," said Fred Tavill, MD, who directed the center until 1995.

In addition to the more than 70,000 out-patient visits each year, the Clement Center provides services for some of the city's estimated 5,000 to 20,000 homeless.

"We've found that people who are homeless don't use our medical clinics the way others do," said Henry Walker, MD, director of medical services at the Clement Center. "They fear being ostracized. There is also a fear of being confronted. We don't want them to wait until problems are acute enough to go to the emergency room."

Now health care practitioners at the Clement Center seek out homeless with mobile vans that offer health care on the streets. They have also established clinics at homeless shelters and provided counseling at food centers.

Walker said another problem facing patients who visit the center is a reluctance to take charge of their own health. For example, patients with high blood pressure have had difficulty obtaining and understanding prescribed medication. To combat this, the Clement Center joined a multi-hospital effort called the High Blood Pressure Coalition that combines doctors and resources to help educate patients.

Similarly, the Clement Center's KAP (knowledge, attitude, prevention) program mobilizes community members to teach their neighbors about drug abuse and teen pregnancy, among other problems. Outreach workers at 30 neighborhood sites screen more than 1,500 inner-city residents for cardiovascular risk factors each year. Door-to-door visits to promote wellness reach more than 1,000 households a year. The program also demonstrates healthy food preparation at local grocery stores.

Return to the menu of articles