This month marks the 20th anniversary of the St. Petersburg Free Clinic. Throughout its history the clinic has targeted the most neglected needs of low-income people, offering alternatives for those who are least "entitled" to adequate health care, nutrition and social services. Unlike most service agencies, which focus on single issues, the Free Clinic often moves on to something new when entitlement levels change or larger institutions find a problem worthy of attention. Such decisions are a hallmark of the clinic's development, and they offer a unique chronology of America's changing assumptions about the nature of poverty. In the early 1970s, for instance, the organization began to provide drug treatment. Too few recognized the enormity of the substance abuse problem, or its long-term damaging effects on the employment and educational opportunities of low-income people.
"By the time 1976 came along, there were some pretty good drug treatment programs," said Sister Margaret Freeman, who took over management of the Free Clinic that year. "I made the decision that we would not renew our license for being a drug treatment center."
After Medicare and Medicaid were introduced, many communities began to phase out public health clinics that had served low-income people. It took a while for planners to realize that many clients were not quite poor enough for Medicaid, or quite old enough for Medicare.
"There was a very definite need among much of the population that was between the ages of 55 and 65," Sister Margaret explained. "At one point in that era, 70 percent of the people we were taking care of were older people. They were not eligible for any kind of benefits."
Advocacy by the Free Clinic and its social services arm, We Help, helped to change eligibility restrictions and expand the benefit options for this group.
While one gap was closing for older people, holes were widening in the network of services for families and children. Sister Margaret hired a nurse-practitioner, who was quickly swamped with requests for prenatal care. The clinic founded its own alternative birthing center in 1981, a program that was later turned over to the Pinellas County Health Department.
Other gaps in the services for families and children became wider in the 1980s as well. "There was a change in the whole atmosphere with regard to any kind of social programing," Sister Margaret said. Many existing programs were cut back, and others were allowed to languish without adequate budget increases:
"Houses were not being built. Programs that had proven themselves, such as Head Start, were cut back. The homeless situation was just absolutely, totally ignored. The people in that situation were said to be there because "that is the way they want to live.'
Meanwhile, industrial plants in the Midwest were shutting down, further swelling the ranks of the homeless. Many who came south were families, headed by men without skills or with skills that had suddenly turned obsolete.
"They all took to the road," Sister Margaret said. "Very frequently, they ended up here with nothing but a ramshackle car. Many of the men were still looking for work, family people."
Slowly, public opinion was ignited and more agencies began responding more fully to the needs of families and children hard-pressed by new poverty. Now the Free Clinic is focusing again on an older clientele, especially working people and retirees who find vital prescription drugs priced out of reach.
Sister Margaret is gratified by society's response to the medical needs of children, and by the awareness of other needs as well. "There is definitely a beginning of a recognition of the fact that if we don't do something about the basic poverty levels, education levels of our kids, there will be no future," she said.
As for the most basic causes of poverty, though, "I don't see any real change," Sister Margaret offered flatly. Instead, she pointed out, the materialistic values that define rich and poor have become even more dominant, more corrosive to the individual's sense of self-esteem.
Life histories of low-income adults can provide a social and psychological contrast. In a book called Hard Times: Cotton Mill Girls, 20 women describe their experiences growing up poor in North Carolina factory towns. Their clear sense of family and place stands out boldly against the experiences of many children who live below the poverty line today.
"I had a good childhood and I had a good mother and father," says mill worker Billie Parks Douglas. "And we young'uns didn't know that we was poor until they told us on television. We really didn't. My mother and daddy never made us feel like we was poor."
Mrs. Douglas tells interviewer Victoria Byerly about growing up in a family of seven, sleeping three to a bed and sharing a bicycle among the crowd.
"Then they started talking about the poverty-stricken area," she recalls. "In the '60s . . . this was the area that was designated as the poverty-stricken area. We were shocked. We just laughed because we didn't know."
If Mrs. Douglas' surprise was a measure of her oppression, it was also a measure of her self-esteem and her family pride. Today's disadvantaged children are made painfully aware of their status from an early age, not only by television but by obvious and dangerous rents in the social fabric. Here, for instance, are a few lines from a performance by young teens for their peers at a youth rally in Boston:
There are families in the world with no place to go
They sleep in the gutter
In the rain or snow
Some killin' others, and others stealing from friends
Drugs and alcohol
That's where it begins
That's probably also where it ended for John Thomas Jones, a talented 8-year-old who died Monday after he was caught in the cross-fire between two anonymous gunmen on a New York City street.
"I'm scared," a young friend of the victim told a New York Times reporter. "I hope I'm not next. You just got to be ready to duck whenever somebody drives by or some guys are moving together."
"We are never going to be able to do anything about this crime scene and this drug scene until we can instill some kind of possibility about the future, some kind of hope," said Sister Margaret.
Maria D. Vesperi is a staff writer for the St. Petersburg Times.