The Wisconsin Magazine; 720

[Intro music] There's an old saying bigger is better. And when you walk into a massive clinic you it's impressive and you feel like I'll find out whatever's wrong with me here and it just has a certain magnetism. The magnetism of big city clinics poses problems for country docs. A report on tonight's magazine. The Wisconsin Magazine for March 5. Reporting from Madison Dave Iverson. Good evening welcome to this week's magazine. Rural health care is changing. In fact all of our reports this week are about change. In a moment our feature story looks at a group called the commandos in the 1960 the militant Milwaukee group played a prominent part in that city's social unrest. The commandos are still around, they've kept the same name but they've certainly changed their tactics. Also tonight the DNR wanted to ban lead shot but the legislature changed the rules and a lot of geese were poisoned as a result.

We'll consider the conflict between the agency, the legislature and vested interests. And then we'll get to our report on the rural doctor. A term that conjures up Norman Rockwell images but times have changed and so have rural docs and rural patients. Now let's take a short step back in time to the 1960s the decade in our recent past noted for social unrest and for bringing the issue of civil rights to the front pages. In Wisconsin most of that action took place in Milwaukee with marches led by the NAACP Then Catholic priest Father James Groppi and a group called the Commandos. The Commandos were identifiable people wearing uniforms and assigning themselves military rank. And like the Black Panthers the name Commandos sometimes brought fear to the city of Milwaukee. The Commandos are still an active organization today, but their activist nature has changed. Now if you see a clenched fist in the air at Commando headquarters it'll probably have a book in it.

Carol Larson reports. It is the summer of 1967 and Milwaukee is erupting from the inside out. Hundreds of people from the inner city are marching for 200 consecutive days they marched demanding that the City Council ban discrimination in housing. Looking back at it all the open housing marches here were comparatively nonviolent for the times despite what appeared to be a tough band of young uniformed men that accompanied each march. The Commandos a security force for the NAACP they were tough-talking, military-looking and proud to commando body, and Ima wear my shirt, and ima march on that line if you want to put me to jail and throw the key away, that's alright because I'll still be here. I don't call us paramilitary because we didn't have any weapons on us so we didn't have any clubs. We wasn't the police force. But we were, sort of protectors for the marches. During this march I seen

There was beginning to get so hostile. That people just didn't want I would see the black people moving outside of the inner city. In other words, they didn't want you to be the next door neighbor. I wanted to be a part of that Marching for the open housing, because I seen what they were trying to do, and I felt I wanted to be part of it. Jesse Wade became part of it. He marched and he saw Milwaukee pass the open housing ordinance. Later he also saw the Commandos severe ties with the NAACP as well as with Father Groppi, and in 1968 he helped negotiate their first independent grant. Money from the state to fund Commando youth projects. Wade, known as Hook, a nickname from his boxing days, is now the director of the Commandos and the Commandos are one of the largest social service agencies in Milwaukee's inner city. But his pictures on his wall attest the transition was not an easy one. At that time, it was a lot of Fight-ness I would say on the part of the legislators because they were looking at us as

a terrorist group or whatever you want to call it. And we had to take this little money $47,000 and work with the youth, and prove that we were actually going to do with the money what we said we were going to do. We gained respect from each other. And can we get our education without giving that due respect back to one another? Youth counseling was the first project keeping young blacks parolees from going back to jail. And it worked, because the counselors could look at the parolees and say I've been there. Most of the original Commandos including Hook Wade were dropouts and ex-offenders. Because many of them Of these kids I see myself as the same way. When I was they age I considered myself tough. I was tough. I was tough. I look at our kids just a wondering

that somebody don't try and work with these young people to deal with them a little while, just let them talk. You'll find out they're looking for guidance, they're looking for love, they're looking for someone to care about them. I'm not saying that I'm the perfect person to do it or my organization is the perfect [inaudible] But I am saying that many of us have to concentrate more on them. Putting the youth to work was the next program putting brooms and shovels in the hands of the kids. Each year now the Summer Youth Corps literally cleans up their neighborhoods. During the winter several kids help Commando employed workers here. Building wheelchair ramps for the elderly and physically handicapped. Forty-four ramps have been installed already this year. They also build garbage can racks elevated stands that when set in a back yard keep garbage away from rats, a major summer health problem in Milwaukee. Workers also go on pest control inspections, spray for rodents and bugs as well as winterizing

homes, putting up storm doors and windows, insulating the houses in the older parts of the city. For the few workers this is their full time job. But for the kids the mornings are spent back at Commando headquarters on the city's near north side where they go back to basics. I had to study every night to pass all of my courses. This is Commando Academy and the focal point of the Commandos' work. It is a school for dropouts not funded by the Milwaukee School System. These are kids that have been expelled, walked out or thrown out of school for whatever reason. This year there are 33 students enrolled here. Some came to Commandos on their own. Some the Commandos brought in and the first problem for most is discipline. One has to be pretty strong to be able deal with this type of thing. I think that I'm tough at times and I think that I'm soft at times. I try to put it in the right order. I try to spend as much time in the classroom as I possibly can. I try to make it my work. Know you're here for a reason. We all know

you're here for a reason, we've all got problems and we're gonna work out these problems together. Once you can get them to sit down and calm down and not show all this toughness because when you lacking something in one area you show toughness in another area. to pick up for that. We're gonna kick it back, what we've learned already. Outside of learning the math, the reading and so forth, an essential part of the Academy school is the rap session. Sit down and be real just tell it like it really it's tough out here. It's rough out here, It's hard. I know it's tough out there too. And once they see that you are a real, and you are concerned about them they'll sit down and talk to you. And once you start communicating with each other you'll find out that a whole lot will come out of this child that you can begin to pinpoint some of the problems, see because all those problems might not be there. He's just hostile and don't want to do this and do that. He might have a

problem at home and this is what brought this on. And after we get this what? We get a job. You'll be able to deal with that life out there. Dealing with life out there as it is, it is not an easy thing to do. Some of the kids won't learn it. Many do and some return to the Commandos to help others cope with problems. The personal ones or ones not of their own making. Some problems are the same as they were in 1967. I think that I feel that we've done much more in the social service program for people. We've just grown over the time from then to now we've showed a period of maturity. I don't see us ever being like we really were then, that day was that day.

This is a new day. We want to stay away. The size and budget of the Commandos has fluctuated over time. There are currently about 60 staff members on board there but because of government changing, cutbacks rather it looks like the Commandos along with many other social agencies will shrink with these tough economic times. The democratic process is sometimes fraught with frustration and there are winners and losers. And it's fascinating to see just how that process works. Our next report looks at one incident that made headlines recently. The apparent lead poisoning of some 3000 geese in the lawmaking conflict behind that event. Lead shot had been banned in almost one third of Wisconsin. But the legislature un-banned the DNR ban on the sidelines during all this were [inaudible] and persuasive lobbyists. Here's a look at the participants in a lawmaking battle nobody won. [Noise from a helicopter]

[Noise from a helicopter] A few weeks ago the news helicopters took off but not the geese. News of lead poisoned birds cluttered the airwaves and newspapers because thousands of Canada geese littered three of the central Wisconsin swamp lands. Fingers pointed to lead shot and at Senator Gary Goyke of Oshkosh. Most agree the geese died from eating lead pellets the poisonous pellets the DNR tried to ban. The ban was shot down by an amendment to last year's budget review bill. An amendment sponsored by Senator Goyke. The unfortunate situation is it and I say it's a national tragedy. You know I do feel I feel responsible but I'm not the person who fired the lead shot. Nor am I an agency that never promulgated a rule to do anything about it in the past 10 years. They knew these things if they did then they should have gone out and convinced us that this needed to be done and they did not do their work in that area. We've had ample documentation in the state. Some folks didn't think we did that we

needed more that we were moving too far too fast. But there comes a point when one has to make a decision. And we felt that a good decision had been made and we were moving in the right direction. Last March a group of hunters approached Senator Goyke in an attempt to block the DNR's expanded rule against lead shot. They felt the DNR was moving too fast that the agency hadn't substantiated their claims. One of those hunters was Jeff Renarde of Neenah. They've done their homework but I don't think they went about it in the right chronological method. The other states and the Flyaway had done the Gizzard studies Wisconsin had not. They were totally convinced they would march off a cliff for this, they absolutely believed in what they were doing. I was not convinced. It's a matter of persuasion and those who can give the best case hopefully will come out that the right decision will come out. In this particular instance we felt we had a good decision.

Hindsight supports the DNR. Nonetheless, the lead shot ban was gutted by what became known as the Goyke amendment. The DNR didn't think the Goyke amendment had a chance to get past the legislature or the governor. DNR was wrong. Governor Ledray has refused to veto the amendment because it illustrated quote the value in need for legislative involvement in an issue when a non cabinet state agency does not adequately involve or consider its constituency. There is a strong feeling that the DNR does not in fact adequately have a mechanism to listen to the hunting constituency. I heard him called by one DNR person the neanderthals you know the guys out there the gals out there who really aren't up with all the latest trends and they kind of treat them that way sometimes that's my observation and I served on the DNR committee for several years that somehow if you don't agree you're not very bright. DNR gets criticized for many things but when an agency

has to tell somebody no or has to regulate. Certainly if each of us were good stewards of the air and the land and the water we wouldn't need to have a lot of regulation. In light of this year's geese die-off the DNR is planning to propose a lead shot ban more restrictive than the one overturned by the legislature last year. But can the same thing happen again. Should the legislature overturned rules set by a state agency when it feels pressure from a special interest group. I certainly hope there is not another amendment. I think it's very important that the legislature and the sportsman and of course the agency to all realize that a number of years ago the legislature gave the department the authority to set the Fish and Game rules. Because of the expertise in various programs and I don't think one should be legislating these type of technical matters. Sure it should happen again. Why not? The DNR is a toll is a

taxpayer supported administration. The people of the state of Wisconsin fine the DNR because the changes in our society are involved in more and more decisions. When an issue comes up I'm not going to give them a blank check to do whatever they want regardless. Like I say they don't run for elected office. We all learned a good lesson to sit out and let's talk about it let's figure out what we're going to do and do it without involving the political or the legislative branch of government in it. We, ya run each battle and you let it run its course and you either win or lose. That's how it is that's how this game is played. And I shouldn't really say game because it's much more serious than that. I think there are feelings about the DNR but I think it's because the agencies sometimes act and acts like it has the only answer. You can only take that so long and sometimes they've been wrong too. Despite the DNR proposal to reinstate the lead shot ban similar proposals may not fare so

well nationwide. Congress has now imposed new restrictions on the authority of the federal Fish and Wildlife Service to enforce lead shot bans elsewhere across the country. One problem that many people associate with small towns is the shortage of physicians. It's not that there are not enough doctors. It's all a matter of proportion. Too many in large cities and too few in rural areas. Many towns spend a lot of time and money seeking a doctor. But not just any doctor. People want the permanence of the old fashioned country doctor and the specialization of modern clinics. Those patient attitudes are just one of the hurdles along the rocky road of today's rural doc. Art Hackett reports. As the t-shirt shows these people are from Blanchardville. They're going to a doctor in Madison. They represent one of the problems in delivering health care to rural areas. How are you going to keep down on the farm after they've seen a specialist? I wanted to work in a rural area. I wanted to work in an area that

was under-served. I wanted to work in an area that provided some opportunities for doing things that were not directly curative medicine. Dr. Erica Voss formerly practiced in India and Bangladesh. Four years ago she came back to her home state and to the town of Blanchardville. Her clinic uses a team approach. Doctor and pharmacist working to prevent disease rather than treat. There's a pretty good one in there about the stress EKG. All these nice trim women. The Blanchardville clinic was started as part of a federally subsidized Rural Health Corporation. But so far, the clinic hasn't attracted enough patients to meet the federal program's guidelines. This summer the clinic will have to start making it on its own without federal aid. The lack of patients has been a frustration to the doctors committee that worked for 11 years to find a physician.

Between the time that the general practitioner died and we recruited Dr. Voss people were forced to seek medical care elsewhere. And once you establish a rapport with a doctor it's not easily changed and they were a bit reluctant to switch doctors switch back to Blanchardville They weren't sure how long our doctor would stay in Blanchardville So it was a difficult time for them to change. This sparked a community meeting last summer. We talked about the need to use the clinic now and the pharmacy now. We talked about the fact that we had reached a plateau in our usage of the clinic and that we just couldn't go on indefinitely with that level of usage. These bumper stickers were free to all anybody that wanted to put them on their car. We have a little discs here. We support the Blanchardville clinic. They're about the size of a 50 cent

piece that can be put on envelopes. We have. "We support the Blanchardville clinics" signs. The idea is to pass the word on. But it takes more than stickers on envelopes to attract a doctor and bring in patients. It's a battle against patient attitude and sometimes the federal bureaucracy. Well I think sometimes people view the small time doctor as being not quite as competent as a doctor in a large multi specialty center. And I think possibly that's due to the fact that they don't really understand what primary care is and how it fits into the overall system. There's an old saying bigger is better. And when you walk into a massive clinic you it's impressive and you feel like my gosh they'll find out whatever's wrong with me here and it just has a certain magnetism.

Dr. Voss has been practicing for many years, that's somewhat of a rarity among today's rural doctors. Many are fresh from med school facing heavy tuition payments. Many have joined another federal program The Rural Health Service Corps these doctors get a break on their college loan if they serve in a doctor short area like Lafayette County for a set number of years. The problem is the doctors often leave as soon as their time is up. They return to places where they went to med school creating a doctor surplus in places like Madison and Milwaukee. And some cities, like Poynette, consider themselves doctor short, but the federal government doesn't. This new clinic may help solve that part of the problem. When it, pharmacist Don Sandmen says the lack of a large permanent building may have cost the community the doctor they did have. A small converted home wasn't enough. But without that facility they cannot attract associates and without associates they cannot continue to practice in this small rural area.

And Dr. MacNeill that had located here had 24 hours of calls seven days a week could not see any progress towards the facility and then decided that he would have to look elsewhere. For the benefit of his family and his family life and everything else. The pointed clinic is now staffed with out of town doctors on a rotating part time basis. Poynette, like Blanchardville, is fairly close to Madison and Portage where there are large clinics but Poynette, like Blanchardville, wants a doctor of its own. Nancy Marquard works at the Poynette clinic explained why. For years we took our children into Madison for medical care. It's just much nicer to not have to drive. So did Clara Geezey, a woman we ran into in Sandman's drug store. Usually runs me about $50 for a visit. Social Security doesn't cover a lot of that stuff either.

Do you use a physician here in town when you can. If not for myself because I've been going to Portage for about 10 years. But if we had a physician in town here I'm sure I would change and so would a lot of others that have to go to Madison or Portage. If they will stay! Can they guarantee that they stay if they'll be outta here two or three months then you have to go all through that again of changing records. Although in doing the story we found out it's sort of part of the problem the patients don't come because the doctors are temporary. The doctors are temporary because the patients don't come to them. Yes, but could we be guaranteed that the physicians would stay then I would change to it so would others that I know of. If doctors aren't flocking to places like Poynette they are getting closer. Madison clinics are setting up satellite clinics on that city's fringes. They are trying to draw rural patients in. It's a byproduct of the doctor surplus in Dane County but Sandmen says that's not his idea of rural health care.

I think we're lucky that we have an independent practice out here rather than an arm of a larger clinic which uses their outreach clinics solely to bring in material for the specialists. They make the money on the specials so they use the rural clinic so to speak as a means of attracting patients and work for their own specialists. Like it or not there are a lot of multi specialty clinics in Wisconsin and there are few communities that aren't within an hour's drive of one. Small town family practitioners are an alternative. Some people like Carl Chandler are optimistic they can make that alternative work. But we ran into a nurse at the clinic in Poynette who is less optimistic. I just don't think people can make those kinds of commitments. You know doctors can make those kinds of commitments today. I think that maybe they have in mind that they would like to work in a small town, try it out. Most of these doctors were educated

in big cities, you know. And I think that there's some dedication but I think they need to try it out and see how it is. You know maybe they'll stay for five years maybe they'll stay for 10 years but I don't think it's the same thing as the ol country doctor you know that had his horse and cart and I don't think that's how life is anymore. Things are beginning to look up in Poynette, the patient load has quadrupled since last fall when our report was filmed. A spokesman for the Poynette clinic says the chances of finding a permanent doctor there are now very good. The clinic will have an open house by the way on March the 15. This week's most critical rural problem though isn't health care at least not if you're a dairy farmer. This week's point of view comes from dairy man Gregory Blasca. He opposes the Reagan plan to cut price supports for the dairy industry. Reducing price of supports to 75 percent of parity, Blasca says will put some of his fellow dairy farmers right out of work. Parity ensures that a farmers real earnings will always be a given percentage of what he would have earned during a

base year established by the federal government. In other words, the government helps farmers remain in business by adjusting for inflation and change in the marketplace. Here's Gregory Blasca with tonight's point of view. Well the stock-man Reagan's proposals for Wisconsin [inaudible] seem to me to be pretty bleak. I hate to think of fixing something that works as well as our very economy and Wisconsin and United States. I would think that if these proposals are carried to their end whereas the government has no intervention and in dairy that will be a real black day for Wisconsin ag culture The first consequence of course will be the elimination of 10 to 15 percent of Wisconsin dairy production through I would say bankruptcies of young dariymen that right now are probably heavily financed and need all

the income that 80 percent of parity generates 80 percent of parity is not high. It's it's not a parity that offers any excess profit to any dairymen. So even if people think that's dairying is profitable that's not true because the debts are exceeding the profit at this present time. We are we are a public service to furnish a supply of milk for all the people in this country safe dependable supply of milk at a fair price. You see the cut has not happened and legislation for the new farm bill of 1981 is before the Congress now and I feel that the debate is just starting and we'll join hands with the tobacco farmers and other people across this country that believe these programs work well and I think that agriculture act of 1981 will be a good one for the farmers of the country. That chapter in that debate Gregory Blasca mention was written in part yesterday when the Senate Agriculture Committee recommended an April 1st freeze on dairy price support. Next week on the

Wisconsin Magazine we're going to take a closer look at the parity problem. We'll take a look at what those proposed cuts will mean for Wisconsin dairy farmers. Also next time we'll have a report on Wisconsin's juvenile justice system and what that system means particularly for girls in our state. Those stories next time on the Wisconsin Magazine. I'm Dave Iverson. Have a good week.