UBC Theses and Dissertations

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UBC Theses and Dissertations

A study of women using a self help clinic Steele, Darlene Shirley 1974

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A STUDY OP VOVF.N USINO A SELF HFLP C L I N I C by DARLENE SHIRLEY STEELE B.Sc.N., University of Alberta, 1967 A THESIS SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE IN NURSING in the School of Nurs ing We accept this thesis as conforwinp to the required standard THE UNIVERSITY OF BPITISW COLUVBIA September, IP 74 I n p r e s e n t i n g t h i s t h e s i s I n p a r t i a l f u l f i l m e n t o f t h e r e n u l r e -ments f o r an a d v a n c e d d e c r e e a t t h e U n i v e r s i t y o f B r i t i s h C o l u m b i a , I a r r e e t h a t t h e L i b r a r 7 r s ^ a l l r a k e i t f r e e l y a v a i l -a b l e f o r r e f e r e n c e and s t u d y . I f u r t h e r aprree t h a t p e r m i s s i o n f o r e x t e n s i v e c o p ^ i n c o f t h i s t r e s i s f o r s c h o l a r l y p u r p o s e s may be g r a n t e d b y t h e Head o f my D e p a r t m e n t o r by h i s r e p r e -s e n t a t i v e s . I t i s u n d e r s t o o d t h a t c o p y i n g o r p u b l i c a t i o n o f t h i s t h e s i s f o r f i n a n c i a l c o i n s h a l l n o t be a l l o w e d w i t h o u t my w r i t t e n p e r m i s s i o n . Department The U n i v e r s i t y o f B r i t i s h Columbia Vancouver 8, Canada Date J#f)t ??/lH ABSTRACT A STUDY OF WOMEN USING A SELF HELP CLINIC The purpose o f t h i s s t u d y was t o crather i i n f o r m a t i o n about the women who used a S e l f H elp c l i n i c f o r t h e i r rrvne-c o l o g i c a l h e a l t h c a r e needs. The i n f o r m a t i o n f a t h e r e d i n -c l u d e d demographic data about the women and i n f o r m a t i o n about t h e women's responses t o t h e i r h e a l t h c a r e , i n c l u d i n g t h e i r f e e l i n g s about the S e l f H elp h e a l t h c a r e e x p e r i e n c e s . The s t u d y was conducted u s i n g q u e s t i o n n a i r e s and i n t e r -v i e w s . S i x t y - o n e women completed the q u e s t i o n n a i r e s ; of t h e s e , s i x women were i n t e r v i e w e d . The da t a c o l l e c t e d d u r i n g the i n -t e r v i e w c o r r e s p o n d e d t o the i n f o r m a t i o n on the q u e s t i o n n a i r e s . The d a t a were a n a l y s e d by c o m p u t a t i o n of f r e q u e n c y o f r e s p o n s e s and c a l c u l a t i o n o f p e r c e n t a g e s . The d a t a on the open-ended q u e s t i o n s were grouped i n t o c a t e g o r i e s which a r o s e from t h e comments o f the r e s p o n d e n t s . The t e x t was w r i t t e n u s i n g a n a r r a t i v e , d e s c r i p t i v e f o r m a t . The r e s u l t s from the st u d y were d i v i d e d i n t o two a r e a s ; demographic data and the women's responses t o t h e i r h e a l t h c a r e and S e l f H e lp e x p e r i e n c e s . The demographic d a t a show t h a t s t y p i c a l woman's p r o f i l e i s as f o l l o w s : the woman i s between the aces o f 2S-29 y e a r s , s i n p l e , l i v e s i n a communal/cooperative h o u s i n r s e t - u p , i s a p r o f e s s i o n a l o r t e c h n i c a l w h i t e c e l l a r w o r k e r , has a u n i -v e r s i t y e d u c a t i o n , comes from an up p e r - m i d d l e c l a s s f a m i l y . The d a t a r e g a r d i n p t h e women's r e s p o n s e s t o t ^ e i r h e a l t h care and S e l f H e l p • e x p e r i e n c e s I n d i c a t e d t h a t women hove many i i h e a l t h needs w h i c h a re unmet i n the ^ r-nri 1 +-1 nna ] ^ e d ' c a l c e r e s y s t e m . Sorre o f t h e s e needs were ^ e t i n the S e l f H e l p c l i n i c e x p e r i e n c e . The d a t a i n d i c a t e d the a r e a s o f the S e l f H e l p e x p e r i e n c e w h i c h women p a r t i c u l a r l y f e l t s u i t e d t h e i r needs o r w h i c h t h e y l i k e d . They a r e a s f o l l o w s : 1. Women l i k e d t h e p e r s o n a ] a t t e n t i o n and i n t e r e s t t h e y r e c e i v e d a t t h e S e l f H e l p C l i n i c . 2. Women l i k e d t h e o p p o r t u n i t y to l e a r n about t h e i r b o d i e s , t h e i r h e a l t h c a r e , and t o be a b l e t o ask q u e s t i o n s o f the l a y h e a l t h c a r e w o r k e r s . 3. Women l i k e d the c o n c e p t o f S e l f H e l p w h i c h e n c o u r a g e s p e o p l e t o be i n c o n t a c t w i t h t h e i r b o d i e s , t o be i n f o r m e d and to make d e c i s i o n s about t h e i r h e a l t h c a r e . 4 . Women wanted t n l e a r n p r e v e n t a t i v e h e a l t h c s r e . They wanted t o know how t o g i v e t h e m s e l v e s b a s i c i n t e l l i g e n t g y n e -c o l o g i c a l h e a l t h c a r e . 5. Women l i k e d r e c e i v i n g t h e i r h e a l t h c a r e f r o m o t h e r women. T>ey l i k e d the e x c h a n g e s and s h a r i n g w h i c h emerged f rom a p e e r r e l a t i o n s h i p w i t h the l a y h e a l t h c a r e w o r k e r s . 6. Women l i k e d t h e o p e n , h o n e s t a t t i t u d e of t h e l a y h e a l t h c a r e w o r k e r s . They a p p r e c i a t e d be inp - d e a l t w i t h i n an e m p a t h e t i c , s u p p o r t i v e and r e s p o n s i b l e m a n n e r . 7. Women e n i o y e d r e c e i v i n g t h e i r h e a l t h c a r e i n a warm, r e l a x e d end c o m f o r t a b l e a t m o s p h e r e . The d a t a f r o m the s t u d y s u f m e e t e d a ^ e a s f o r f u r t h e r s t u d y . The m a i n one was t h a t a s i m i l a r s t u d y be done w i t h a random sample s e l e c t i o n and a l a r g e r p o p u l a t i o n . T M p would b r o o d e r the d a t a TABLE OP CONTENTS Page LIST OP TABLES v i i ACKNOWLEDGEMENT i x Chapter 1. INTFODUCTION 1 THE PROBLEM 2 J u s t i f i c a t i o n of the Problem 2 D e f i n i t i o n of Terms Used 6 SUMMARY 6 2. REVIEW OF THE LITERATURE 7 PROFESSIONAL PUBLICATIONS 8 The S e l f Help Movement and Medicine .... 8 Roles of P r o f e s s i o n a l s 10 Why Has S e l f Help Emerged? 11 What Are The Ram i f i c a t i o n s of The S e l f Help Movement? 13 SUMMARY 14 LAY PUBLICATIONS 14 Why We Need Women's C l i n i c s 14 C r i t i c i s m of the Women's S e l f Help Movement 17 SUMMARY 18 i v V Chapter Page 3. METHODOLOGY " 19 SETTING 20 DATA COLIFCTTON 22 PROCEDURE 26 LIMITATIONS OF THE STUDY 27 ANALYSIS OP DATA 27 CONCLUSION 27 4. FINDINGS AND DISCUSSION 28 DEMOGRAPHIC DATA 28 Age 28 M a r i t a l S t a t u s 29 Pres e n t Address 29 Permanent Address 31 L i v i n g Arrangements ' 31 Women's O c c u p a t i o n s 32 E d u c a t i o n Completed 34 O c c u p a t i o n o f P a r e n t s ..' 36 Source o f F i n a n c i a l S upport 39 M e d i c a l I n s u r a n c e 40 S e l f - D e f i n i t i o n o f H e a l t h S t a t u s 42 Route o f F i r s t C o n t a c t t o t h e S e l f Help C l i n i c 44 WOMEN'S RESPONSES TO THEIR HEALTH CARE AND THE SELF HELP EXPERIENCE 46 Reasons f o r C h o o s i n g the S e l f Help C l i n i c 46 The D i f f e r e n t Focus o f the S e l f Help C l i n i c SO v i C h a p t e r p 9 P e 4. Comparison o f F e e l i n g s and E x p e r i e n c e s With D o c t o r s and With The S e ] f Help C l i n i c 55 Women's G e n e r a l A t t i t u d e s Towards The S e l f Help C l i n i c 58 The Most P o s i t i v e Focus o f The S e l f H e l p E x p e r i e n c e As P e r c e i v e d B y The Women • 64 The Most N e g a t i v e Focus o f The S e l f H e l p C l i n i c 69 SUMMARY 72 5. CONCLUSION 74 SUMMARY 74 IMPLICATIONS 78 RECOMMENDATIONS 79 RECOMMENDATIONS FOR FUTURE RESEARCH 80 BIBLIOGRAPHY B l APPENDIXES 85 A. QUESTIONNAIRE 86 B. MAP OF CITY OF VANCOUVER 9>» ' N LIST OF TABLES TABLE Page I . Age D i s t r i b u t i o n o f Women A t t e n d i n g S e l f Help C l i n i c . 28 I I . M a r i t a l S t a t u s o f Women A t t e n d i n g The S e l f Help C l i n i c 29 I I I . P r e s e n t A d d r e s s e s o f Women A t t e n d i n g The S e l f Help C l i n i c . 30 IV. Permanent Addresses of Women A t t e n d i n g The S e l f H e l p C l i n i c 31 V. L i v i n g Arrangements o f Women A t t e n d i n g The S e l f Help" C l i n i c .' 32 V I . O c c u p a t i o n a l Groups o f The Women A t t e n d i n g The S e l f H e l p C l i n i c . . . . 33 V I I . O c c u p a t i o n a l C o m p o s i t i o n o f The W:omen C l a s s i f i e d as G a i n f u l l y Occupied 34 V I I I . E d u c a t i o n Completed By The Women A t t e n d i n g The S e l f H e l p C l i n i c "... 35 IX. • Number o f Y e a r s Post High S c h o o l Completed Bv The Women A t t e n d i n g The S e l f Help' C l i n i c '. 36 X. O c c u p a t i o n o f F a t h e r s o f The Women A t t e n d i n g The S e l f H e l p C l i n i c 37 X I . O c c u p a t i o n a l C o m p o s i t i o n of The F a t h e r s o f Women A t t e n d i n g The S e l f H e l p C l i n i c 38 X I I . O c c u p a t i o n Groups o f the Mothers o f The Women A t t e n d i n g The S e l f Help C l i n i c 39 X I I I . Sources o f F i n a n c i a l Support o f Women A t t e n d -i n g The S e l f Help C l i n i c 40 XIV, M e d i c a l I n s u r a n c e Coverage of W0men A t t e n d i n g The S e l f H e lp C l i n i c A1 v i i v i i i TABLE Page XV. Reasons For Not H'avinp Medical Insurance Coverage of The Women Attending The S e l f Help C l i n i c &1 XVI. Women's S e l f - E v a l u a t i o n of T h e i r Health Status 43 XVII. Occurrence of a Serious I l l n e s s at Some Time i n the Woman's L i f e 43 X V I I I . Occurrence of a Doctor's V i s i t W i t h i n the Previous Year Bv The Women Attending The S e l f Help C l i n i c XIX. Reasons For V i s i t s to Doctor In Previous Year Bv The Women Attending The S e l f Help C l i n i c XX. Route of The F i r s t Contact of Women Attend iner The S e l f Help C l i n i c XXI. Number of V i s i t s By The Women To The S e l f Help C l i n i c X X II. Reasons For Choosing A S e l f Help C l i n i c Instead of a Doctor 49 X X I I I . The D i f f e r e n c e i n Focus of The S e l f Help C l i n i c as Compared to Other Medical Se r v i c e s 53 XXIV. How The Focus of The S e l f Help C l i n i c Is D i f f e r e n t From Other A v a i l a b l e Medical Services S4 XXV. Rating of S a t i s f a c t i o n L e v e l of S e l f Help C l i n i c Experience SS XXVI. Words D e s c r i b i n g Experiences With Doctors and S e l f Help C l i n i c as Checked By The Women i n the Study S7 i x ACKNOWLEDGEMENTS Thanks t o everyone who h e l p e d me complete t h i s s t u d y . Those i n p a r t i c u l a r , the women who g e n e r o u s l y p a r t i c i p a t e d by s h a r i n g i n f o r m a t i o n about themselves and t h e i r f e e l i n g s . A l s o , to the women o f the Vancouver Women's H e a l t h C o l l e c t -i v e who c o - o p e r a t e d and a s s i s t e d me w i t h t h e i r i d e a s , sup-p o r t and work. My warmest thanks t o my committee members, Ms. H e l e n E l f e r t and Ms. M e l a n i e Conn f o r t h e i r h e l p and c o n s t a n t en-couragement . A l s o , my a p p r e c i a t i o n t o my f r i e n d s who have s t o o d by me throughout t h i s o r d e a l w i t h u n f a i l i n g f a i t h t h a t I'd p-et i t done. P a r t i c u l a r thanks t o Ja n e t D a v i s and R i t a McKay. Chapter 1 INTRODUCTION The S e l f Help Movement has a r i s e n as an a l t e r n a t i v e t o the present h e a l t h care system. Consumers want to have more input i n t o the d e c i s i o n making processes which determine the kind of h e a l t h care they r e c e i v e . People want to have h e a l t h care d e l i v e r e d i n a more personal, i n d i v i d u a l i z e d manner. There i s a great outcry f o r more p u b l i c education regarding h e a l t h matters. Women are the most frequent users of the heal t h care system and are beginning to be more v o c a l regard-*-ing t h e i r concerns about the h e a l t h care they are r e c e i v i n g . Groups of women have organized to educate themselves about t h e i r bodies In order to be more aware of t h e i r h e a l t h care needs. The combination of an increased body awareness and d i s s a t i s f a c t i o n with the care they were r e c e i v i n g from the medical p r o f e s s i o n has given r i s e to the S e l f Help Move-ment. The S e l f Help Movement e x i s t s w i t h i n the h e a l t h care system but i s not under the c o n t r o l of any group of h e a l t h care p r o f e s s i o n a l s . The focus i s on l a y p a r t i c i p a t i o n i n hea l t h c a r e . The philosophy of -the S e l f Help movement s t r e s s e s the i n d i v i d u a l ' s knowledge, r e s p o n s i b i l i t y , informed d e c i s i o n making and p r e v e n t i o n . 1 THE PROBLEM 2 The general focus of t h i s present study i s t h i s : To c o l l e c t i n f o r m a t i o n about the people who choose a S e l f Help c l i n i c f o r t h e i r h e a l t h care needs. The s p e c i f i c focus of the present study i s t h i s : To c o l l e c t i n f o r m a t i o n about the women who choose the Vancouver Women's S e l f Help C l i n i c f o r t h e i r s p e c i f i c ( g y n e c o l o g i c a l ) h e a l t h care needs. The t a r g e t areas of in f o r m a t i o n are as f o l l o w s : 1. demographic data 2 . motive f o r u s i n g a S e l f Help c l i n i c 3. r e a c t i o n s to the S e l f Help c l i n i c as a h e a l t h care s e r v i c e , as compared to the t r a d i t i o n a l medical care s e r v i c e The i n f o r m a t i o n w i l l be gathered through the use of a questionnaire and through i n t e r v i e w s . J u s t i f i c a t i o n of the Problem Women's expectations and needs f o r h e a l t h care are changing. Women expect more i n d i v i d u a l i z e d care; they want to be informed about the nature of t h e i r problem, the p o s s i b l e causes, the a l t e r n a t i v e s i n treatment and methods of preven-t i o n . Women want more i n f o r m a t i o n about t h e i r bodies, ^hey want more i n f o r m a t i o n about b i r t h c o n t r o l i n c l u d i n g the pro's and con 1s of each method. They are no longer happy to take a p r e s c r i p t i o n f o r b i r t h c o n t r o l p i l l s without d i s c u s s i n g the other methods a v a i l a b l e , the p o s s i b l e side e f f e c t s and r i s k s , and the r e l a t i o n s h i p of the p i l l to t h e i r s e x u a l i t y . G e n e r a l l y , 3 women want to take back the d e c i s i o n making power regarding t h e i r bodies and t h e i r l i v e s . There i s a l s o a need f o r h e a l t h care to be pe r s o n a l i z e d so that women can experience some emotional contact with the person who i s d e l i v e r i n g t h e i r h e a l t h care. This emotional contact would allow the women to discuss t h e i r concerns, ask worrying questions and f e e l that t h e i r a n x i e t i e s are r e a l and are taken s e r i o u s l y . Women want to be t r e a t e d as whole people. These are not new needs f o r women, but are becoming more evident as women speak more f r e q u e n t l y to the issue of t h e i r h e a l t h care. The f a c t that they expect t h e i r needs to be met i s perhaps new. The emergence of these expectations and needs i s causing changes i n the demands that women place on h e a l t h care p r o f e s s i o n a l s . The h e a l t h care p r o f e s s i o n a l s must be attuned to these changes i n order to accommodate them. We are at an important crossroads - we must e i t h e r change to meet womens' needs or condone t h e i r own s e l f -care . 1 Women have already taken t h e i r h e a l t h care i n t o t h e i r own hands. In the United States many Women's S e l f Help c l i n i c s have emerged, the o r i g i n a l ones being i n C a l i f o r n i a . Many more have blossomed a l l over the other s t a t e s of the United S t a t e s . In Canada, the f i r s t Women's S e l f Help c l i n i c was s t a r t e d i n Vancouver by the Vancouver Women's Health C o l l e c t i v e . I V a l e r i e Jorgensen, "The Gynecologist and the Sexu a l l y Liberated Women", O b s t e t r i c s and Gynecology. 42:4 (October, 1973), 607. 4 There are, as of summer 1974, only two women's Self Help cl i n i c s in Canada. There are several other women's centers in other provinces which are planning to start Self Help clinics based on a similar philosoohy to that of the Vancouver Self Help C l i n i c . The Vancouver Women's Self Help Cl i n i c arose out of basic dissatisfaction with the health care being received from the medical profession. Some of these basic dissatisfactions w i l l be discussed. One major area of dissatisfaction had to do with the "attitude" of doctors to women. Many of these attitudes are generally present in our male orientated society: The attitudes In question Included the stereotypical one that women need kind guidance and firm handling. This coincides with the idea that women don't want information but rather just want someone to make the f i n a l decision for them. There are many other attitudes which the medical profession seems to support. Those attitudes which perceive women to be neuro-tics, sex objects, or baby machines, are a l l very destructive. Attitudes influence action; and the medical profession has In the past reflected these attitudes in Its treatment of women patients. Another dissatisfaction with the health care received from doctors is that doctors have not been willing to allow women to participate in Informed decision-making about their health. Doctors have carefully guarded their medical informa-tion, and have produced a mystic about bodily functions and 5 di s e a s e . The m y s t i f i c a t i o n of normal b o d i l y f u n c t i o n s means that women themselves do not have power over t h e i r bodies; doctors do. Women went more i n f o r m a t i o n and power than doc-to r s 8re w i l l i n g to g i v e . The medical p r o f e s s i o n i s i l l n e s s - and treatment o r i e n t a -t e d . Many of the s i t u a t i o n s about which women consult doctors 8re not r e l a t e d to an i l l n e s s . On account of t h e i r p h y s i o l o g i -c a l processes women re q u i r e h e a l t h as w e l l as i l l n e s s c are. Women re q u i r e p r e v e n t i o n as a major focus o f t h e i r h e a l t h c a r e . For example, a woman who goes to a doctor f o r b i r t h c o n t r o l Is not 111, nor does she need treatment; r a t h e r she needs i n -formation and a method to prevent a pregnancy. Women want to enter the h e a l t h care system as w e l l persons seeking preventa-t i v e i n f o r m a t i o n and h e a l t h care. The philosophy of the Vancouver Women's Health C o l l e c t i v e i s based on a l a y p a r t i c i p a t i o n model which focuses on c l i e n t p a r t i c i p a t i o n , Informed d e c i s i o n making, education and preven-t i o n . These concepts are o f t e n v e r b a l i z e d i n h e a l t h s e r v i c e c i r c l e s but are r a r e l y implemented. The Women's S e l f Help C l i n i c implements these p r i n c i p l e s In the care given to women c l i e n t s . The approach is . Innovative, r a d i c a l and has not yet been documented. The women who use the f a c i l i t i e s have chosen them f o r a v a r i e t y o f reasons. Information about S e l f Help c l i n i c s and t h e i r c l i e n t s i s scarce. The recent upsurge of the S e l f Help Movement i n h e a l t h care means the area has been s p a r s e l y researched. The current 6 journals (medical, nursing, s o c i a l sciences) r e v e a l l i t t l e documentation and d i s c u s s i o n of the S e l f Help Movement. The present study i s a p i l o t p r o j e c t i n that i t i s e x p l o r a t o r y and focuses at a grassroots l e v e l of in f o r m a t i o n o-athering. Further s t u d i e s w i l l be necessary to expand upon the informa-t i o n gathered. D e f i n i t i o n s of Terms Used Needs - a perceived d e f i c i t of something wanted or deemed necessary. Motive - a prompting force o r incitement working on a person to i n f l u e n c e a c t i o n . Reaction - a p a r t i c u l a r response t o a p a r t i c u l a r t r e a t -ment, s i t u a t i o n or other s t i m u l u s . SUMMARY The present study w i l l focus on the women who use the Vancouver Women's S e l f Help C l i n i c . Demographic data, motives and r e a c t i o n s of these women w i l l be s t u d i e d . Since the Women's S e l f Help Movement i s f r e q u e n t l y seen as an a l t e r n a t i v e or an augmentation.to the e x i s t i n g h e a l t h care system, some compari-son of the two w i l l be done. I t i s important to note that a l -though the Women's S e l f Help C l i n i c has d i f f e r e n t f o c i and p r i o r i t i e s , i t does e x i s t w i t h i n the l a r g e r h e a l t h care systems. Chapter 2 REVIEW OF THE LITERATURE L i t e r a t u r e on the subject of the Women's S e l f Help Movement i s very scarce. An extensive search i n d i c a t e d that t h i s t o p i c i s not w r i t t e n about f r e q u e n t l y i n the p r o f e s s i o n a l j o u r n a l s . Therefore, the researcher has d i v i d e d the l i t e r a -ture a v a i l a b l e i n t o two c a t e g o r i e s . One category i s the l i t -e rature located i n p r o f e s s i o n a l j o u r n a l s , a v a i l a b l e to a min-o r i t y of the p o p u l a t i o n , those who are p r o f e s s i o n a l workers i n the f i e l d of h e a l t h care d e l i v e r y : t h i s category i s r e -f e r r e d to as p r o f e s s i o n a l p u b l i c a t i o n s . The second category i s the l i t e r a t u r e which i s a v a i l a b l e to the m a j o r i t y of the population through p u b l i c a t i o n i n p e r i o d i c a l s on s a l e i n most book r e t a i l s t o r e s . This category i s r e f e r r e d to as l a y p u b l i -c a t i o n s . The m a j o r i t y of a r t i c l e s about the S e l f Help Health Care Movement are l o c a t e d i n l a y p u b l i c a t i o n s . This may be because most of the people involved i n S e l f Help h e a l t h care are l a y h e a l t h care workers. Lay h e a l t h care workers have no formal education i n the f i e l d of medicine. They o f t e n have education i n the a u x i l i a r y h e a l t h care f i e l d s , T n e education process f o r lay h e a l t h care workers i s u s u a l l y i n f o r m a l and p a r t i a l l y done i n the work area. Since the education process i s not 7 8 i n s t i t u t i o n a l i z e d , i t means that l ay h e a l t h care workers are not members of a s s o c i a t i o n s ( p r o f e s s i o n a l ) , t h e r e f o r e u s u a l l y do not have access to the formal p r o f e s s i o n a l communications network i . e . the j o u r n a l s . PROFESSIONAL PUBLICATIONS The S e l f Help Movement and Medicine The Women's S e l f Help Movement i s causing some i n t e r e s t and concern w i t h i n the medical p r o f e s s i o n . In an a r t i c l e , Women's L i b e r a t i o n and the P r a c t i c e of Medicine, some of these f e e l i n g s are expressed. Some doctors view the S e l f Help trend w i t h alarm; others w i t h h o s t i l i t y . But there are a growing number who see the movement as a c o n s t r u c t i v e step towards b e t t e r p u b l i c h e a l t h and pr e v e n t a t i v e medicine, informed p a t i e n t s , and improved d o c t o r - p a t i e n t r e l a t i o n s . 2 There i s much d i s c u s s i o n about the new demands that women are making on h e a l t h care p r o f e s s i o n a l s . Today's woman wants co n s i d e r a t e , r e s p e c t f u l t r e a t -ment from her p h y s i c i a n , wants complete i n f o r m a t i o n about her b o d i l y c o n d i t i o n and wants a r e a l voice i n medical d e c i s i o n s that a f f e c t her.5 Because of these new exp e c t a t i o n s , women approach heal t h care p r o f e s s i o n a l s i n a more organized and confiden t manner. ^"Women's L i b e r a t i o n and the P r a c t i c e of Medicine", Medical World News. June 2 2 , 1973, 35. 3 I b i d . 34. 9 Refusing any longer to regard doctors as swesome gods, she comes armed with a l i s t of what she expects, including prompt explanation of the results and mean-ing of tests or examinations; discussion of alterna-t i v e treatments and t h e i r pros and cons; f u l l inform-ation about the purpose and possible r i s k s of any pre-scribed drugs; and respect f o r her right to request that an examination or procedure be stopped at any time and to seek a second opinion.^ Discussions l i n k i n g Women's Liberation and consumer involvement are evident. The concept of c i t i z e n input into health care has been much discussed since the report of the Hasting's Commission on the Community Health Center."^ The recent pu b l i c a t i o n of the report, Health Security for B r i t i s h Columbians stresses c i t i z e n involvement at a l l lev e l s of decision making. The decision making process i s dominated by the medical profession and the bureaucrats. It is they, rather than the consumer who decide where, when, how, and by whom patients w i l l be treated. Women are becoming more aware of t h e i r rights as con-sumers. They are reacting against doctor dominated medical care • The women's health movement i s a blend of consum-erism and feminism. To women's rights advocates the predominantly masculine medical profession and i t s i n -s t i t u t i o n s represents c l a s s i c examples of the male authority structure they seek to end.7 4"Women's Liberation and the Practice of Medicine", Medical World News. June 22, 1973, 34. 5john E. Hastings, Community Health Centers Project Queens Printer, Ottawa, 1972. ^Richard G. Foulkes, Health Security f o r B r i t i s h  Columbians. Queens Printer, V i c t o r i a , 1973. 7W omen's Liberation and the Practice of Medicine . Medical World News. June 22, 1973, 34. 10 ROLES OF PROFESSIONALS What role can p r o f e s s i o n a l s p l a y i n the Women's S e l f Help Movement? Dr. Gendel ... b e l i e v e s medicine should work with, not against, women's s e l f help groups not only f o r the h e a l t h of women but f o r the improvement of h e a l t h care f o r everyone.8 P r o f e s s i o n a l s can be Involved as teachers and resource persons when needed by the S e l f Help groups.9 In t h i s c a p a c i t y they have much to o f f e r and to l e a r n . In an a r t i c l e by A. H a l l , the r o l e of nursing i s com-mented upon. Too o f t e n , the process of becoming q u a l i f i e d i n nursing or medicine produces a person with c o n s i d e r -able t e c h n i c a l knowledge, but with tunnel v i s i o n i n other respects and an acceptance of the status quo. Nurses are of t e n r e l u c t a n t to share i n f o r m a t i o n w i t h laymen; they hide behind a p r o f e s s i o n a l facade, which may conceal much ignorance. 10 Nurses have a d e f i n i t e r o l e and c o n t r i b u t i o n to make i n the S e l f Help Movement, ^hey are themselves, f o r the most part, women, consumers of h e a l t h s e r v i c e s and workers i n the h e a l t h care f i e l d ; t h e r e f o r e they have an investment i n the improve-ment o f h e a l t h care. Nursing i s p r e s e n t l y s t r u g g l i n g to de-f i n e i t s r o l e and f u n c t i o n i n the h e a l t h care system. In many 8"Women's L i b e r a t i o n and the P r a c t i c e of Medicine", Medical World News. June 22, 1973, 35. 9 I b i d . 35. lOAudrey H a i l , "A S e l f Help C l i n i c f o r Women", The Canadian Nurse. 70:5 (May, 1974), 36. 11 ways i t seems the r o l e of a nurse p r a c t i t i o n e r and that of a lay h e a l t h worker have some s i m i l a r i t i e s . Nursing must exa-mine these s i m i l a r i t i e s and begin to recognize the a v a i l a b l e l e a r n i n g p o s s i b i l i t i e s . Medical s e l f help challenges nurses who can con-t r i b u t e a l o t to p r o j e c t s such 8 S ours. I b e l i e v e they can g a i n even more, p e r s o n a l l y and p r o f e s s i o n a l l y . i l The h e a l t h care p r o f e s s i o n a l s are attempting to look at the p a t i e n t i n a more h o l i s t i c f a s h i o n . In f a c t , t h i s i s a p a r t i c u l a r g o a l of n u r s i n g . They are examining s o c i e t a l changes, pressures, and trends i n attempts to l e a r n how these are i n f l u e n c i n g the pop u l a t i o n as w e l l as the p r o f e s s i o n s . Because the Women's L i b e r a t i o n Movement and the Women's S e l f Help Movement are both major, c u r r e n t , changes w i t h i n our s o c i e t y , the p r o f e s s i o n a l s must be informed and Involved i n the i s s u e s , c o n t r o v e r s i e s and changes that are ensuing. The Women's Movement i s one of the most s i g n i f i c a n t s o c i a l movements of our time and the f a i l u r e of nurses to recognize that s i g n i f i c a n c e could g r e a t l y r e t a r d the p r o f e s s i o n of nursing.12 WHY HAS SELF HELP EMERGED? S e l f Help has emerged out o f ba s i c d i s s a t i s f a c t i o n w i t h the medical (health) care being received w i t h i n the i n s t i t u t i o n -a l i z e d , doctor-dominated h e a l t h care system. HAudrey H a l l , "A S e l f Help C l i n i c f o r Women", The Canadian Nurse. 70:5 (May, 1974), 36. 12Hal i , p. 36. 12 The d e c i s i o n makers i n the system tend to be ph y s i c i a n s , bureaucrats, h o s p i t a l a d m i n i s t r a t o r s and business e x e c u t i v e s . Power i s f i r m l y i n the hands o f males, despite the f a c t t h a t the labour force i n the industry i s 80 per cent female. The var i o u s advisory boards tend to be s e l f - p e r p e t u a t i n g and h e a v i l y weighted by p h y s i c i a n s to the e x c l u s i o n of nurses, other h e a l t h p r o f e s s i o n a l s and h e a l t h workers.13 The system as described, with a male power h i e r a r c h y , does not meet a l l the needs o f the women usi n g and working w i t h i n the system. This i s pointed out i n the Poulkes' report i n the s e c t i o n on Health Care Needs f o r Women. 1. Many women are c r i t i c a l of " a t t i t u d e s " towards the important areas of f a m i l y planning, t h e r a p e u t i c abor-t i o n , s e x u a l i t y g e n e r a l l y and are concerned w i t h the ob-j e c t i v i t y of the p r o f e s s i o n a l s . 2. Women are p l a c i n g Increased emphasis on s e l f -d e termination. This i s associated with the s u s p i c i o n that male domination and b u r e a u c r a t i c r e s t r i c t i o n s are not operating i n the best i n t e r e s t s of women ... . There i s an express i o n of eagerness f o r r e l i a b l e informa-t i o n and c o u n s e l l i n g i n areas i n which emotional f a c t o r s are i n v o l v e d . 3. There appears to be a d e s i r e that more care be given by nurses, p a r a p r o f e s s i o n a l s and volunteers i n the home.14 r S e l f Help, h e a l t h care has a r i s e n out of a number of areas of d i s c o n t e n t : discontent w i t h t r a d i t i o n a l women's r o l e s , with h e a l t h care received and w i t h the options o f f e r e d . 13Richard 6. Foulkes, Health S e c u r i t y f o r B r i t i s h  Columbians. Queens. P r i n t e r , V i c t o r i a , 1973, p.II-3-8. 14Foulkes. p. IV C-17-2 13 If the growth of the women's health movement had to be attributed to one p r e c i p i t a t i n g factor, that phenomenon could be called heirhtened awareness. Con-sumerism caught on; and people who demanded quality and honesty from t h e i r purchases were no longer shrugged o f f as "crack pots". Coupled with that was the i n -creasing d i s s a t i s f a c t i o n with the housewife role carved out f o r the American wife (which up u n t i l recently was a term considered synonymous with woman), e s p e c i a l l y i n the l i g h t of the higher levels of education being sought and achieved by these women. The Women's Liberation Movement^ however r i d i c u l e d and c r i t i c i z e d by men and "content 1 women ali k e , and however hindered in i t s nub-i l e ima£?e by the extremists, had an unmistakable ring of truth t o " i t . 1 5 A l l of these factors lead to the opening on "... A p r i l 7 1971, of the world's f i r s t gynecological s e l f help c l i n i c ..." Prom th i s evolved the concept of Self Help. The philosophy is the basis of many women's c l i n i c s throughout the United States and Canada. WHAT ARE THE RAMIFICATIONS OF THE SELF HELP MOVEMENT? The ramifications of the Self Help Movement are very broad. They can be seen from many l i g h t s . They are personal, emotional and growth-producing. They are p o l i t i c a l , l e g a l , and s o c i a l . They have impact on the medical care system, the education system and on the mores of society. And the changes that are coming about--and w i l l come about--in laws, i n p o l i c i e s , in health services, i n health manpower, i n gynecological procedures, i n gynecologists' attitudes and c l i n i c a l r e l a t i o n s h i p s , i n women's awareness about t h e i r bodies and t h e i r needs, 1 5 M u r i e l J. Reynard, Gynecological Self Heln: An  Analysis of i t s Impact on the Delivery and Use of Medical Care  for Women. Thesis, Stony Brook, June 1 9 7 3 . p.87, l 6Reynard. p. 9 1 . 14 In women's expectations of t h e i r care, in women's c o l l e c t i v e s and i n the indiv i d u a l i z e d women--these changes are the Women's Health Movement.1-? The f u l l ramifications of t h i s movement are not as yet known because of i t s recent b i r t h . SUMMARY The majority of a r t i c l e s written i n the professional journals focus on discussions about the upsurge of the Se l f Help Movement and about the philosophy behind the movement. This i s often related to the apparent shortcomings of the present health care d e l i v e r y system. Roles of various pro-fessionals, i . e . doctors and nurses, are examined and c r i t i -c ized. The general attitude of the professionals towards Se l f Help seems to be s c e p t i c a l , perhaps querulous, perhaps somewhat anxious. LAY PUBLICATIONS The most notable feature i n the lay l i t e r a t u r e i s the scathing, blatant, outright c r i t i c i s m of doctors. The sto r i e s which are recounted describe repeatedly the suff e r i n g that women have undergone i n t h e i r contacts with doctors. Certainly these acts and attitudes have been very responsible for women seeking a l t e r n a t i v e health services. "Why We Need Women's C l i n i c s " The reason why we see a need f o r women's c l i n i c s to meet the special health care needs of women are as numerous as the many "horror s t o r i e s " we hear from wo-men who have received humiliating, impersonal and often p a i n f u l treatment at the hands o f the established medical 17Muriel J. neynard, Gynecological S e l f Help: An  Analysis of i t s Impact on the Delivery and Use of Medical Care  for Women. Thesis, Stony Brook, June, 1973, p7^5. 15 professionals. l"e f e e l for the most part that doctors are unable to give adequate, sensitive and comprehen-sive care to women for three major reasons. 1) Doctors are not v/omen (onlv 7 ^  of a l l doctors are women). 2) They do not educate us about our bodies, or explain what procedures and tests they take; often they don't even t e l l us what i n f e c t i o n we've got ... 3) Doctors b e l i t t l e our i n t e l l i g e n c e , and do not recog-nize our f u l l humanity; they treat us as i f we " g i r l s " wouldn't understand or be interested in a l l that medi-c a l s t u f f he knows about what goes on "down there". Withholding information creates mystery 8 n d gives power to him who holds that information, so as long as he knows about our bodies and we don't, we must return to him for diagnosis and treatment of our problems. Because i n this system of "fee f o r ser-vice" medicine, most patients are o b j e c t i f i e d , women again suffer since society has also made us sexual objects with our sexual attentions as the prize ... . There i s no connection between the woman's face and mind and her ge n i t a l s , no explanation of what is going on "down there", of what i s or isn't normal, or of what your i n f e c t i o n may be or what caused it.18 It seems women have started S e l f Help c l i n i c s as a defense against the ex i s t i n g medical services offered. Most of the writings have been about e x i s t i n g c l i n i c s i n the United States, and few have been about the Canadian scene. The changes that d i f f e r e n t groups of women would l i k e to see come about range from changes within the existi n g medical system a l l the way up to and including a demand fo r medical care that is completely separate from the current medical establishment.19 ISBetty Kay Andrade, Karen Borchgrevink, Cathy Ceunin Moosh Graber, Pat Teare, Ginny H. Yark, An A p p r 0 a c h to Women's ' Health Care, The People's Health. No. 9, (April-May 1973) 1-2. ^ E l i z a b e t h B. Connell, What You Should Know Before You T ry to do i t Yourself, Redbook Magazine. November, 1973, 82. 16 As the above quote by Dr. Cornell states, women want a variety of changes; not a l l of these changes w i l l be a t o t a l breakaway from the establishment. The major point which is made repeatedly is that women see a need for changes. The philosophy of the S e l f Help Movement stresses edu-cation, involvement, and r e f l e c t s constructive attitudes to-wards women. Like the women who are jamming medical s e l f help c l i n i c s around the country, I would l i k e to have more of a sense of me, to be less intimidated about asking questions of my gynecologists, and to understand and f e e l at one with my body i n a l l situations.20 Women want to know more about themselves; they are a c t i v e l y going about getting the needed information. Out of this b e l i e f In "body education is care education" evolved the Self Help credo and S e l f Help c l i n i c s , the most f l o u r i s h i n g outpost of counter-culture medicine.21 Women have again taken on the r e s p o n s i b i l i t y f o r t h e i r own education. Part of t h i s education occurs at the S e l f Help c l i n i c s , but many women's c o l l e c t i v e s have established S e l f Help educational publications. These publications are e i t h e r p e r i o d i c a l s or books, offering copious amounts of information about women, their l i v e s , and t h e i r physiology. The new a v a i l -a b i l i t y of t h i s kind of information may i t s e l f be a change 20Susan Braudy, Women Discovering Their Bodies, Harpers. January 1973. p. 8. 2 l E l i z a b e t h F i s h e l , Women's Self Help Movement, Ramparts. 12 (November 1973) p. 30 17 agent within the health care system. The b e l i e f that women should have basic knowledge about t h e i r own bodies seems to be one of the l a s t heresies i n a world that otherwise claims to believe so much in knowledge and freedom of knowledge. This book (Our Bodies Our Selves) i s one way of breaking down that taboo; f o r some women this kind of knowledge is a step towards action.22 Most of the lay l i t e r a t u r e proclaims the positi v e aspects of the S e l f Help Movement. But not a l l does so. CRITICISM OF THE WOMEN'S SELF HELP MOVEMENT Some authors view the Self Help Movement as necessary i n that i t i s f i l l i n g a gap which exists because the medical profession i s n ' t t o t a l l y current i n i t s attitudes and approaches to women. These authors seem to indicate that as this gap i s f i l l e d , there w i l l again be no need f o r the Self Help Movement. There are references to the Self Help Movement as "second c l a s s 23 medicine". It seems important to mention that most of the negative comments arise from medical doctors who write f o r both the professional journals and those who write health columns and a r t i c l e s f o r lay publications. Dr. C-endei writes i n Redbooks Don't treat y ourself to second class medicine. With .the kind of impersonal treatment some.women are'receiving from t h e i r gynecologists, i t ' s no wonder they're fed up with the medical profession. But some have chosen to turn 22The Boston Women's Health Book C o l l e c t i v e , Our Bodies  Our Selves. Simon and Schuster, New York, 1973, p. 270. 23Evalyn S. Gendel, It's Your Bodv ... Not Your Doctor's Redbook Magazine. March 1974, p. 168. ' 18 t o r e p r e s e n t a t i v e s o f the new " S e l f H e l p " Movement, and much as I welcome and apnrove of the movement, two t h i n g s about i t r e a l l y c o n c e r n me. One i s the d e c i s i o n by some women t o go beyond e x a m i n a t i o n and s c r e e n i n g i n t o d i a g -n o s i n g and even t r e a t i n g one a n o t h e r and t h e m s e l v e s ex-c l u d i n g p r o f e s s i o n a l m e d i c a l h e l p e n t i r e l y . 24 C r i t i c i s m s which e x i s t o f t e n i n d i c a t e f e a r t h a t S e l f Help w i l l o v e r s t e p i t s b o u n d a r i e s and a c t u a l l y f o c u s on t h e d i a g n o s i s and t r e a t m e n t o f d i s e a s e . I t seems t o be a f e a r o f the m e d i c a l p r o f e s s i o n t h a t some o f i t s l o n g - s t a n d i n g power and a u t h o r i t y i s g o i n g t o be w r e s t e d from them. I t must be u n d e r s t o o d t h a t S e l f H e lp h e a l t h c a r e was never meant t o r e p l a c e t h e g y n e c o l o g i s t . S e i f H e l p i s u s e f u l as an a d d i t i o n a l and supplementary s e r v i c e . - S i s not t o say t h a t t h e S e l f H e l p Movement w i l l not i n f l u e n c e i n some way the r o l e o f the g y n e c o l o g i s t . SUMMARY Lay p u b l i c a t i o n s are b e g i n n i n g t o e x p l o r e the p r o s and cons o f the S e l f H e l p Movement. The m a j o r i t y o f a r t i c l e s a r e f o c u s i n g on the d i f f e r e n c e s t h a t e x i s t between S e l f H e l p and the t r a d i t i o n a l t y p e o f m e d i c a l c a r e . I t I s v e r y apparent t h a t t h e r e i s a need and a f u n c t i o n i n the f i e l d of h e a l t h c a r e f o r women's S e l f H e l p c l i n i c s . ^ E v a l y n S. Gendel I t ' s Y o u r Body ... Not Y o u r D o c t o r ' s , Redbook Magazine. March 1974, p. l 6 R . Chapter 3 METHODOLOGY The purpose of the study was to c o l l e c t i n f o r m a t i o n about the women who attended the Vancouver Women's S e l f Help C l i n i c . The researcher chose the q u e s t i o n n a i r e as the basic t o o l with which to c o l l e c t the data. A sm a l l percent-age of the women who answered the q u e s t i o n n a i r e were then in-? terviewed i n order to augment and to check the r e l i a b i l i t y of the i n f o r m a t i o n given i n the q u e s t i o n n a i r e . The format of the in t e r v i e w was open-ended f o l l o w i n g up on some general comments which had a r i s e n from the answers i n the q u e s t i o n n a i r e . The tar g e t p o p u l a t i o n included women who had attended the c l i n i c during the period under study. The study was c a r r i e d out i n Vancouver between December 1973 and J u l y 1974. The women s e l e c t e d had attended the S e l f Help C l i n i c d u r i n g t h i s p e r i o d . I f the women who completed the ques t i o n n a i r e s agreed to an i n t e r v i e w , a time was arranged l a t e r by the researcher. The Interviews occurred between two and fo u r months a f t e r the v i s i t to the c l i n i c and the completion of the q u e s t i o n n a i r e . This was due to the a v a i l a b l e time of the researcher. 19 20 SETTING The Vancouver Women's Sel f Help C l i n i c i s operated by the Vancouver Women's Health C o l l e c t i v e . The Self Help C l i n i c opened i n December, 1972. The location of the c l i n i c changed several times throughout the duration of the study. O r i g i n a l l y , i t operated out of the Vancouver Free C l i n i c , which was a drop-? in community oriented youth c l i n i c . Then the c l i n i c moved temporarily into the Pine Street Youth C l i n i c , another free c l i n i c setting, operated by the Metropolitan Health Department, The study was completed while the c l i n i c was located i n a tra-? d i t i o n a l medical group practice s e t t i n g . In each of the three settings the format and goals of the c l i n i c were the same, The S e i f Help C l i n i c used the available space and provided a l l i t s own supplies, lay health care workers and doctors. The S e l f Help C l i n i c operates one evening per week from 6 p.m. - 10 p.m. Women may drop In, or phone ahead f o r appoints ments. Approximately 8-10 women are seen at each c l i n i c , T© date, summer 1974, more than 450 women have been seen at thi s c l i n i c , not incl u s i v e of women who return f o r a second or th i r d v i s i t . W'omen may use t h e i r medical insurance plan while others who do not have insurance are provided with free care. Presently a sessional payment scheme Is being worked out with the P r o v i n c i a l Government which w i l l replace b i l l i n g through the medical insurance schemes. The women are encouraged to pay.for t h e i r own medications, b i r t h control equipment and speculums. 21 The main focus of the c l i n i c i s edu c a t i o n a l and preventa-t i v e care f o r women's g y n e c o l o g i c a l , b i r t h c o n t r o l and s e x u a l i t y concerns. Women are not seen f o r general p h y s i c a l h e a l t h concerns. Each woman who attends the c l i n i c i s requested to complete a medical h e r s t o r y ( h i s t o r y ) form and i s then seen by. a team of two or three l a y h e a l t h care workers. The team does the workup of the h e r s t o r y and completes the r e g u l a r t e s t s and pro-cedures. Doctors are c o n s u l t a n t s , a v a i l a b l e every c l i n i c n i g h t , to examine the women, and to do any s o p h i s t i c a t e d examination or treatments. Each woman i s seen by the doctor. A l l of the doctors are women. The doctors v o l u n t e e r on a r o t a t i n g b a s i s . Each woman h8s many o p p o r t u n i t i e s to di s c u s s her f e e l i n g s , questions and problems with the team, and the doctor. The t e s t s are sent to the p r o v i n c i a l l a b o r a t o r y ; f o l l o w -up to report and f i l e r e s u l t s end provide necessary medication i s done once each week. E v e r y t h i n g which i s done i s f u l l y ex-plai n e d to the woman. She i s encouraged t o p a r t i c i p a t e as much as she would l i k e i n the c e r v i c a l exam. She i s included i n d e c i s i o n s about treatments. The atmosphere i s relaxed and comfortable. The woman i s given a copy of her h e r s t o r y and other ex-planatory pamphlets on breast s e l f - e x a m i n a t i o n , c e r v i c a l s e l f -examination, v a g i n i t i s , and the h e a l t h c o l l e c t i v e i t s e l f , to take home with her. ^ome women take home the n l a s t i c speculum used i n the examination. 22 SUMMARY The focus of the Women's Self Help C l i n i c i s somewhat di f f e r e n t because: 1) the care Is mainly given by the lay health care team. 2) the women are encouraged to pa r t i c i p a t e and take res-p o n s i b i l i t y f o r t h e i r own care. 3) the focus is educational and preventative. 4) a l l of the people involved are women. 5) the atmosphere i s conducive to p a r t i c i p a t i o n (I.e. relaxed). DATA COLLECTION At the time when the study began, there was no available precedent study with a s i m i l a r approach or topic. Since that time, however, one s i m i l a r study has emerged, c a l l e d "Gynecolo-g i c a l S e l f Help". 2^ There i s no nursing research on the subject of women's Self Help. Studies by other health professionals have been done on the populations who use free c l i n i c f a c i l i t i e s . A 2 6 study done i n San Francisco by ^ r . S chatz on the populations who used several d i f f e r e n t available health services used the 25Muriel J. Reynard, Gynecologies! Self Help: A n  Analysis of i t s Impact on the Delivery and Use of Medical Care  for Women. Thesis. Stony Brook, June, 1973. ^Bernard E. S c n a t z , Free C l i n i c Patient Character-i s t i c s , American Journal of Public Health. 62:10 (October 1972) 23 questionnaire method. Since there were no a v a i l a b l e t o o l s i n the nursing research, the researcher wrote to Dr. b c h a t z and requested a copy and permission to use h i s research t o o l . The q u e s t i o n n a i r e developed and used by Dr. ^chatz was uns u i t a b l e on the whole f o r the po p u l a t i o n being studied be-cause of i t s cumbersome length and massive scope of the ques-t i o n s . Nevertheless, s e v e r a l ideas were used from that t o o l i n the development of the subsequent q u e s t i o n n a i r e which was used. The qu e s t i o n n a i r e was developed with suggestions and r e v i s i o n s from a number of research e x p e r t s . The review of the l i t e r a t u r e , and the experiences of people working at the S e l f Help C l i n i c suggested some areas to be explored i n the qu e s t i o n n a i r e . The qu e s t i o n n a i r e was then submitted to the Vancouver Women's S e l f Help C l i n i c group f o r suggestions and approval. The areas explored i n the qu e s t i o n n a i r e were as f o l l o w s : Demographic Data: Age M a r i t a l Status Present Address Permanent Address L i v i n g A r r a n g e m e n t s Women's Occupations Education Completed Occupation of the Parents Source of F i n a n c i a l Support Medical Insurance S e l f D e f i n i t i o n of h e a l t h status Route of F i r s t Contact to the S e l f Help C l i n i c Women's Responses to t h e i r Health Care and the S e l f Help Experience: - Reasons f o r Choosing the S e l f Help C l i n i c - The D i f f e r e n t *"ocus" of the S e l f Help C l i n i c 24 - Comparison of Feelings and Experiences with Doctors and the Self Help C l i n i c - Women's General Attitude towards Self Help C i j n i c - Most Positive Aspect of the Self Help Experience as Perceived by the Women - Most Negative Aspect of the S e l f Help Experience as Perceived by the Women The questionnaire was pretested on a group of seven wo-men who attended the c l i n i c one s p e c i f i c night. 1he answers to the questions seemed to Indicate that the questionnaire was e f f e c t i v e , relevant, and r e l a t i v e l y thorough. It was de-cided by the researcher and the research committee to proceed using the questionnaire i n i t s present form. The pretest sam-ple was then added to the actual study sample. The c r i t e r i a for the sample group were that they had to have attended the c l i n i c during the period of study, and they had to give t h e i r consent to be questioned. Everyone who at-tended and agreed to be studied was considered e l i g i b l e . The questionnaires were sent by mail (in a self-addressed stamped envelope) to f i f t y women who attended the c l i n i c from the date of December 1973 onward. These were the l a s t f i f t y f i l e s i n the c l i n i c records. The only women who were not sent questionnaires, who attended the c l i n i c in this time period, were those who s p e c i f i c a l l y requested in t h e i r v i s i t to the c l i n i c that they not be contacted at home. Of the f i f t y ques-tionnaires sent out, four were returned unopened, because the person had moved. Twenty-six questionnaires were returned completed. 25 The que s t i o n n a i r e s were a l s o d i s t r i b u t e d to women who attendedthe c l i n i c , i . e . not mailed. Unfortunately, since the researcher did not attend every c l i n i c s e s s i o n , the co-ord1nator at the c l i n i c was re s p o n s i b l e f o r handing; o u t t h e q u e s t i o n n a i r e s and she d i d not always remember to do t h i s . T h i r t y - f i v e Q u e s -t i o n n a i r e s were returned completed from the c l i n i c . A t o t a l of sixty-one q u e s t i o n n a i r e s were returned com-p l e t e d . One q u e s t i o n n a i r e was returned w i t h a name and address attached but with no questions answered. This q u e s t i o n n a i r e was not counted In the sample. Of the sixty- o n e women who responded, t h i r t y - t w o consented to be interviewed, twenty* nine refused to be Interviewed. In order to t e s t the r e l i a - * b i l i t y of the q u e s t i o n n a i r e , the researcher interviewed 10$ of the sample p o p u l a t i o n , which was s i x persons. The data c o l l e c t e d during the i n t e r v i e w s was comparable to the data col« l e c t e d on the q u e s t i o n n a i r e s . Of the t h i r t y - t w o persons who consented to be int e r v i e w e d , s i x were chosen by process of e l i m i n a t i o n . T n e researcher I n* terviewed the f i r s t s i x people who could be reached by phone and who again consented to an Inter v i e w . Many of the women who had consented to be interviewed had moved from t h e i r l i s t e d number and some were away out of town at the time. The format of the i n t e r v i e w was open-ended. The researcher had s e v e r a l general questions p e r t a i n i n g to previous h e a l t h ex^ periences of the person and t h e i r r e a c t i o n s to the S e l f Help 26 experience. The i n f o r m a t i o n gathered at t>e i n t e r v i e w c o r r e -l a t e d to the i n f o r m a t i o n given on the q u e s t i o n n a i r e s . •'•he only d i f f e r e n c e noted between the i n f o r m a t i o n from the q u e s t i o n n a i r e s and the i n t e r v i e w was that during the i n t e r v i e w the women tended to t a l k much more about the d e t a i l s of t h e i r previous experiences with h e a l t h p r o f e s s i o n a l s . PROCEDURE The f o l l o w i n g steps were taken i n planning the study a f t e r the Idea was formulated. 1. The Vancouver Women's S e l f Help C l i n i c was approached to dis c u s s the idea of the study. They approved of the Idea and b a s i c format. 2. The l i t e r a t u r e review was begun. 3. People were asked to act as committee members. 4. The research design was evolved and presented to the committee members. 5. Correspondence was begun to o b t a i n research t o o l s from other sources. 6. The q u e s t i o n n a i r e was designed i n c o n j u n c t i o n with two research e x p e r t s . 7. The q u e s t i o n n a i r e was approved by the research committee and the Vancouver Women's S e l f Help C l i n i c group. 8. Data c o l l e c t i o n began i n February, 1974, and was completed i n J u l y , 1974. 9. Data t a b u l a t i o n and a n a l y s i s was begun. 10. The outside reader was i n v i t e d to nartlcl.pate and accepted . 27 LIMITATIONS OF THE STUDY The major l i m i t a t i o n of t h i s study was the sample s i z e . Time and energy l i m i t s permitted only a s m a l l sample of s i x t y -one women. A l a r g e r sample would have been more r e p r e s e n t a t i v e of the women who use the Vancouver Women's S e l f Help C l i n i c . The sample used was not one obtained by random s e l e c t i o n ; t h e r e f o r e i t may not have been r e p r e s e n t a t i v e of the t o t a l popu-l a t i o n . The i d e a l s i t u a t i o n would have been to use the que s t i o n -n a i r e and i n t e r v i e w f o r each woman. This would b8ve allowed c l a r i f i c a t i o n and e l a b o r a t i o n f o r every point on the question-n a i r e . This would have been very time-consuming. ANALYSIS OP DATA The demographic data was analysed by computation of f r e -quency of responses' and c a l c u l a t i o n of percentages. No complex s t a t i s t i c a l a n a l y s i s was done. The area on the women's r e s -ponses to t h e i r h e a l t h care i s discussed i n n a r r a t i v e , d e s c r i p -t i v e format. CONCLUSION This study used a qu e s t i o n n a i r e to gather i n f o r m a t i o n about women who choose the Vancouver Women's S e l f Help C l i n i c f o r t h e i r h e a l t h needs. Interviews were then conducted with 10$ of these women to v a l i d a t e and c l a r i f y d e t a i l s on the quest i o n n a i r e s . The data c o l l e c t e d i s d e a l t with through systematic a n a l y s i s of t>e questions posed. Chapter 4 FINDINGS AND DISCUSSION The r e s u l t s of the study w i l l be presented i n two s e c t i o n s . The f i r s t s e c t i o n w i l l be the demographic data of the women. The second s e c t i o n w i l l be the women's responses to t h e i r h e a l t h care and the S e l f Help experience. There i s a t o t a l of 6 l respondents i n t h i s study. DEMOGRAPHIC DATA Age: The age range of the p o p u l a t i o n was from 14 to 44 yea r s . The m a j o r i t y of the p o p u l a t i o n (39.3^) were between the ages of 25-29 ye a r s . The second l a r g e s t age group was 20-24 years, that being 26.2^ of the p o p u l a t i o n . Table I . TABLE I Age D i s t r i b u t i o n of Women Attending S e l f Help C l i n i c Age i n Years Number t 0-14 1 1.6 15-19 9 14.7 20-24 16 26.2 25-29 24 39.3 30-34 9 14.7 35-39 0 0 40-44 1 1.6 no response 1 1.6 TOTAL 61 99.7 28 29 Marital Status; The majority of the women i n this study were single {10.tt). (Table I I ) . TABLE I I Marital Status of Women Attending the Self Help C l i n i c Status Number t Single 43 70.4 Divorced 6 9.8 Married 5 8.1 Separated 5 8.1 Common Law 2 3.2 TOTAL 61 99.6 Present Address: The addresses of the women in the study were pertinent because i t was not known i f the c l i n i c population was drawn from the area around the c l i n i c , which would be the K i t s i l a n o area, or i f the population was being attracted from a wider base. The c l i n i c nopulation was approximately l/3 (32.7$) from the K i t s i l a n o area. The other 2/3 (66^) were mainly from other parts of Vancouver such as: East End, West End, Shaugh-nessy, Kerrisdale, Pairview, Cedar Cottage, False Creek, Mount Pleasant, ^urnaby, North Vancouver, West Vancouver. (Table I I I ) . TABLE I I I Present Addresses of Women Attending the S e l f Help C l i n i c L o c ation Number K i t s l l a n o ' 20 East Vancouver 10 West Vancouver 5 West End 4 P a i r v i e w 4 Shaughnessy 3 K e r r i s d a l e 2 Mount Pleasant 2 Burnaby 2 North Vancouver 1 False Creek 1 Cedar Cottage 1 Elsewhere i n B r i t i s h Columbia 1 Another Canadian Province 1 U.S.A. 1 No response 3 TOTAL 61 31 Permanent Address A q u e s t i o n was asked to dete r m i n e i f t h e permanent a d d r e s s o f t he women was the same as t h e i r p r e s e n t a d d r e s s . The r e -s u l t s show t h a t the ad d r e s s e s g i v e n as p r e s e n t a d d r e s s , were i n 7J>.7% o f the cases the woman's permanent a d d r e s s . I h i s s e e m s t o i n d i c a t e a s t a b l e p o p u l a t i o n g r o u p . ( T a b l e I V ) . TABLE IV Permanent A d d r e s s e s o f Women A t t e n d i n g the S e l f H e l p C l i n i c As Compared to Present Address Number Same 45 D i f f e r e n t 13 No response 3 TOTAL 61 L i v i n g Arrangements The l i v i n g arrangements of the women seemed to most f r e -quently be the communal/cooperative s t y l e (32.7^). The next most frequent were women l i v i n g with another of the opposite sex or l i v i n g alone. (Table V ) . 32 TABLE V L i v l n f Arrangements of Women Attending the Self Help C l i n i c Type Number Communally/cooperatively 20 With another of opposite sex 10 Alone 10 With another of same sex 8 Husband (and children i f applicable) 3 Children 3 Parents 2 Common-law with c h i l d 2 T r a v e l l i n g 2 Part-time roommate (male) 1 TOTAL 61 Women's Occupations The data on occupations of the women indicated that the majority of women were gainfully' occupied ( 5 7 . 3 ^ ) . The next largest group of women were those who were l i s t e d as students (27.8#). Not one woman l i s t e d h e r s e l f as a homemaker. Of th respondents, °.R# answered with "none" or made comments l i k e 33 " a n y t h i n g " , and " I am j u s t crowing i n s i d e these days", i n r e s -ponse t o the q u e s t i o n about t h e i r o c c u p a t i o n . The o c c u p a t i o n s which c o u l d be c l a s s i f i e d i n the g a i n f u l l y employed c a t e g o r y were t h e n examined i n terms of the Can a d i a n o c c u p a t i o n c o m p o s i t i o n scale.'""-'- The o c c u p a t i o n s o f the women were found t o be n-a i n l y under the t i t l e of w h i t e c o l l a r workers i n t he s e c t i o n o f p r o f e s s i o n a l and t e c h n i c a l w o r k e r s . The r e s -pondents were 62.8# i n the p r o f e s s i o n a l and t e c h n i c a l c a t e g o r y . T h i s i n d i c a t e s the p o p u l a t i o n i s from the m i d d l e and unper c l a s s o f the s o c i o - e c o n o m i c s c a l e s . ( T a b l e s VI and VII). TABLE VI O c c u p a t i o n a l Groups o f the Women A t t e n d i n g the S e l f H e l p C l i n i c * " 2 O c c u p a t i o n a l Groups Number G a i n f u l l y o c c u p i e d 35 R e t i r e d 0 Homemaker 0 Student 17 None 6 No response 3 TOTAL 61 -::-lSylvia O s t r y , The O c c u p a t i o n a l Compos i t i o n o f the  Canadian Labour F o r c e . Dominion Bureau o f S t a t i s t i c s , Ottawa, 1967. -"-2 Frank Denton, S y l v i a O s t r y , H i s t o r i c a l E s t i m a t e s o f  Cana d i a n Labour F o r c e . Dominion Bureau o f S t a t i s t i c s , Ottawa, T (l67. 34 TABLE V I I Occupational Composition of the Women C l a s s i f i e d as G a i n f u l l y Occupied C l a s s i f i c a t i o n s Number White C o l l a r Managerial 0 P r o f e s s i o n a l and t e c h n i c a l 22 C l e r i c a l 4 Sales 0 Blue C o l l a r Craftsmen 1 Labourers 1 Primary Farmers 1 Loggers 0 Fishermen (etc.) 1 Miners 0 Tr a n s p o r t a t i o n and communications 0 Service and Personnel 5 TOTAL 35 Education Completed The education l e v e l of the respondents i n d i c a t e s that the c l i n i c p o p u l a t i o n i s very well educated, f a r beyond the l e v e l of the general p u b l i c . Of t^e respondents, 8 8 . 5 ^ have 35 completed sorre education beyond M.ph school g r a d u a t i o n . The majo r i t y of the persons with post high school education had attended u n i v e r s i t y . Of the respondents, 7^.d^ had attended u n i v e r s i t y . The number of years of post high school education range from s l i g h t l y l e s s than one to seven y e a r s . Some of the women had completed Ph.D.'s i n various areas. From t h i s i t can be seen that the c l i n i c a t t r a c t s well-educated women. (Tables V I I I and I X ) . TABLE V I I I Education Completed by the Women Attending the S e l f Help C l i n i c Type of School Number Junior High 1 High 5 Tech n i c a l 1 Bus iness 1 Community College 4 Univers i t y 46 Other Art 1 Nurs 1 ng 1 TOTAL 61 TABLE IX Number of Years Post High School Completed by the Women Attending the S e l f Help C l i n i c Number of Years Number of Women Up to 1 - 13 2 3 3 11 4 12 5 7 6 4 7 4 TOTAL 54 Occupation of Parents The socio-economic standing f o r a f a m i l y i s determined by the f a t h e r ' s occupation. This i s always the case unless there i s no male head of the household. I f there i s no male head of the household, then the mother's occupation i s used to determine the socio-economic standing. For the purpose of t h i s study, the B l i s h e n Socio-Economic Index f o r Occupa-t i o n s i n Canada was used f o r the f a t h e r ' s occupation. For the mother's occupation, since they were not heads of the household, a c l a s s i f i c a t i o n by Ostry occupation groups was used. 37 The Socio-Ecnnnv!c Index f o r Occupations i n Canada ^ as s i x c l a s s e s of occupation; with Class I beinp - the h i g h e s t . In the data c o l l e c t e d , more of the f a t h e r s ' occupations rated i n Class I than any other i n d i v i d u a l c l a s s . There seems to be a d e f i n i t e breakdown of the p o p u l a t i o n i n t o the three c l a s s groups of upper, middle and working c l a s s . I f Classes I and I I are combined, too, f o r the upper c l a s s group there were 17 f a t h e r s i n t h i s category. In c l a s s e s I I I and IV, combined to form the middle c l a s s , t h i s group had 18 f a t h e r s . The j o i n i n g of Classes V and VI i n t o the working c l a s s had 15 f a t h e r s . This seems to In d i c a t e a heavy r e p r e s e n t a t i o n from the upper arid middle socio-economic c l a s s e s ; ( i f the o v e r a l l break-down of s o c i e t y Is used as the gauge). Not as many women from working c l a s s f a m i l i e s are using the S e l f Help C l i n i c . (Tables X, XI, X I I ) . TABLE X Occupation of Fathers of the Women Attending the S e l f Help C l i n i c C l a s s * Number I 16 1 1 1 I I I 12 IV 6 V 13 VI 2 Not enough information given 6 No response " 5 TOTAL 61 TABLE XI Occupational Composition of the Fathers of the Women Attending the S e l f Help C l i n i c 38 C l a s s i f i c a t i ons Number White c o l l a r Managerial P r o f e s s i o n a l and t e c h n i c a l C l e r i c a l Sales Blue c o l l a r Craftsmen Labourers Primary Farmers Loggers Fishermen Miners T r a n s p o r t a t i o n and communication Service and personnel 5 15 2 8 6 4 3 1 1 0 2 3 TOTAL 50 39 TABLE X I I Occupation Groups of the Mothers of the Women Attending the S e l f Help C l i n i c Occupational Groups Number G a i n f u l l y occupied 28 Re t i r e d 2 Homemaker 25 Student 0 None 2 No response 4 TOTAL 61 Source of F i n a n c i a l Support The m a j o r i t y of women attending the S e l f Help C l i n i c are s e l f - s u p p o r t i n g (72.1$). Of these, 68.8$ of the popula-t i o n i s s e l f - s u p p o r t i n g through e i t h e r f u l l - t i m e or p a r t -time earnings. The other 3.3$, which i s two women, are supporting themselves, one with a s e l f - s u f f i c i e n t farm and the other on a f e l l o w s h i p . The remaining population i s supported i n a v a r i e t y of ways. (Table X I I I ) . 4 0 TABLE X I I I Sources of F i n a n c i a l Support of Women Attending the S e l f H e l p C l i n i c Sources Number F u l l - t i m e earnings 27 Part-time earnings (3 15 s t a t e d 1/2) Unemployed 2 Unemployment insurance 2 Welfare (3 2 sta t e d 1/2) Parents or r e l a t i v e s (2 5 s t a t e d 1/2) Other S e l f - s u f f i c i e n t farm 1 Fellowsh i p 1 Volunteers Opportunity Program (2 stated 1/2) No response 2 TOTAL 61 Medical Insurance The ^ e l f Help C l i n i c o f f e r s s e r v i c e t o women i r r e s p e c t i v e of whether they have medical insurance or not. I f the women cannot pay and do not have insurance then the s e r v i c e i s f r e e . The p o p u l a t i o n sampled i n d i c a t e d that 7R.6^ had an e l i g i b l e medical insurance p l a n . The remaining 21.4^ d i d not have any medical insurance e l i g i b l e In t h i s p r o v i n c e . The main reason, checked f o r not having medical insurance was the op t i o n of " j u s t haven't gotten i t t o g e t h e r . y e t " . This seems to i n d i c a t e these women are aware of t h e i r need f o r insurance, and may i n the future apply f o r I t . (Tables XIV and XV). 4 1 TABLE XIV Medical Insurance Coverage of Women Attending the Self Help C l i n i c E l i g i b l e Medical Insurance Number % Yes 48 78.6 No 13 21.4 TOTAL 61 100.0 • TABLE XV Reasons For Not Having Medical Insurance Coverage of the Women Attending the S e l f Help C l i n i c Re a so ns Numb e r Can't a f f o r d i t 1 Just haven't gotten i t together yet 7 Don't need i t 0 Don't b e l i e v e i n doctors 0 Not e l i g i b l e 4 Other Am j u s t v i s i t i n g In B r i t i s h Columbia 1 TOTAL 13 42 S e l f - D e f i n i t i o n of Health Status Each woman was asked f o r a s e l f - e v a l u a t i o n of her h e a l t h s t a t u s . In response to the question, "do you consider your-s e l f to be a healthy person?", 90.1$ of the respondents answered yes. Only 4.9$ answered no. When the women were asked i f they had ever had any se r i o u s i l l n e s s e s i n t h e i r l i f e , the response was 39.?$ p o s i t i v e and 59.0$ negative. The population g e n e r a l l y seems to be healthy according to s e l f - e v a l u a t i o n . The women were asked i f they had v i s i t e d a doctor w i t h i n the l a s t year. Responses were 83.6$ to the a f f i r m a t i v e and 11.4$ negative. Women who are g e n e r a l l y healthy have needs which they must go t o doctors f o r because of the e x i s t i n g set-up of the he a l t h system. I t seemed p e r t i n e n t to determine why the v i s i t s to the doctors were made. Of the doctors' v i s i t s , 64.9$ were f o r routine gynecolo-g i c a l h e a l t h c a r e . Routine g y n e c o l o g i c a l h e a l t h care included a l l aspects of b i r t h c o n t r o l : such as education about the methods, choice of a method, i n s t i t u t i n g method of b i r t h c o n t r o l , and follow-up of problems r e l a t i n g to i t ; and the diagnosis and treatment of v a g i n a l i n f e c t i o n s . These are the same kinds of concerns which are being d e a l t with by the l a y h e a l t h care-team at the S e l f Help C l i n i c . I f adequate S e l f Help s e r v i c e s were a v a i l a b l e , women would not have to seek out c o s t l y p h y s i c i a n s ' s e r v i c e s f o r these concerns which can be d e a l t with more e f f e c t i v e l y in a le s s c l i n i c a l l y o r i e n t e d s e t t i n g . (Tables XVI, XVII, X V I I I , X I X ) . 43 TABLE XVI Women's S e l f - E v a l u a t i o n of Th e i r Health Status Perceive Y o u r s e l f as Healthy Number % Yes 55 90.1 No 3 4.9 No response 3 4.9 TOTAL 61 99.9 TABLE XVII Occurrence of a Serious I l l n e s s at Some Time i n the Woman's L i f e Serious I l l n e s s Number % Yes 24 39.3 No 36 59.0 No response 1 1.7 TOTAL 61 100.0 TABLE X V I I I Occurrence of a Doctor's V i s i t W i t h i n the Previous Year by the Women Attending the S e l f Help C l i n i c Doctor's V i s i t Number % Yes 51 83.6 No 7 .11.4 No response 3 5.0 TOTAL 61 100.0 44 TABLE XIX Reasons f o r v i s i t s to Doctor i n Previous Year By the Women Attending the S e l f Help C l i n i c Reasons Number B i r t h C o n t r o l concerns 41 Vag i n a l I n f e c t i o n s 15 I l l n e s s e s 21 Operations 3 P s y c h i a t r i c v i s i t s 6 C h i l d b i r t h 1 Education (general) 1 TOTAL 88 Route of F i r s t Contact to the S e l f Help C l i n i c Over h a l f , 52.6$ of the women p a r t i c i p a t i n g i n the study, f i r s t heard about the S e l f Help C l i n i c from f r i e n d s . The i n -formal network between f e m i n i s t s i n Vancouver seems to be very a c t i v e . The other 47.4$ of the study group heard about the c l i n i c i n a l a r g e v a r i e t y of ways. (Table XX) TABLE XX Route of the F i r s t Contact of Women Attending the S e l f Help C l i n i c Route Number Friends 32 Speaker, group d i s c u s s i o n s 5 Newspaper 4 Doctor 1 R e f e r r a l s e r v i c e 5 Route 45 Number Other: Company Young Canadians 1 Pine Street C l i n i c 2 Sought i t out 1 Bookwork 1 Vancouver Women's Health C o l l e c t ive 1 YWCA 2 I work there 1 Green Health Booklet 1 Family Planning S e r v i c e s , Vancouver 1 P u b l i c L i b r a r y 1 response 1 TOTAL 61 It was necessary to know i f the women were there f o r the f i r s t time. In the case of 63.6$ i t was a f i r s t v i s i t . The other 27.9^ of the women had been to the c l i n i c e i t h e r two or three times. (Table X X I ) . TABLE XXI Number of V i s i t s by the Women to the S e l f Help C l i n i c Number of V i s i t s Number of Women F i r s t 40 Second 11 Thi r d 5 No response 5 TOTAL 61 46 WOMEN'S RESPONSES TO THEIR HEALTH CARE AND THE SELF HELP EXPERIENCE Reasons for Choosing the Self He In C l i n i c Women were asked why they chose the Se l f Help C l i n i c i n -stead of going to the doctor. There were eleven choices, of which they could check o f f as many as they wished. (Table XX). The choice which was checked most frequently was that they "appreciate being seen by women paramedics and doctors". This reinforces the concept that women have unique problems which can be dealt with best by other women. The l e v e l of un-derstanding, concern and empathy i s much higher when women are dealing with other women. Women lay health care workers are i n a peer r e l a t i o n s h i p with the women who attend the c l i n i c . This discourages any authority-power type of relat i o n s h i p and encourages an e g a l i -t a r i a n one. The atmosphere i s more relaxed because of this and two-way learning process ensues. A comment from one of the women elaborates on this theme. "Focus exclusively on women, there was no moral b u l l s h i t heaped on my head. There was much personal interest shown. I learned and even the para-medics were learning." The second most frequent response was to the statement, " I find doctors' v i s i t s rushed and impersonal". Women want more interest and concern to be shown to them. They want to be able to discuss t h e i r worries. The words "more personal" appeared over and over again i n the women's description about 47 what they l i k e d abm;t the S e l f K e l p C l i n i c . One woman s t a t e d , " I f e l t t h a t o t h e r women would t a k e my q u e s t i o n s and co n c e r n s s e r i o u s l y . I t was more p e r s o n a l , more thorough e x p l a n a t i o n s and I had a chance t o l e a r n t o use a speculum". Women a l s o d e s c r i b e d t h e i r e x p e r i e n c e at the S e l f H e l p C l i n i c as h a v i n g more "humanism" i n v o l v e d . These seem t o be e s s e n t i a l a s p e c t s o f any v i s i t w i t h any type o f h e a l t h c a r e worker, which women haven't been g i v e n c o n s i s t e n t l y i n t h e i r i n t e r a c t i o n s w i t h the m e d i c a l p r o f e s s i o n . The t h i r d a r ea o f l a r g e response was to the s t a t e m e n t , " I f e e l I r e c e i v e b e t t e r c a r e h e r e " . Women want t o know about t h e i r b o d i e s ; they want t o be a b l e t o have enough knowledge to t a k e p a r t i n making d e c i s i o n s about t h e m s e l v e s . T h i s know-ledge,, must be g i v e n t o them by h e a l t h c a r e workers as p a r t and p a r c e l o f t h e i r h e a l t h C8re. One woman s t a t e s , "The Women's S e l f Help C l i n i c would l i k e you t o know what i s happening w i t h y o u r a i l m e n t and y o u r body; i n o t h e r words, h e l p i n g you to h e l p y o u r s e l f . Many o t h e r m e d i c a l s e r v i c e s keep t h i s k i n d of I n f o r m a t i o n t o t h e m s e l v e s " . A n o t h e r woman s t a t e s , "The focu s i s l e a r n i n g and d o i n g r a t h e r than b e i n g c h e c k e d " , ^'omen seem t o be w a n t i n g o p p o r t u n i t i e s t o l e a r n . Four women com-mented t h a t they wanted t o l e a r n t o do s e l f - e x 8 m i n a t i o n . As one woman put i t , " I want t o see me f o r m y s e l f " . The f o u r t h area o f f r e q u e n t response was to the s t a t e -ment, " I don't l i k e g o i n g t o d o c t o r s " . The t r a d i t i o n a l d o c t o r -p a t i e n t r e l a t i o n s h i p i s f r a u g h t w i t h many d i f f i c u l t i e s . Those 48 d i f f i c u l t i e s seem even more unchangeable i f the p a t i e n t 1s a woman. Therefore women are lo o k i n g f o r other a l t e r n a t i v e s t o t h i s t r a d i t i o n a l d o c t o r - p a t i e n t r e l a t i o n s h i p . One woman sta t e d , "Doctors make too many assumptions that i n t e r f e r e with my v i s i t s " . Other statements which women made were, " I don't t h i n k male doctors know much about diaphragms", and "Dr. d i d n ' t seem to be g e t t i n g r i d of my complaint". One woman r a i s e d the area of s e x u a l i t y when she s t a t e d , " I f e l t you would understand s e x u a l i t y problems more f r e e l y than a doctor and would make me f e e l more at ease". Doctors have been the t r a d i t i o n a l sex t h e r a p i s t s i n t h i s s o c i e t y u n t i l now. Male doctors do not understand women's sexual needs or f e e l i n g s and problems. They are ofte n very uncomfortable d e a l -ing with areas of s e x u a l i t y as t h e i r medical education r e a l l y i n no way prepares them f o r sexual c o u n s e l l i n g . Women need other women to di s c u s s t h e i r f e e l i n g s and concerns with openly. • The S e l f Help C l i n i c assumes that women are sexual beings and the team always asks about f e e l i n g s r e l a t e d to sexual i s s u e s . Sexual f e e l i n g s are discussed openly by the h e a l t h care workers with the women and the atmosphere i s one of s h a r i n g . Doctors o f t e n do not incl u d e s e x u a l i t y as a routine area to e x n l o r e . I f anything they ask the woman i f she i s having orgasms and often leave i t at t h a t , i r r e s p e c t i v e of i f the answer i s yes or no. The area of women's s e x u a l i t y seems to be g e n e r a l l y an uncomfortable one f o r d o c t o r s . 49 The remaining choice of statements i n t h i s question were checked more i n f r e q u e n t l y and i n two cases not at a l l . The statements under the heading "Others" have been c l a s s i f i e d i n t o f i v e c a t e g o r i e s . The quotations used above were a l l from the "Other" category of the q u e s t i o n . (Table X X I I ) . TABLE XXII Reasons For Choosing a S e l f Help C l i n i c Instead of a Doctor Reasons Number Appreciate being seen by women paramedics and doctors 43 I f i n d d o c t o r s ' v i s i t s r a t h e r rushed and impersonal 38 I f e e l I r e c e i v e b e t t e r care here 33 I don't l i k e going to the doctor's 24 I didn't understand something my doctor t o l d me and I wanted to t a l k about i t 12 I cannot a f f o r d to go t o a doctor's o f f i c e ' 10 I t h i n k I might be i n t e r e s t e d i n becoming a paramedic and thought I would come and see what i t was l i k e f i r s t ~ 9 I do not have medical insurance 8 I came because I couldn't get an appointment with my doctor r i g h t away 6 I u s u a l l y come to t h i s c l i n i c , I didn't exnect to f i n d the S e l f Help C l i n i c here 0 I r e a l l v p r e f e r a doctor, i t was j u s t convenient t h i s ' time 0 Other - s p e c i f y : C u r i o s i t y 7 Because i t ' s personal, f r i e n d l y and concerned 5 B e l i e v e i n S e l f Help and to l e a r n 10 D i s s a t i s f a c t i o n with doctors 6 Miscellaneous 3 TOTAL RESPONSES 214 50 The D i f f e r e n t Focus o f the S e l f Help C l i n i c I t was i m p o r t a n t to a s c e r t a i n i f the women a t t e n d i n g the S e l f Help C l i n i c p e r c e i v e d i t s f o c u s as b e i n g d i f f e r e n t t h a n o t h e r m e d i c a l s e r v i c e s a v a i l a b l e t o them. The responses i n d i -c a t e d they d e f i n i t e l y d i d f e e l i t was d i f f e r e n t . Of the 6 l re s p o n d e n t s , 59 s a i d t he f o c u s was d i f f e r e n t , two s a i d i t was not d i f f e r e n t . I f the women answered " y es" to the q u e s t i o n about t h e fo c u s of the c l i n i c b e i n g d i f f e r e n t they t h e n were asked t o check o f f s t a t e m e n t s which d e s c r i b e d how i t was d i f f e r e n t . Each woman c o u l d check as many s t a t e m e n t s as she w i s h e d . Three o f the s t a t e m e n t s were checked by 55 women. The f i r s t one was the st a t e m e n t , " I l i k e the p e r s o n a l a t t e n t i o n and i n t e r e s t I r e c e i v e h e r e " . The response t o t h i s s t a t e m e n t c o r r e l a t e s t o the r e s p o n s e s i n t h e p r e v i o u s q u e s t i o n about d o c t o r s ' v i s i t s b e i n g rushed and i m p e r s o n a l . Women d e f i n i t e l y want and need time and i n t e r e s t i n o r d e r t o e x p r e s s t h e i r needs and q u e s t i o n s and t o have them d e a l t w i t h . One woman s t a t e s , " I t h i n k the care here i s more thorough and c a r e f u l l y done. I t r u s t i t more than r e g u l a r c l i n i c s because of the time t a k e n . I d i d l e a r n something about m y s e l f " . The second statement w h i c h had 55 res p o n s e s was, " I can l e a r n about my body". H e a l t h c a r e workers have i n the r a s t c a r e f u l l y guarded t h e i r " p r o f e s s i o n a l " knowledge. ^omen want some of t h i s knowledge, and i n f a c t a r e b e g i n n i n g t o demand 51 i t as one of t h e i r r i g h t s . One of the r e s p o n d e n t s s t a t e s , "You spread knowledge around i n s t e a d o f i t always b e i n g a s s e s s e d by e x p e r t s . I l e a r n e d a l o t " . The focus of the S e l f Help C l i n i c i s r e c i p r o c a l l e a r n i n g . One woman s t a t e d i t ve ry s u c c i n c t l y , "The c l i n i c i s open to l e a r n i n g from women's e x p e r i e n c e s i n o r d e r to improve h e a l t h c a r e " . I t i s impor tant tha t each wo-man becomes h e r own exper t about h e r own b o d y . When women have b a s i c body knowledge, they w i l l then use a v a i l a b l e h e a l t h care s e r v i c e s more e f f i c i e n t l y and w i s e l y . The S e l f Help C l i n i c "presumes t h a t women are i n t e r e s t e d i n t h e i r b o d i e s " . From t h i s p o i n t women themselves g a i n more i n t e r e s t and l e a r n . The t h i r d area o f l a r g e response was t o the s t a t e m e n t , "I f e e l f r e e to ask as many q u e s t i o n s as I w a n t " . T h i s t i e s i n w i t h want ing more i n f o r m a t i o n and b e i n g r e l a x e d enough to be ab le to ask f o r i t . P a r t o f b e i n g r e l a x e d has to do w i t h the women's r e l a t i o n s h i p to the l a y h e a l t h c a r e w o r k e r s ; bo th p a r t i e s have t o be f r e e and open to a s k i n g and answer ing q u e s -t i o n s . One woman s t a t e d t h a t the d i f f e r e n c e at the S e l f Help C l i n i c was " b e i n g t r e a t e d l i k e an e q u a l " . In a p e e r r e l a t i o n -s h i p i t i s p o s s i b l e to share f e a r s , p rob lems , j o y s . One s t a t e -ment by a woman seems to sum up why r e l a t i o n s h i p s with d o c t o r s are d i f f i c u l t : "I get the f e e l i n g male d o c t o r s are beiner c o n -d e s c e n d i n g and p a t r o n i z i n g because I'm a woman - seems l i k e they w i l l never know what to do wi th or about a woman so lust t r y to get though i t as q u i c k l y as p o s s i b l e " . The fourth area of large response was to the statement, "The atmosphere Is comfortable". People seem to need to be relaxed and comfortable in order to express concerns. Health care workers must themselves be relaxed i f the c l i e n t i s going to be relaxed. Women often do not encounter the necessary de-gree of comfort i n t r a d i t i o n a l health care s etti n g s . The next area of large response was to the choice, "The concept of Sel f Help appeals to me". One woman merely stated, "I believe in i t " . In this alienating, techno-bureaucratic society i t i s important to slow down and i n fact touch down to something which is integrated into a person's l i f e . Be-cause Self Help i s care or body knov/ledge, i t i s not aliena-? ting, rather i t i s integrating. Women have had d i f f i c u l t y i n the past integrating t h e i r bodies, t h e i r reproductive functions and t h e i r sexuality. The concept of Self Help promotes t h i s . Self Help also i s a way of taking back personal power. •'•bis seems to be an important element. The l a s t area of frequent response was to "I f e e l I w i l l learn more about preventative health care here". The majority of women's general gynecological health care i s of a preventative nature. B i r t h control, pap smears, breast self-examination, vaginal smears, e a r l y control of v a g i n i t i s , can a l l be seen as preventative health care. In order to pro-vide women with good health care they must have information about t h e i r own normal cycles, and about these preventative measures. '•'•his education is routinely given as part of the 53 v i s i t at the S e l f Help C l i n i c . Adequate knowledge a l s o a l l a y s a n x i e t i e s which are unfounded. G e n e r a l l y from the responses t o t h i s q u e s tion i t seems the focus of the S e l f Help C l i n i c i s d i f f e r e n t from the t r a -d i t i o n a l h e a l t h care because of i t s e d u c a t i o n a l , comfortable and personal nature. The i n t e r a c t i o n s which occur there seem to be unique i n that they are e g a l i t a r i a n and p e r t i n e n t to the women's l i v e s . V i s i t s to the S e l f Help C l i n i c seem to aid wo-men i n i n t e g r a t i n g h e a l t h i n t o t h e i r d a i l y l i v e s . The women were asked to rat e t h e i r s a t i s f a c t i o n l e v e l with t h e i r S e l f Help experience. The m a j o r i t y of the responses rated the l e v e l as "high - e x c e l l e n t " . (Tables X X I I I , XXIV, XXV) . TABLE X X I I I The D i f f e r e n c e i n Focus of the S e l f Help C l i n i c as Compared t o Other Medical S e r v i c e s The Focus i s D i f f e r e n t Number Yes No 59 2 9 6 . 7 3.3 TOTAL 61 100.0 54 TABLE XXIV How the Focus of the S e l f Help C l i n i c i s D i f f e r e n t from Other A v a i l a b l e Medical Services D i f f e r e n t Focus Number I l i k e the personal a t t e n t i o n and i n t e r e s t receive here I 55 I can l e a r n about my body 55 I f e e l f r e e to ask as many questions as I want 55 The atmosphere i s comfortable 51 The concept of S e l f Help appeals to me 49 I f e e l I can l e a r n more about p r e v e n t a t i v e c a re he re h e a l t h 39 I l i k e knowing that n e i t h e r p a r e n t a l nor l e g a l consent or knowledge are involved 13 I found i t d i f f i c u l t to t a l k to two people about personal h e a l t h matters at once 3 I came because I thought i t would be e a s i e r p r e s c r i p t i o n s , e t c . here to get 1 I t i s too casual f o r me to consider t h i s as h e a l t h s e r v i c e a r e a l 1 I don't f e e l as comfortable w i t h paramedics do with doctors and nurses as I 0 Other -Some quoted i n the w r i t t e n s e c t i o n 21 TOTAL RESPONSES 343 TABLE XXV R a t i n g o f S a t i s f a c t i o n L e v e l o f S e l f H e l p C l i n i c E x p e r i e n c e S a t i s f a c t i o n L e v e l Number Low - f e l t d i s p l e a s e d 0 0 Adequate - OK 1 1.6 Good - above average 12 19.6 High - e x c e l l e n t 43 70.4 No response 5 8.1 TOTAL 61 99.7 Comparison o f F e e l i n g s and E x p e r i e n c e s W i t h D o c t o r s and W i t h The S e l f H e lp C l i n i c The women i n the s t u d y were asked to check o f f words from a l i s t o f a d j e c t i v e s w h i c h d e s c r i b e d t h e i r e x p e r i e n c e s and f e e l i n g s w i t h d o c t o r s and which d e s c r i b e d t h e i r e x p e r i e n c e s and f e e l i n g s w i t h the S e l f H e lp C l i n i c . The a d j e c t i v e s checked most f r e q u e n t l y f o r the S e l f Help C l i n i c were the f o l l o w i n g : r e l a x e d , i n f o r m a t i v e , c a r i n g , under-s t a n d i n g , s u p p o r t i v e , competent, t h o r o u g h , t r u s t w o r t h y , and c o n f i d e n t . Each o f the s e ^ad 35-54 res p o n s e s t o them. The a d j e c t i v e s checked most f r e q u e n t l y f o r d o c t o r s were the f o l l o w i n g : c l i n i c a l , i m p e r s o n a l , rushed, competent, con-d e s c e n d i n g , a u t h o r i t a t i v e , c o n f i d e n t , i n t i m i d a t i n g and d i s -t r a c t e d . Each o f the s e was checked 2 0 - 4 2 t i m e s . The two words which were checked f r e q u e n t l y f o r both 56 the S e l f Help C l i n i c and doctors were competent and c o n f i d e n t . The word competent was checked 4 3 times f o r the S e l f Help C l i n i c and 3 2 times f o r doc t o r s . The word confident was checked 3 5 times f o r the S e l f Help C l i n i c and 26 times f o r doctors. * Some of the frequency of responses f o r the a d j e c t i v e s were d i f f e r e n t f o r the two groups. The a d j e c t i v e s checked once or not at a l l f o r the S e l f Help C l i n i c were the f o l l o w i n g : rushed, condescending, bossy, i n t i m i d a t i n g , impersonal, em-ba r r a s s i n g , s e c r e t i v e , and i n a t t e n t i v e . Of these a d j e c t i v e s f o u r appear on the l i s t of words checked most f r e q u e n t l y f o r do c t o r s . The words checked l e a s t f r e q u e n t l y f o r doctors were: d i s o r g a n i z e d , supportive, c a r i n g , relaxed and i n f o r m a t i v e . Each o f these was checked les s than nine times. Of these ad-j e c t i v e s , f o u r were found on the l i s t of the most f r e q u e n t l y checked f o r the S e l f Help C l i n i c experience. I t can be concluded that experiences w i t h the S e l f Help C l i n i c and doctors are very d i f f e r e n t . The focus and f e e l i n g s that the women had at the c o n c l u s i o n of the two v i s i t s are d r a s t i c a l l y d i f f e r e n t . I t seems that the S e l f Help experience i s a more p o s i t i v e emotional and p h y s i c a l experience than a v i s i t to the docto r . (Table XXVI). 57 TABLE XXVI Words D e s c r i b i n g Experiences w i t h Doctors and S e l f Help C l i n i c as checked by the Women i n Study D e s c r i p t i v e Words S e l f Help C l i n i c Experience Yes Sometimes Yes Doctors Sometimes Competent 43 4 32 1 C l i n i c a l 8 42 Rushed 1 37 1 Condescending 1 28 4 Bossy 0 14 1 Thorough 42 3 15 3 Relaxed 54 7 2 Informa t i v e 52 9 2 I n t i m i d a t i n g 1 23 3 Impersonal 1 39 Confident 35 1 26 Caring 51 5 1 Disorganized 9 3 2 1 Embarrassing 1 19 1 S e c r e t i v e 0 19 1 D i s t r a c t e d 3 20 1 I n a t t e n t I v e 1 15 1 A u t h o r i t a t i v e 2 27 2 Understand ing 48 1 5 4 Supportive 47 1 4 Trustworthy 40 2 17 TOTALS 431 15 405 29 58 Women's G e n e r a l A t t i t u d e Toward The S e l f H e l n C l i n i c The women i n the study were asked t o comment on t h e i r f e e l i n g s about the S e l f Help C l i n i c . This question brought i n a wide range of responses. The responses ranged from one or two words to a paragraph. The responses have been categorized i n t o groups and w i l l be discussed a c c o r d i n g l y . Some of the headings used are d i r e c t quotations from the women's answers. "Your Work Is Great" The area most commented on was t h 8 t the women l i k e d the c l i n i c , f e l t the work was great and were committed to or impressed w i t h the S e l f Help concept. There were 15 responses In t h i s category. Some comments i n t h i s group which i n d i c a -ted women's f e e l i n g s about S e l f Help were: " I l i k e the con-cept of S e l f Help - most doctors are s e l f i s h about t h e i r know-ledge". " I l i k e the idea that the s t a f f wants to help you to l e a r n to give y o u r s e l f i n t e l l i g e n t g y n e c o l o g i c a l h e a l t h c a r e . " Women want to be resp o n s i b l e f o r t h e i r h e a l t h care. This was expressed i n s e v e r a l ways. " I t ' s a new experience to help my-s e l f and hard a f t e r being used to doctors being i n c o n t r o l of the s i t u a t i o n . I was never asked to be responsible f o r my body before ." Another woman expressed these f e e l i n g s by say-ing, "the aspect of personal r e s p o n s i b i l i t y " . G e n e r a l l y the women's comments seemed to i n d i c a t e t h a t the S e l f Help experience 59 was very rewarding and s t i m u l a t i n g . " I t was a super experience--I plan to go again f o r any problems and/or f o r check-ups." "Fine Time" Many women merely s t a t e d " f i n e time", " I l i k e i t " , "need more" and " i t i s very much needed". Many comments were g e n e r a l l y p o s i t i v e about the c l i n i c and i t s e x i s t e n c e . There were 13 responses i n t h i s category. I t appears that the S e l f Help C l i n i c i s f i l l i n g a need f o r women i n a way that i s not being met i n other h e a l t h care s e t t i n g s . One woman st a t e d t h i s more p e r s o n a l l y . " I t seems t o f i l l a gap i n the medical f i e l d . I have been to many d i f f e r e n t doctors and yet I learned more i n the short time 8t the c l i n i c . " Another woman s t a t e d , " I am very Impressed with what i s being accomplished and under-taken at the c l i n i c " . " L i k e Your A t t i t u d e " Women s t a t e they l i k e the a t t i t u d e at the c l i n i c . There were 11 responses i n t h i s category. Women are often t r e a t e d very c l i n i c a l l y and r o u t i n e l y by doct o r s . Because the S e l f Help C l i n i c i s t o t a l l y run by women f o r women, the a t t i t u d e i s much more sympathetic and supp o r t i v e . One woman s t a t e s , " I am t r e a t e d l i k e r e a l people as I should be, but am not always". Another comment made was, " I t h i n k women have a l o t to share with each other about anything they are involved i n . The women at the c l i n i c are valuable because they not only have considerable medical knowledge, but they are also w i l l i n g to t 8 l k from and share t h e i r p e r s o n a l experiences". Openness 60 to share seems very important. People need to know that they are not s i n g u l a r i n any of l i f e ' s experiences. The comment made by the f o l l o w i n g woman seems to summarize the a t t i t u d e 8 t the S e l f Help C l i n i c . "V'hen I came to the c l i n i c I found the focus W8S on me - my body - my mind - my f e e l i n g s , as w e l l as how I f e l t about myself f o r myself. There was ab-s o l u t e l y no power t r i p involved - I d i d n ' t f e e l l i k e a s i c k person or an ignorant one, instead there was a f e e l i n g that I was sharing an experience w i t h two other people who were open, s e n s i t i v e and d i g g i n g the experience too.'! Lay Health Care Workers Five women made comments s p e c i f i c a l l y about the l a y h e a l t h care workers or paramedics, ^otnen seem to appreciate them because they are women, because of t h e i r : m e d i c a l know-ledge, because they are w i l l i n g to share t h e i r own experiences with.them. Lay h e a l t h care workers have the a b i l i t y to form a rapport which allows women to discuss very personal matters with some degree of comfort. S o r n e comments were: "Para-medics make the c l i n i c worthwhile and a greater l e a r n i n g ex-perience", and " I found I t e x c i t i n g to examine my body as shown by the paramedics", ^omen want to become more involved i n t h e i r h e a l t h c a r e . S o m e women express i n t e r e s t i n becoming lay h e a l t h care workers. What i s so e x c i t i n g about t h i s i s that i t i s a p o s s i b i l i t y f o r the women. " I t was a most im-pressive experience - makes me want to be a c l i n i c h e l per too -61 I learned sore '^port-ant things about rry body and my a t t i -tudes." Comments about the s k i l l s of the paramedics point out technical and interpersonal s k i l l s . "What surprised and pleased me most was the balance the women maintained between fr i e n d l y , personal caring and cool competence, both of which put me at ease ." Learning About Health Care Four women's comments pertained to the learning they had done at the c l i n i c . ^his i s a repeating theme i n many of the other comments as well. It i s a d e f i n i t e fact that the Self Help C l i n i c offers a personal learning experience which women have not received from other medical services. Women comment on being able to ask questions. They comment on how they could express t h e i r concerns. "The experience was very rewarding - was able to talk about things thst bothered me, but I had pushed out of my mind as t r i v i a ." There i s a sense of r e l i e f i n at least finding a knowledgeable source for some long standing questions. Learning seems very Important. "I wish that there had been a c l i n i c like this one four years ago -so I could have gone there and experienced what I did the f i r s t time I went to the Self Help C l i n i c . I know that I would have had a completely d i f f e r e n t f e e l i n g about my body and myself ." Differences Betv.een Self Help and Other Medical Services Some women ( 4 ) commented about the differences i n t h e i r 6 2 S e l f Help experiences as compared t o t h e i r doctor experiences. The comments u s u a l l y had to do with f e e l i n g more at ease with the l a y h e a l t h care worker as opposed to the p r o f e s s i o n a l . Comments made weret "Don't f e e l I can ask questions of doc-t o r s " , "Regular doctors make me f e e l dependent", and " I f e e l n e u r o t i c a f t e r v i s i t i n g a doctor". The focus of most doctors' v i s i t s i s i l l n e s s o r i e n t e d . The focus of S e l f Help h e a l t h care i s w e l l n e s s and p r e v e n t i o n . This r e a l l y changes the per-s p e c t i v e s f o r the women. One woman t a l k s about her f e e l i n g s about the S e l f Help C l i n i c . " I am t e r r i b l y p o s i t i v e and f i n d that it's part of the t h i n g (Women's L i b e r a t i o n Movement) which i s happening that g i v e s me hope f o r the f u t u r e . Things are so bad now. The c l i n i c i s so much the opposite of the whole s t r a i g h t medical scene." A High L e v e l of Comfort Women report much pleasure i n being comfortable when i n t e r a c t i n g w i t h h e a l t h care workers. They want t o be able to speak out without so much anxiety and r e s e r v a t i o n . T h i s was discussed by four of the respondents i n the study. Women made reference to being "completely at ease", ^ l s o , there was reference to being comfortable w i t h t h e i r bodies. T h i s , f o r some women, Is a new experience. " I t concentrates on the patient being comfortable with her body." One woman commented on the d i f f i c u l t y she had i n t a l k i n g about s e x u a l matters with doctors. " I f e e l i t i s a good thing because 63 people are mnro wi 11 ing to come to you with t h e i r problems whereas they might be afraid to go to doctors, because doc-tors usually are less understanding sod too narrow-minded about sexual problems and make you f e e l uneasy about sexuality." When people are more comfortable they are able to tal k about the i r sexuality. This section can be concluded with these comments by one of the women. "Although I had some idea of what i t might be l i k e , the experience was f a r more personal and relaxed. During and a f t e r I f e l t that i t had r e a l l y been an experience, one which most people never have, so I f e l t s a t i s f i e d and fortunate." Individuals' Concerns About Self Help C l i n i c Five women posed questions about the thoroughness of the care they received, or about the s k i l l of the lay health care workers. One woman comments, "I did not receive a blood test and I f e e l they have importance". Another woman commented, "The only spot where I f e l t a lack of competence was the blood test - lots of jabbing". One woman stated she f e l t that deal-ing with two or three lay health care workers was very d i f f i -c u l t . She would have preferred more of a one-to-one approach. The f i n a l comment which indicated some d i s s a t i s f a c t i o n had to do with the value of assessing one's s e l f against general norms. " S t i l l too much emphasis on that impossible value normal'. Should help women to accept themselves i n terms of indi v i d u a l 'normalacy'. I can't compare myself medically to 64 what i s u s u a l f o r women. I have to see myself i n terms of myself." This i s an important i s s u e , one which r e q u i r e s much more thought. Summa ry The women's f e e l i n g s toward the S e l f Help C l i n i c ex-perience are g e n e r a l l y very p o s i t i v e . The g e n e r a l consensus was t h a t i t was a rev/arding personal experience. H i g h l i g h t s of the experience seemed to be the openness of the l a y h e a l t h care workers, the opportunity to ask questions and l e a r n about t h e i r bodies, and the pleasure at how comfortable and relax e d i t a l l was. I t i s evident that S e l f Help h e a l t h care i s very essen-t i a l f o r women's needs, ^omen who had no previous experience with the concept, were very impressed w i t h the philosophy and with the r e s u l t a n t c a r e . I t allows them to be res p o n s i b l e f o r t h e i r h e a l t h care i n a knowledgeable way. I t seems t h i s w i l l remain to be an important a l t e r n a t i v e f o r women's h e a l t h care i n the f u t u r e . The Most P o s i t i v e Focus of the S e l f Help Experience As  Perceived By The ^orven The women i n the study group were asked to di s c u s s what they l i k e d the most about the S e l f Help C l i n i c . I'he answers received were i n some ways s i m i l a r to the responses In the previous question, although the women answered t h i s question 65 a b i t more e x p l i c i t l y . The responses have been ca t e g o r i z e d i n t o groups and w i l l be discussed a c c o r d i n g l y . Wome n When asked what they l i k e d most about the S e l f Help C l i n i c , the respondents most f r e q u e n t l y answered "the women". There were 15 respondents i n t h i s category with many more over-lapping i n t o other groups, ^omen appreciate r e c e i v i n g care and concern from other women. I t r e a l l y seems to be a case of understanding and empathy that can only be received from another woman. One woman stated she l i k e d "the open f e e l i n g , treatment as a r e a l person, enough time t o r e l a x and discuss t r o u b l e , gentle c a r i n g women around who helped me gain know-ledge and thereby make some healt h and mind d e c i s i o n s " , ^he women who come to the S e l f Help C i j n i c f e e l that they are con-t r i b u t i n g to women as w e l l . One woman stat e d that what she l i k e s i s "support fo r and from other women". Women can emit an acceptance about being women together. "The f e e l i n g of acceptance I got about my own body - coming from the openness and enthusiasm of the paramedics. I l i k e d the non-male atmo-sphere - f e l t good about being a woman." Because I t i s new i n t h i s medical system f o r l a y women to be he l p i n g other wo-men, most people are very s u r p r i s e d and pleased at the r e s u l t s . One woman stated her a p p r e c i a t i o n of "the warmth of the per-sonnel - I'm a l i t t l e a f r a i d of women (and men I suppose) at f i r s t , but I r e a l l y f e l t at ease with you people". This seems 66 to be a component of h e a l t h care which i s v i t a l f o r r e a l communication. I t seems people communicate best with p e e r s . This i s c e r t a i n l y one of the f o r t e s of S e l f Help h e a l t h c a r e . Abundant I n f o r m a t i o n Women l i k e o p p o r t u n i t i e s to d i s c u s s concerns about t h e i r h e a l t h c a r e , t h e i r l i v e s i n g e n e r a l , t h e i r s e x u a l i t y . The f a c t that a l l a v a i l a b l e i n f o r m a t i o n i s shared with them, at the S e l f Help C l i n i c i s r e a s s u r i n g . When i n f o r m a t i o n i s shared i t de-m y s t i f i e s the whole d o c t o r - p a t i e n t r e l a t i o n s h i p . T h i s i s one of the aims of the S e l f Help C l i n i c - to demysti f y bodies and h e a l t h c a r e . One woman s t a t e s i t l i k e t h i s , " R e c e i v i n g the i n f o r m a t i o n you r e c e i v e and not having It i n a f i l e I never see". Another woman s t a t e s , "That I got s t r a i g h t answers and i n f o r m a t i o n about my s i t u a t i o n and body r a t h e r than j u s t treatment. I f e l t more r e l a x e d t h e r e f o r e , more i n v o l v e d " . People cannot take r e s p o n s i b i l i t y and make d e c i s i o n s about themselves unless they have the necessary f a c t s to go on. It seems important to r e a l i z e t h a t women oft e n have things they wish to know but, because o f a n x i e t y , are unable to ask d i r e c t l y . Development of good r a p p o r t and communica-t i o n are r e q u i r e d to a s s i s t these women to speak up. One woman t a l k s about her f e e l i n g s : "I l i k e the way any l i t t l e enquiry, no matter how embarrassed I f e l t , was t r e a t e d with a l l s e r i o u s n e s s and answered with onenness and frankness -makes me f e e l mo^e at ease and g i v i n g me more c o n f i d e n c e to enquire f u r t h e r " . 67 Information about personal matters seems to be at a premium. The S e l f Help C l i n i c i s one place where i t can be obtained. Concept of S e l f Help Ten women commented that what they l i k e d most was the concept or philosophy of S e l f Help. They stated they b e l i e v e i n i t , f e e l i t i s an asset to women. T Q quote one woman, "that i t e x i s t s and while t r y i n g to reach or s e r v i c e a l o t of people i t s p r i o r i t i e s of c a r i n g , informing and he l p i n g wo-^  men are not being s a c r i f i c e d " . Part of S e l f Help i s to l e a r n e s s e n t i a l i n f o r m a t i o n which i s b asic to gene r a l h e a l t h care. One woman discusses t h i s , " I l i k e the g i r l scout s p i r i t , I r e a l l y mean i t . The a b i l i t y to determine the amount of medical knowledge necessarv to f i t a diaphragm or diagnose a minor i n f e c t i o n and then to make t h i s a sm a l l part of the v i s i t ... emphasizing the s i s t e r h o o d f e e l i n g - love and c a r i n g and sharing between women." Vv'omen must l e a r n f o r themselves, S e l f Help i s a process of s e l f d i s c o v e r y . Being i n touch with your own body i s the core of the ^ elf Help Health Movement. One woman t a l k s of t h i s d i s c o v e r y . " i t ' s the laughter i n the c o n s u l t a t i o n rooms-*-? being able to do, to see, to f e e l things f o r y o u r s e l f . " This i s d e f i n i t e l y one of the strengths of the experience at the S e l f Help C l i n i c . 68 Time Women are used to being rushed i n and out of a doctor's o f f i c e i n a few minutes, perhaps IS - 30 minutes. When they have an opportunity to spend as much time as they need with a hea l t h care worker, i t i s considered a r e a l a s s e t . Many wo-men commented about having the time they needed at the S e l f Help C l i n i c . " I enjoy the time you take to e x p l a i n e v e r y t h i n g c l e a r l y . " " I l i k e the system of having a l l the time you need to t a l k about your problems and that I t makes me f e e l l i k e I am spending an evening w i t h f r i e n d s instead of an appointment with a doctor." " I l i k e the amount of time they spend with you." "Time i s not a scarce commodity." The Caring Approach The words the women most used to d e s c r i b e t h e i r S e l f Help experience were the f o l l o w i n g : c a r i n g , concern, respect, supportive, f r i e n d l y , p e r s o n a l , and honesty. Many women com-bined the ideas and f e e l i n g s above i n t o statements. A few of these statements f o l l o w . " I t ' s i n f o r m a l , p e r s o n a l atmosphere, combined w i t h thorough care from women l i k e myself - f r i e n d s . " "The very personal, very c a r i n g i n t e r a c t i o n between my-s e l f and the women who work there." "The personal care and i n t e r e s t - I came away very s a t i s -f i e d and with a good f e e l i n g about my body - a l l bodies. I t was a very j o y f u l experience f o r me." 6 9 "The people i n v o l v e d are s o . s i n c e r e and i n t e r e s t e d and w i l l i n g t o take time t o h e l p you. becorre aware o f y o u r s e l f . " Other s t a t e m e n t s made c o n t a i n e d s i m i l a r f e e l i n g s from the women. T h i s i s an a s p e c t of h e a l t h c a r e which p r o f e s s i o n a l s have g i v e n l i p s e r v i c e t o e v e r s i n c e t h e i r e x i s t e n c e . I t seems t h a t p e r s o n a l c o n c e r n can b e s t be conveyed from h e l p e r s who are i n peer r e l a t i o n s h i p s w i t h the c l i e n t s . Comments about the c a r i n g approach were made by 27 o f the r e s p o n d e n t s . Summa r y I t seems the a s p e c t s o f the S e l f Help C l i n i c which women l i k e d the most were the warm res p o n s e s t h e y r e c e i v e d from the women l a y h e a l t h c a r e w o r k e r s . They a p p r e c i a t e d the work, knowledge, time and e f f o r t o f the l a y h e a l t h c a r e w o r k e r s . M a i n l y I t h i n k the women l i k e d the way they were a b l e t o be t h e m s e l v e s , t o d i s c u s s t h e i r f e e l i n g s and c o n c e r n s , t o get i n t o u c h w i t h t h e i r b o d i e s , a l l o f w h i c h o c c u r r e d as a r e s u l t o f the a c c e p t i n g and s u p p o r t i v e atmosphere a t t h e S e l f H e lp C l i n i c . Most N e g a t i v e Focus o f the S e l f H e l p . C l i n i c Women i n the s t u d y group were asked t o comment on the t h i n g s thev l e a s t l i k e d about t h e i r c l i n i c e x p e r i e n c e . The comments have been c a t e g o r i z e d i n t o s e v e r a l g r o u p s . The d i s c u s s i o n o f t h e s e groups f o l l o w s . The main d i s l i k e o f the c l i n i c c e n t e r e d around t h e ap-pointment and d r o p - i n system of s e e i n ^ women. The system 70 seems to be d i s f u n c t i o n a l i n t h a t many women s t a t e d t h e y had w a i t e d t o be seen f o r s e v e r a l h o u r s . There were 15 r e s p o n s e s which f i t t e d i n t o the c a t e g o r y of w a i t i n g t o be seen, whether o r not the v/oman had an appointment. One woman commented on the l a c k o f c h i l d c a r e at the c l i n i c which made i t d i f f i c u l t f o r h e r , p a r t i c u l a r l y i f she had t o w a i t a l o n g t i m e t o be seen. Some comments t h a t women made about h a v i n g t o w a i t were as f o l l o w s . " I was so p i s s e d o f f w i t h w a i t i n g ( t ^ r e e h o u r s ) t h a t I began t o q u e s t i o n the c r e d i b i l i t y o f the c l i n i c s t a f f . " "The l o n g w a i t i n g p e r i o d , though I e x p e r i e n c e d t h a t a t the d o c t o r ' s o f f i c e as w e l l . " "The l o n g w a i t was a d r a g , came a t 6 . 3 0 , l e f t at 10 p.m. B a b y s i t t e r problems - c o u l d t h e r e be c h i l d c a r e ? Perhaps o t h e r hours - I know t h i s i s tough w i t h v o l u n t e e r s . " The m8in problem, t h e n , seems t o be p r o v i d i n g prompter s e r v i c e t o t h e women, thus r e d u c i n g the w a i t i n g p e r i o d . The n e x t most f r e q u e n t a rea commented on was the c a s u a l -ness and d i s o r g a n i z a t i o n o f t h e S e l f H e l p C l i n i c . Two women f e l t t h a t the c a s u a l appearance and manner o f the l a y h e a l t h c a r e workers made i t d i f f i c u l t t o r e l a t e t o them as a s e r i o u s s o u r c e o f h e l p o r i n f o r m a t i o n . One woman s t a t e s , " I t ' s a l i t t l e too c a s u a l f o r some - open d i s c u s s i o n about o t h e r s may embarrass o r o f f e n d some p e o p l e . I a p p r e c i a t e t h e openness, but may be l o s i n g some p o t e n t i a l u s e r s . " I n r e l s t i o n t o the p o i n t about d i s o r g a n i z a t i o n , i t was mentioned by f i v e women, but In a r a t h e r i n d e f i n i t e way. One woman commented t h a t what was needed was "a more o r g a n i z e d appointment s c h e d u l e " . • 7 1 The n e x t area o f d i s l i k e had to do w i t h the s i z e and capa-c i t y and f a c i l i t i e s o f the c l i n i c . Comments were made t h a t the hours o f s e r v i c e were t o o s h o r t , t h a t the c l i n i c s h o u l d e n l a r g e t o accommodate more women, t h a t a l l k i n d s o f m e d i c a l c a r e s h o u l d be o f f e r e d , not i u s t g y n e c o l o g i c a l c a r e and t h a t the f a c i l i t i e s were t o o s m a l l and d i n g y . One woman t a l k s o f i t i n t h i s way. "As y e t the f a c i l i t i e s c o u l d be expanded and improved. I r e a l i z e t h i s i s a m a t t e r o f time and monev. An i n c r e a s e i n e f f i c i e n c y o f t e n l e a d s t o a d e c r e a s e i n p e r s o n a l s e r v i c e which i s more i m p o r t a n t at a c l i n i c such as t h i s . " A n o t h e r woman comments on h e r f e e l i n g s about e n l a r g i n g the s e r v i c e . "The o n l y t h i n g I f e e l i s e s s e n t i a l t o i m p r o v i n g t h e c l i n i c i s t o e n l a r g e , because t h e r e i s a g r e a t need f o r such a p e r s o n a l emphasis on our b o d i e s and e v e r y woman would b e n e f i t from a v i s i t . " There were a few s i n g l e comments made by i n d i v i d u a l wo-men. One woman f e l t t h a t t h e r e was a " s t r o n g mark of d i s t i n c -t i o n between the c l i n i c and n o n - c l i n i c p e o p l e " . T h i s seemed to be i n t e r p r e t e d as c l l q u i s h n e s s on the p a r t o f the l a y h e a l t h c a r e w o r k e r s . T h i s seemed t o i n t e r f e r e w i t h the women's com-f o r t l e v e l . A n o t h e r woman commented t h a t " t h e r e was too much o f a women's l i b t r i p f o r me p e r s o n a l l y , a l t h o u g h I f e l t i t i s v e r y h e l p f u l f o r o t h e r s " . One comment p e r t a i n e d t o the dex-t e r i t y o f the l a y h e a l t h c a r e worker d u r i n g the e x a m i n a t i o n . The woman s t a t e d , " a l s o , I found my examiners a b i t clumsy, a b i t rough. That i s f o r g i v e a b l e of c o u r s e , many d o c t o r s a r e 7 2 not very smooth e i t h e r ..." The l a s t s i n g l e comment which was made was about c o n t i n u i n g v i s i t s . There c e r t a i n l y i s a lack of c o n t i n u i t y between l a y h e a l t h care workers and the women. One woman who tal k e d about t h i s said the f o l l o w i n g . " I can't t h i n k of anything except that i f I had a problem and were to r e t u r n to the c l i n i c more than once, I t h i n k I may f i n d i t d i s t u r b i n g to see a d i f f e r e n t team each time and to have no say i n who I wanted to see." Gen e r a l l y , the thing most d i s l i k e d about the S e l f Help C l i n i c seems to be d i s o r g a n i z a t i o n around appointments and the consequent long wait which ensued p r i o r to being seen by the l a y h e a l t h care team. This c e r t a i n l y can be seen as a f u n c t i o n of i n s u f f i c i e n t f a c i l i t i e s and l a c k o f adequate num-bers of l a y h e a l t h care workers to accommodate the number of women to be seen. Summary The main f i n d i n g s of the study were that women want and need more personal, c a r i n g h e a l t h care. They want more op-p o r t u n i t i e s to lea r n about t h e i r h e a l t h and t h e i r bodies; they would l i k e t h i s education to be i n c l u s i v e i n t h e i r v i s i t s to h e a l t h care workers. The women's response to S e l f Help h e a l t h care was en-t h u s i a s t i c , with p o s i t i v e f e e l i n g s about t h e i r experience,, There was much v e r b a l i z a t i o n of a need f o r more S e l f Help experiences 8 n d more education of t h i s kind f o r women. The women's response to la y h e a l t h care workers i n d i c a -ted t h e i r a p p r e c i a t i o n of t h e i r s k i l l s and knowledge. The 73 e g a l i t a r i a n r e l a t i o n s h i p w i t h the l a y h e a l t h care workers a l l o w e d the women to e x p e r i e n c e 8 n d d i s c u s s many t h i n g s which they had been unable t o do u n t i l t h i s t i m e . I n o t h e r words, t h e r e was a warm welcome from the women towards S e l f Help h e a l t h c a r e . Chapter 5 CONCLUSION The purpose of t h i s t h e s i s was to gather i n f o r m a t i o n about the women who used a S e l f Help C l i n i c f o r t h e i r gyne-c o l o g i c a l h e a l t h care needs. The in f o r m a t i o n gathered i n -cluded demographic data about the women and Information about women's responses to t h e i r h e a l t h care and f e e l i n g s about the S e l f Help h e a l t h care experience, SUMMARY There has been l i t t l e research done on the concept of S e l f Help Health Care or the users o f t h i s type of s e r v i c e . In p a r t , t h i s i s because S e l f Help Health Care has emerged as a v i t a l movement only since 1971. The researcher was i n t e r -ested i n g a t h e r i n g some b a s i c i n f o r m a t i o n about the women who use S e l f Help f a c i l i t i e s and t h e i r responses i n general to health care and S e l f Help experiences. The study included q u e s t i o n n a i r e s completed by 6 l wo-men who had attended a S e l f Help C l i n i c . Interviews were conducted with 10$ of the po p u l a t i o n to c l a r i f y and exnand, i f necessary, on in f o r m a t i o n given i n the q u e s t i o n n a i r e s . The i n t e r v i e w s used an open-ended format. The data c o l l e c t e d were d i v i d e d i n t o two s e c t i o n s ; the demogranhic data and women's responses to t h e i r h e a l t h care. The data were 74 75 analysed by computation of frequency of response and c a l c u -l a t i o n of percentages. Whenever p o s s i b l e complete and d i r e c t quotations as w r i t t e n by the women were used i n the t e x t . The data on the open-ended questions were grouped i n t o c a t e g o r i e s which arose from the comments of the respondents. The t e x t was w r i t t e n using a n a r r a t i v e , d e s c r i p t i v e format. The r e s u l t s from the study can be d i v i d e d i n t o the two areas, the demographic data and the women's responses to t h e i r h e a l t h care and S e l f Help experiences. The demographic data shows th a t a t y p i c a l woman's pro-f i l e i s as f o l l o w s : The woman Is between the ages of 25-29 years, s i n g l e , l i v e s i n Vancouver, most probably K i t s i l a n o , l i v e s In a communal/cooperative housing set-up, i s a p r o f e s -s i o n a l or t e c h n i c a l white c o l l a r worker, has a u n i v e r s i t y edu-c a t i o n , comes from an upper-middle-class f a m i l y where the f a t h e r i s l i k e l y to be a p r o f e s s i o n a l or t e c h n i c a l white-c o l l a r worker and the mother i s g a i n f u l l y occupied. The woman supports h e r s e l f w i t h her own earnings, had medical i n -surance and g e n e r a l l y seems to be i n good h e a l t h . The r e s u l t s which emerged from the area of women's r e s -ponses to t h e i r h e a l t h care and S e l f Help h e a l t h experience suggest that women have many h e a l t h care needs which are not being met i n the t r a d i t i o n a l system of medical s e r v i c e s . Some of these unmet h e a l t h care needs i n c l u d e : the d e s i r e f o r an e g a l i t a r i a n r e l a t i o n s h i p with the h e a l t h care worker, 7 6 a v a i l a b i l i t y of accurate information about t h e i r bodies and health concerns, the right to partake i n decisions about t h e i r own health care, time and opportunity to ask questions and seek information on areas of concern from the health care worker, an atmosphere which i s relaxed, comfortable and caring in which to deal with t h e i r concerns, the desire to be seen as sexual beings and the opportunity to share feelings and problems about sexuality with other open and empathetic per-sons, and the wish to be treated i n a resp e c t f u l , humanistic adult fashion. Many of the needs which were unmet by the t r a d i t i o n a l medical services were met i n the women's Self Help experience. This seems to indicate that the services offered i n a lay pa r t i c i p a t i o n model of health care are more in tune with the needs of the users of the service. For some of the women, the Self Kelp C l i n i c was an a l t e r -native service to the t r a d i t i o n a l medical care system. *or other women, i t was seen as an addition to the t r a d i t i o n a l medical services a v a i l a b l e . But, i n either case, i t was ap-parent that the Se l f Help experience had met needs which had not previously been met i n the t r a d i t i o n a l health care system. The data indicated the areas of the Self Help health care experience which the women p a r t i c u l a r l y f e l t suited t h e i r needs or which they l i k e d . The following are the areas of positive response to Self Help Health Care. 77 1. Women l i k e d the p e r s o n a l a t t e n t i o n and i n t e r e s t t h e y r e c e i v e d at the S e l f Help C l i n i c . 2 . Women l i k e d the o p p o r t u n i t y t o l e a r n about t h e i r b o d i e s , t h e i r h e a l t h c a r e , and t o be a b l e to ask q u e s t i o n s o f the l a y h e a l t h c a r e w o r k e r s . 3. Women l i k e d t he concept o f S e l f H e l p which encourages people t o be i n c o n t a c t w i t h t h e i r b o d i e s , t o be i n f o r m e d , and t o make d e c i s i o n s about t h e i r h e a l t h c a r e . 4. Wromen wanted t o l e a r n about p r e v e n t a t i v e h e a l t h c a r e . They wanted t o know how t o g i v e themselves b a s i c i n t e l l i g e n t g y n e c o l o g i c a l h e a l t h c a r e . 5 . Women l i k e d r e c e i v i n g t h e i r h e a l t h c a r e from o t h e r women. They l i k e d the exchanges and s h a r i n g which emerged from a p e e r r e l a t i o n s h i p w i t h a l a y h e a l t h c a r e team. 6. Women l i k e d the open, honest a t t i t u d e o f the l a y h e a l t h c a r e w o r k e r s . They a p p r e c i a t e d b e i n g d e a l t w i t h i n an em p a t h e t i c , s u p p o r t i v e and r e s p o n s i b l e manner. 7. Women e n i o y e d r e c e i v i n g t h e i r h e a l t h c a r e i n a warm, r e l a x e d and c o m f o r t a b l e atmosphere. G e n e r a l l y , i t seems t h a t women f e l t t h e y had g a i n e d a g r e a t d e a l t h r o u g h t h e i r S e l f Help e x p e r i e n c e . T h e i r o v e r a l l a t t i t u d e was v e r y p o s i t i v e about- the e x p e r i e n c e . The a r e a s which were responded t o n e g a t i v e l y were t h e l o n g w a i t i n g p e r i o d p r i o r to b e i n g seen by the team and the d i s o r g a n i z a t i o n o f the c l i n i c g e n e r a l l y . These f a c t o r s seem to be common i n c l i n i c s which a l l o w p a t i e n t s t o be seen on a d r o p - i n b a s i s . 78 IMPLICATIONS The f i n d i n g s of t h i s study suggest that women have a large number of unmet h e a l t h needs i n t h e i r contact with t r a -d i t i o n a l medical s e r v i c e s . Some of these needs were met i n the women's experiences at the S e l f Help C l i n i c . I t appears that the l a y p a r t i c i p a t i o n model f o r h e a l t h care i s a v i a b l e and p e r t i n e n t f o r c e i n the h e a l t h care system. S e l f Help h e a l t h care could w e l l be the method whereby many women are going to become a c t i v e l y involved i n h e a l t h Issues. The S e l f Help Health Movement d e f i n i t e l y d e p r o f e s s i o n a l -i z e s h e a l t h c a r e . This move toward l a y people p a r t i c i p a t i n g i n t h e i r own and other people's h e a l t h care w i l l have many i m p l i c a t i o n s f o r the he a l t h p r o f e s s i o n a l s . Nursing has op-p o r t u n i t i e s to p a r t i c i p a t e i n the S e l f Help Health C a r e Move-ment, but f i r s t must recognize i t s impetus and Importance. Since most nurses are women and the ma j o r i t y of S e l f Help c l i n i c s i n existence at t h i s time are women's c l i n i c s , i t would be advantageous f o r nurses to be open to l e a r n i n g and sharing experiences w i t h l a y h e a l t h care workers. I t seems that a l l h e a l t h care p r o f e s s i o n a l s have something to l e a r n from the i n t e r p e r s o n a l approach of the la y h e a l t h care worker. Since the s e r v i c e and scope of the S e l f Help C l i n i c at t h i s time i s s m a l l , i t seems important to teach other groups of women through a v a i l a b l e people and resources, how to e s t a -b l i s h other S e l f Help C l i n i c s . The Importance of the l a y p a r t i c i p a t i o n model and i t s e f f e c t i v e n e s s must be pointed out 79 to the government In order that more funding be allocated f o r expanding this concept into other parts of the c i t y and pro-vince. It would also be a valuable p i l o t project to have a general medical Self Help c l i n i c available for anyone to use. This kind of concept could well be incorporated Into the philosophy of c i t i z e n p a r t i c i p a t i o n and the community health center. RECOMMENDATIONS The implications of t h i s study suggest several re-commendations for change: 1. Women's unmet health needs should be e x p l i c i t l y expressed so that professional health care workers i n the health care system are aware of the discrepancies between t h e i r needs and the services offered. 2. The e x i s t i n g Self Help services should be strengthened and promoted to f a c i l i t a t e the accommodation of as many women as possible. 3. Other women's groups and community groups should be encouraged through available funding and resources to de-velop Self Help c l i n i c s using the lay p a r t i c i p a t i o n model for health care. 4. Professional health care workers should recognize the learning p o t e n t i a l both f o r themselves and the general public avallable from the Self Help c l i n i c . PO RECOMMENDATIONS FOR FUTURE! RESEARCH T h i s s t u d y has d e s c r i b e d t h e p o p u l a t i o n u s i n g a S e l f ' H e l p C l i n i c , and some of t h e i r responses to h e a l t h c a r e and S e l f Help e x p e r i e n c e s . Areas which r e q u i r e f u t u r e s t u d y which were suggested by t h i s t h e s i s are as f o l l o w s : 1. A s i m i l a r s t u d y , u s i n g a random sample s e l e c t i o n , w i t h a l a r g e r p o p u l a t i o n t h a n p r e s e n t l y s t u d i e d . 2. A s t u d y which would f o c u s on f o l l o w i n g - u p women who had a t t e n d e d a S e i f H e lp e x p e r i e n c e t o d e t e r m i n e the l o n g - r a n g e e f f e c t s i t may have i n t h e i r i n f o r m a t i o n p o o l , a t t i t u d e s , g y n e c o l o g i c a l h e a l t h , and ways of d e a l i n g w i t h h e a l t h p r o f e s s i o n a l s . 3. A s t u d y which would c o r r e l a t e women' s spec * f i c con-cerns f o r a t t e n d i n g the S e l f H e l p C l i n i c w i t h o t h e r v a r i a b l e s (demographic f a c t s ) . 4. A s t u d y t o d e t e r m i n e f u t u r e i n v o l v e m e n t i n the S e l f Help Movement by the women who had a t t e n d e d the S e l f Help C l i n i c . 5. A s t u d y about more e f f e c t i v e ways to meet women's i d e n t i f i e d needs, p a r t i c u l a r l y those p e r t a i n i n g to s e x u a l i t y . BIBLIOGRAPHY 81 BIBLIOGRAPHY A. BOOKS B o s t o n W omen's H e a l t h Book C o l l e c t i v e , Our B o d i e s Oun S e l v e s , New Y o r k : Simon and S c h u s t e r , 1973. E h r e n r e i c h , B a r b a r a , and D i e r d r e E n g l i s h . W i t c h e s . Mjdwives  and Nurses - A H i s t o r y o f Women H e a l e r s . O y s t e r Bay: G l a s s Mountain Pamphlets, 1 9 7 2 . F o u l k e s , R i c h a r d G. H e a l t h S e c u r i t y For B r i t i s h C o l u m b i a n s . V i c t o r i a : Queens P r i n t e r , 1973. F r a n k f o r t , E l l e n . V a g i n a l P o l i t i c s . New Y o r k : Quadrangle Books, 1972. F r i e d a n , B e t t y . The Feminine M y s t i q u e . New Y o r k : WW No r t o n and Company i n c . , 1963. Gr e e r , Germaine. The Female Eunuch. London: MacGibbon and Kee L i m i t e d , 1970. H a s t i n g s , John E. Community H e a l t h C e n t e r s P r o j e c t . Ottawa: Queens P r i n t e r , 1972. B. PERIODICALS Andrade, B e t t y and Kar e n B o r c h g r e v e i n k , Cathy C e u n i n , Moosh G r a k e r , Pat Teare, Ginnv Y o r k . "An Approach t o Women's H e a l t h Care," The P e o p l e ' s H e a l t h . No'. 9, A p r i l - M a v 1973, 1-2. B a r t , P a u l i n e , and Diana S c u l l y . "A Funny T h i n g Happened on the Way t o the O r i f i c e : Women In Gynecology T e x t b o o k s , " J o u r n a l o f S o c i o l o g y ^ J a n . 1973. B l i s h e n , B e r n a r d , "A S o c i o Economic Index f o r O c c u p a t i o n s i n Canada". Braundv, Susan. "Women D i s c o v e r i n g T h e i r B o d i e s " Hnrners Jan. 1973, P. ' ' 82 ?3 C o n n e l l , E l i z a b e t h B. "V'hat You Should Know B e f o r e You 1 ry To Do I t Y o u r s e l f , " Redbook Magazine. November, 1973," 82. P i s h e l , E l i z a b e t h . " W e n ' s S e l f H e lp Movement," Ramparts. Nov. 1973, p. 29*. F r a n k f o r t , E l l e n . "Man H a t i n g and M e d i c i n e , " The V i l l a g e  V o i c e . March 29, 1Q73, p. 9. G e n d e l , - E v e l y n and Di l m a Heyn, " i t ' s Y o u r Body .. Not Your D o c t o r ' s , Redbook Magazine. Mar. 1974, p. 89. H a l l , Audrv, "A S e l f H e l p C l i n i c F o r Women," The Canadian  Nurse. 70:5, May 1974, p. 33-36. H i r s c h , L o l l y , Jea nne H i r s c h , and M i l l i e A l l e y n , The Monthly E x t r a c t " - An I r r e g u l a r P e r i o d i c a l . V o l . 1:2, Oct.-Nov.' 1°72 H i r s c h , L o l l y , Jeanne H i r s c h , and M i l l i e A l l e y n E x t r a c t - An I r r e g u l a r P e r i o d i c a l . V o l . 1 : 3 H i r s c h , L o l l y , Jeanne H i r s c h and M i l l i e A l l e y n E x t r a c t - An I r r e g u l a r P e r i o d i c a l . Vol.1:4 H i r s c h , L o l l y , Jeanne H i r s c h , and M i l l i e A l l e y n E x t r a c t - An I r r e g u l a r P e r i o d i c a l . V o l . 2 : 1 H i r s c h , L o l l y , Jeanne H i r s c h , and M i l l i e A l l e y n E x t r a c t - An I r r e g u l a r P e r i o d i c a l . V o l . 2 : 2 H i r s c h , L o l l y , Jeanne H i r s c h , and M i l l i e A l l e y n E x t r a c t - An I r r e g u l a r P e r i o d i c a l . V o l . 2 : 3 H i r s c h , L o l l y , Jeanne H i r s c h , and M i l l i e A l l e y n E x t r a c t - An I r r e g u l a r P e r i o d i c a l . Vol.2:4 H i r s c h , L o l l y , Jeanne H i r s c h and M i l l i e A l l e y n E x t r a c t - An I r r e g u l a r P e r i o d i c a l , V o l . 2 : 5 H i r s c h , L o l l y , Jeanne H i r s c h , and M i l l i e A l l e y n E x t r a c t - An I r r e g u l a r P e r i o d i c a l , Vo1.3:1 Jorgenson, V a l e r i e , "The G y n e c o l o g i s t and t,h e S e x u a l l y L i b e r a t e d Woman," J o u r n a l of O b s t e t r i c s and Gynecology. 42:4 Oct.. 1973, p. 607-610. The Monthly N o v . - D e c , 1972. The M o n t h l y •Jan. - Feb., 1973. The M o n t h l y Mar.-Apr.,1973-The Monthly May-June,1973. The Monthly Sent .-Oct.', 1973 The Monthly Dec.-Jan.,1973. The Monthly Feb.-Mar.,1973. The M o n t h l y M a r . - A r r i i i 1 Q 7 4 8 4 Klemesrud, Judv. "Why Women are L o s i n g F a i t h i n t h e i r D o c t o r s , " M c C a l l * s."g. June 1973, p. 116. Landsberg, M i c h e l l e , "Your G y n e c o l o g i s t , " C h a t e l a i n e . Aug.lQ73, p. 4 2 4 . . S c b a t z , B e r n a r d E., and Fred E b r a h i m i , "Free C l i n i c P a t i e n t C h a r a c t e r i s t i c s , " American J o u r n a l o f P u b l i c H e a l t h . 62:10, October, 1972, p. 13^4-1363. Tu r n e r , I r e n e , "Free H e a l t h C e n t e r s : A Nev; Concept," Amer 1 can J o u r n a l of P u b l i c H e a l t h . 62:10, Opt. 1 Q 7 2 , p. 1^4P-13C"3. "Consumers' R i g h t s i n H e a l t h Care," Canadian Consumer. 4:2, A p r i l , 1974, P-1-3. " F e m i n i s t s on the F i r i n g L i n e - M e d i c i n e i s Male C h a u v i n i s t , " S c i e n c e News. Mar. 9, 1974, p.l""7. "Women's L i b e r a t i o n and the P r a c t i c e o f M e d i c i n e , " M e d i c a l  World News. June 22, 1973, p.33-38. C. UNPUBLISHED MATERIALS Bony, K a t h l e e n , "A Look a t Male M o t i v a t i o n i n O b s t e t r i c s and Gynecology." 1972. Reynard, M u r i e l J . , " G y n e c o l o g i c a l S e l f H e l p : An A n a l y s i s o f i t s Impact on the D e l i v e r y and Use of M e d i c a l Care f o r Women," T h e s i s , Stony Brook, June, 1973. APPENDIX A THE QUESTIONNAIRE 85 a I, Darlene Steele and the Vancouver Women's Health C o l l e c t i v e would appreciate your help i n the c o l l e c t i o n of data about women who use t h i s c l i n i c . I r e q u i r e t h i s data f o r my masters t h e s i s , which.is a study of the women who chose t h i s c l i n i c as an a l t e r n a t i v e . I a l s o need data about the reasons you chose t h i s c l i n i c and how you f e l t about the experiences you had here. This i n f o r m a t i o n i s e s s e n t i a l f o r the Health C o l l e c t i v e as i t w i l l f i l l i n some missing l i n k s and help us plan f o r the f u t u r e . We are asking you to complete the qu e s t i o n n a i r e attached f t e r you are seen by the team. This i s not required and no bad f e e l i n g s w i l l ensue i f you f e e l you must r e f u s e . We would appreciate your h e l p . A l l i n f o r m a t i o n c o l l e c t e d w i l l be c o n f i d e n t i a l (no one but myself w i l l h a V e access to i t while your name Is attached), NAME ADDRESS PHONE NO. I f you would be w i l l i n g to meet with me to discuss some of these questions f u r t h e r , please check when you might be a v a i l a b l e and I w i l l contact you. Monday - afternoons - evenings Thursday - afternoons - evenings Weekends Other Thank you f o r your help. Darlene 8 6 QUESTIONNAIRE C i r c l e whichever statement best describes your s i t u a t i o n A. 1. Age i 0 -- 14 i i 15 -- 19 i i i 20 -- 24 iv 25 • • 29 V 30 • • 34 v i 35 -- 39 v i i 40 -- 44 v i i i 45 -• 49 i x 50 -• 55 x 56 -2. Present m a r i t a l s t a t u s i s i n g l e i i divorced i i i married i v widowed v separated 3. Present address i K i t s i l a n o - Pt. Grey area - Vancouver i i East End - Vancouver i i i West End - Vancouver i v West Vancouver v North Vancouver v i Elsewhere i n C i t y of Vancouver - s p e c i f y v i i Elsewhere i n Lower Mainland - s p e c i f y v i i i Elsewhere i n Province of B.C. i x Another Canadian Province x U.S.A. x i Other - s p e c i f y 4. Permanent address i f d i f f e r e n t than above: i K i t s i l a n o - P t . Grey area - Vancouver i i East End - Vancouver i i i West End - Vancouver Iv West Vancouver v North Vancouver v i Elsewhere In C i t y of Vancouver - s p e c i f y v i i Elsewhere i n Lower Mainland - s p e c i f y v i i i Elsewhere i n Province of B.C. Ix Another Canadian Province x U.S.A. x i Other - s p e c i f y 87 C i r c l e whichever of the following that describes your present housing s i t u a t i o n the best i l i v e alone i i l i v e with another of same sex i i i l i v e with another of opposite sex iv l i v e communally/co-operatively v l i v e with parents v i l i v e with other family members i . e . brothers, s i s t e r s v i i l i v e with my husband (and children i f applicable) v i i i l i v e with my ch i l d (children) ix am t r a v e l l i n g , l i v e wherever I can x other - specify What is your occupation What schooling have you finished I Junior High School i i High School What post High School education have you had i Technical-School i i Business College i i i Community College iv University v Other - specify . . . . . How many years have you had? What is your father's occupation What i s your mother's occupation What is your primary source of f i n a n c i a l support i f u l l time earnings i i part time earnings i i i unemployed i receive unemployment insurance i i receive welfare i l l supported by parents.or r e l a t i v e s iv other - specify Do you have medical care insurance (usable in B.C.) i ves i i no 88 - 3 -I f answer i s "no" to B . 1 0 - why don't you have medical insurance i cannot a f f o r d i t i i j u s t haven't r o t t e n I t together y e t i i i don't need I t iv don't b e l i e v e i n doctors v I am not e l i g i b l e v i other - s n e c l f v 11. Do you consider y o u r s e l f to be a healthy person? i ves i i no 12. Have you ever had any serious i l l n e s s and/or operations I yes i i ino I f "yes", please s p e c i f y 13. Have you gone to a doctor i n the l a s t year? I yes i l no I f "yes", could you s p e c i f y why you went C . 14. How did you hear about the Women's S e l f Help C l i n i c I f r i e n d s I I speaker or p-roup s e s s i o n you attended i i i newspaper i v doctor v r e f e r r a l s e r v i c e v i other - s n e c l f v 15. Is t h i s your f i r s t v i s i t to the Women's S e l f Help C l i n i c i yes i i no I f "no", how many times have you been to the Women's S e l f Help C l i n i c before? - A -16. CIRCLE AS MANY OF T^E FOLLOWING STATEMENTS THAT APPLY Why did you chose t h i s c l i n i c instead of o-oing to a doctor i cannot afford to go to a doctor's o f f i c e II I do not have medical insurance i i i I don't l i k e going to doctors i v I usually come to th i s c l i n i c , I didn't exnect to find the Sel f Help C l i n i c here v I find doctors' v i s i t s rather rushed and impersonal v i I r e a l l y prefer a doctor, i t was .lust convenient t h i s time v i i I f e e l I receive better care here v i i i I didn't understand something my doctor told me and I' wanted to t a l k about i t i x Appreciate being seen by women paramedics and doctors x I think I might be interested i n becoming a paramedic and thought I would come to see what i t was l i k e f i r s t x i I came because I couldn't get an appointment with my doctor r i g h t away x i i other - specify 17. Do you think the focus of t h i s c l i n i c i s d i f f e r e n t than other medical services available to you I ves i i no If "yes" how i s It d i f f e r e n t CIRCLE AS MANY OF THE FOLLOWING STATEMENTS T UAT APPL V (continued on page - 5 - ) 90 - 5 -i I l i k e the p e r s o n a l a t t e n t i o n and i n t e r e s t I r e c e i v e here I i I l i k e knowing t h a t n e i t h e r p a r e n t a l o r l e g a l c o n s e n t o r knowledge are I n v o l v e d i l l I don't f e e l as c o m f o r t a b l e w i t h paramedics as I do w i t h d o c t o r s and n u r s e s i v I t i s t o o c a s u a l f o r me t o c o n s i d e r t h i s as a r e a l h e a l t h s e r v i c e v The atmosphere i s c o m f o r t a b l e v i I can l e a r n about my body v l i The concent o f s e l f h e l p a p p e a ls t o me v i i i I came because I thought i t would be e a s i e r t o get p r e s c r i p t i o n s e t c , here ix I f e e l f r e e to ask as many q u e s t i o n s as I want x I found i t d i f f i c u l t t o t a l k t o two people at once about p e r s o n a l h e a l t h m a t t e r s x i I f e e l I w i l l l e a r n more about p r e v e n t a t i v e h e a l t h c a r e here x i i Other - s p e c i f y ^ 18. How would you r a t e y o u r s a t i s f a c t i o n l e v e l I n r e g a r d t o t h i s c l i n i c I low - f e l t d i s p l e a s e d II adequate - bk i i i good - above average i v h i g h - e x c e l l e n t 19. Check o f f the words which d e s c r i b e y o u r e x p e r i e n c e s and f e e l i n g s w i t h b o t h o f the f o l l o w i n g . WITH DOCTORS WITH WOMEN'S SELF "EL? CLINIC Competent ; . C l i n i c a l Rushed • Condescending Bossy Thorough Relaxed I n f o r m a t i v e I n t i m i d a t i n g I mpersonal \ C o n f i d e n t O n r i n g 91 - 6 -D i s o r p a n i s e d E m b a r r a s s i n g See r e t i ve D i s t r a c t e d I n a t t e n t i v e A u t h o r i t a t i v e U n d e r s t a n d i n g S u p n o r t i v e T r u s t w o r t h y 21. I am i n t e r e s t e d i n y o u r f e e l i n p s about The V.omen's S e l f H e lp C l i n i c - any comments 1 What do you l i k e most 8bout t h i s c l i n i c i i What do you l i k e l e a s t about t h i s c l i n i c Thank you f o r y o u r c o - o p e r a t i o n . APPENDIX B WAP OF CITY OF VANCOUVER 93 APPENDIX B 94. I N D E X FOR STREETS WITHIN VANCOUVER CITY LIMITS Abbot St Aberdeen St. Adanac St.... Aden St Alamoin ava. Ubernl St... Alberta St... Aider St Alexander St. «lex»ndra St. Aloa St Alma St ancaater Cr. Anderson St.. Anua Dr Antwerp Lane. Anilo Dr Arbor Ave Arbutus St..., Archimedes Av« Argyle Dr 1-10 Argyle 3t 1-10 Arlington St I.1-1? Ash St 0-8 Ash Cr. ..E-8 .H-12 .E-10 .11,1.7 ...E-9 ..0-7 .0-10 .0-11 .1-12 -.0-6 ..1-10 .1-10 ..H-6 ..0-12 .. .0-11 ..1-10 ....c-6 .. .0-10 .E-12 ..1-10 ...J-ll .H.I-ll Aehbum St. sqlth Ave. Athlone St... Atlantic St.. Atln St Aubrey PI Austrey Ave. Avery Ave .1-10 .H-6 .1-11 .0-11 .0-9 .H-U .J-7 Avondale Ave H-7 •litis St Balaclava St. Baldwin St Balfour St Balkan St Balaoral St... Balsas St Barclay St.... Barnard St.... Batison St... Saysvater St. Boaoh Ave Beatrice 31.. Baaty St ..1-10 H-6 E-7 J-7 .11-11,12 F-5 .H.I-10 B.b.link Ave. Bonnacord Dr.. Bonnyvale Ave. Borden St Boulevard. E.U. Boundary Rd Boyd Diversion. Braeburn M.... Brakenridge St. Brant St Brldgevay Brlgadoon Ave. Brlghtwood II.. Broadway, E.U.. Brock St Brooks 3t Broughton St... Bruce St Brunswick St F-9 Burnaby St E-7 Burnfleld Cras H-15 Burqultan Or 1-10 Burard St F-6 Bursll St H-U Butler St. Cambla St 0-8 Cambridge St E-10,11 Cameron Ave F-5 Camoeun St 0-4 Canpbel Ave. Carder. St Cariboo 3t Carlisle St Carnarvon St... Carolina St Carral St Carlngton St. Cartler PI Cartler St Cartwright St.. Casslar St Cecil 3t H-l Cedar Cr 0-6 Cedarhurst St H-5 Celtic Ave 1-5 Central St F-9 Chald^cot St 0-4 Chambero 3t ..E.F-9 B-7 0-12 ....E-ll H-5 F-9 t-8 Bechwo ,| Beg  51 Eala Vleta St. Balavua Or Belmont Ave Brntal Si Ben May St ^  Berkeley St 11-0 aevorly Cr 0-7 Bldwel St E-7 Birch St.. Blake St.. Jlanca St. Blenheim S Blood Alc. 3 Coleridge St 1-1 C. lega St H-l Collngwood H B-5 Collngwood St H-5 Columbia St £-8,0-3 Commercial Dr 0-10 Commercial St H-1C Commisioner St E-1C Ccm-x St E-7 C-nnaught Dr H-7 Cooka St F-8 Copley St 0-10 Coquliala Dr 1-12 Cordova St. E.U E-8 Cordova Dlv E-9 Comet Rd 0-11 Cornish St J-7 Cornwal Ave F-6 Coton Dr F-10 Cottral St F-9 C jrtenay St G-4 Ore. St K-f.O Creelnan Ave.. :-o Crescent, The 0-7 Cronpton St J-9 Cronwel St J-12 Crove St F-8 Crown Cr F-4 Crown St O-J, Culoden St H-9 Cypress Or 0-6 Cypress St H-6 Davla St E-7 Dawson St 1-11 Deal Ave I-U Dease Una 1-12 Denman St E-7 Devonshire Cr G-7 Dieppe Dr G-12 Dieppe PI 0-12 Olnmont Avo 0-8 Discovery St 0-4 1-7 Doman St 2-11 Dominion St J-ll Doncaster Uay 0-4 0-7 Douglas Rd E-ll Drake St F-7 Drummond Dr F-3 Dubois Av 1-12 Duches  St H-l Dudley St J-12 Dufr St 1-10 Duke St H-ll Dumfries St H-20 Dunbar St C-5 Dundas St E-10,11 Dunde  St H-l Dunkirk St 0-5 Dunlevy Ave E-9 Dunsmulr St E-8 Duranleau St F-7 Duruord Avo H-9 Earlee St H-l East Blvd H.l-6 Eddlngton Dr 0-6 • Cr 0-6 Edinburgh St E-12 Elgin St H-9 Elisabeth St H-8 Eliott St 1-10 Elis Ave J-12 Elm St H-6 ElmhurBt St 1-11 Eton St B-10 Euclid Ave H-l Evans Ave F-9 Evelelgh St E-7,8 Fairmont St H-l Falaiae Ave 0-12 Falalse PI 0-12 Fannin Ave F-3 Felowes St E-12 Femdale St E-10 Flndlay St G-10 Fir Cr 0-7 Fir St F-7 Fleming St 0-10 Forbes St E-9 Foster Ave H-12 Frances St F-9,10 Franklin St E-10 Fraser St H-9 Fraservlew Dr 1-10 Frederick St 1-9 Framlin St J-7 French St 1-7 Frontenec St H.I-12 Galino Rd O-S Gait St H-10 Gaoler's Haws E-8 Garden Dr F-10 Gatineau PI 1-11 George St F-9 Georgia St. E.U E-7 Ghent Lane F-4,5 Gilford St ."...E-7 Gladstone St G-10 Olan Dr 0-9 Glendale Rd 0-12 Olondalough PI H-5 Olangyle St G-10 flora Ave E-9 Gothard St H-10,1] Grandview Hwy F.0-10 Grant St F-10 Granvile St 0-7 Graveley St F-10 4 r Av F-6 Ouelph St F-9 Grouse Ualk H-9 Haden Ave F-4 Haggart St 0-6 Halda Dr G-12 Kalg St 1-7 Halsa Cre R-4 Hamilton St F-E Haro St E-7 Harold St H-l Hariet St 0-9 Harison Dr l.J-10 Hartley St J-ll Harvle St 1-12 Harwod St E-7 Hastings St. E.U E-8 Hawks Ave F-9 Hetelton St F-ll Heather St 0-6 Haatley Ave E.F-9 Heb  Ave 0-11 Helmckon St F-8 Hemlock St F-7 Henry St H-9 Harmon Dr F-ll Hlghgate St H-10 Highbury St 0-5 Holand St H-4 Homer St F-7 Horley St H-l Hornby St F-7 Homer Ave 0-6 Howe St E-7 Hoy St H-12 Hoy lake Ave I-10 Kudaon St 1-7 Hul St G-10 Kuan St 1-10 Hurst Avo 1-12 Industrial Ava F-9 Innan Ave 1-12 Inverness St 0-9 Irmln Ava 1-12 Island Ava 1-10 Ivanhoe St H-ll Jackson Ave F-9 James St H-6 Junes Ualk H-8 Jaaper Cr ...1-10 Jelcoe St J-ll Jericho Clrcl F-4 Jervia St E-7 John St G,H-9 Johnston St F-7 ~ 1 Kamlocpa St F-10 Kaelu St E-ll Reefer St E»8 Keith Dr F-9 Kelowna St F-ll Hampton PI 1-11 Kant Ave J-7,11 Kar St 1-1 Kersland Dr H-8 Kevin PI 0-4 Klarnay St H.l-ll King Edward Ava C-5 Kings Av H-l Kingsway 0-9 Kinross St I,J-12 Klrkland St 11,-12 Kltohener St F-10 Kitsilano Dlv f-5,6 Knight St H-9 Kootenay St E-12 Kulahun Dr H-4 Laburnum St • F-6 Lagoon Dr E-7 Lakawod Dr F-10 Lanark St H-10 Lancaster PI 1-11 Lancaster St I-U Langara Ave F-4 l.angara St F-4 Larch St H-6 Lata St H-l Laurel St 0-7 Laurier Av 0-7 Leasidc St 1-10 Leroi St F-ll Lilooet St F-ll Lily St F-10 Lime St 1-6 Lincoln St H-12 Linden Rd H-6 Little St H-10 Locarno Cr............F-4 Logan St J-7 Lord St I,J-E Lome St F-8,9 Lougheod Hwy .F-12 Lynbrook Dr 1-1 McBain Ave C-6 HcCleery St H.l-5 Hacdonald St C-5 McGil St E-10,12 McGuigan Ave H-8 McHardy St G.H-U MacKansio PI H.l-5 KacKensle St H-5 Hackle St H-8 HcHulen A Helical: A HcRa  Ave. KcSpadden Haden St Magnolia St... K.I-ll F-10 0-6 10 hosedale Dr J-10 Rosenvmi Dr 1-11 ROBB St H.J-9 Rosland St F-ll Roxburgh Cr H-7 Ruby St H-12 Rumble Avr 1-12 Rupert St K.l-ll St. Catharines St..F,H-9 St. Clair FI H-i St. George St F.l-9 St. Lawrence St O.H-10 St. Hargarete St H-10 Salerno St .....F-4 Salah Dr H-4 Salsbury Dr E.F-10 Sasamat PI F-4 Seseaat St 0-4 Scarboro Ave 1-10 School Ave H-l Seaforth Dr G-ll Selkirk St 0,1-7 Semana Cr H-4 Samlin Dr F,G-10 Senlac St H-l Senok Cr H-4 Seymour St E.F-7 Shanghai Aley E-6 Shaughnesy St J-7 11 Stamford St H-l Station St F-8 Stajlo Cr H.I-4 Stephens St F.G-5 Stewart 3t E-1G Stirling St H-10 Talisman Ava 0-8 Tamath Cr H-4 Tanner St G.H-12 Tantalus Lane 1-12 Taunton St H-l Taylor St F-8 Tecunaeh Ave 0-7 Templeton Dr E.G-lo Terminal Ava F-9 The'lalwhaltjn Av H-5 Thornhil Dr 1-10 Tnomlon St P-9 Thurlow St B-7 Tlsdal St H.l-8 Todd St ..K-ll Toderiok St H-12 Tolmle St G-4 Townley St. Trafalgar S Trans-C Trimble St Trinity St... Triumph St... Trounce Aley Truteh St.... Tuam PI Tupper St.... Turner St.... Tyne St Tytahun Cr... 0-6 r,H-6 Hwy.F-l,12 F.O-4 Vina St.... Vivian Dr. Vivian St. .F.H-6 ..1-11 ...I-U -fl,K-8 H.l-10 .G-10 C.H-4 Ualden St. Ualee St.. Ualker St. Ual St... Ualace Cr Ualace St Ualnut St. Uaneta PI 0U Uard St H-U Uater St E-6 Uatarloo St 0-5 "etling Ava 1-12 Uatson St G-B Weverly Ave H-10,11 Uebber Ave 0-9 Uelington Ave H-il Uelwyn St G-10 Uenonah St G-10 Uesex St H-U Uost Boulevard H,I-6 Uilam St Ulow St Ullshire St.. Hind. Ulndsor St.... Utnlaw PI Uolfe Av Uoodland Dr.. Uoodstook Ave. Uorthlngton Dr. Uorthlnglon PI Uyla St G.H-7 H-6 F.O-l C.l-9 0-11 F.O-10 E.U H-8 0-12 G-ll Tale St taw St fork Avo.. Xuc.ila Cr. lukon St .fc-10,11 f,l-6 F-6 .1-4 G.J-8 ..F-6,10 SuceedlnG Avenues Run South fiva 1st Av. . 

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