This year we’re discussing aspects of Mount Sinai’s history as a community by joining forces with the Institute for Equity and Justice in Health Sciences Education through a series of three Chats for Change programs. In this post I’ll provide some background about what Chats for Change is, how it came to be, the Institute team we’re working with this year, and what the Archives brought to table.
About Chats for Change
In 2015, Mount Sinai launched the Racism and Bias Initiative (RBI) to center underrepresented voices and experiences, recognize the historical underpinnings of racism and bias in medicine, and explicitly address and undo racism and bias in all functional areas of the medical school. Beginning in the fall of 2018, the Department of Medical Education launched “Chats for Change”—a series of dialogues centered on racism and bias in medicine.
Chats for Change was developed in response to medical education staff, faculty, and medical students who wanted dedicated time to engage in a dialogue as a community and deepen their understanding of and ability to address racism. These sessions were based on the notion that in order to respond to racism and to be anti-racist, we must engage in dialogue, learning, and action. Participants include staff, faculty, and students from across the School and Health System. There is also a National Chats for Change available to all medical schools in North America.
The Process
How does this work? The structure of Chats for Change remains the same regardless of the topic. Held over Zoom, facilitators provide some introductory background information and review the grounding assumptions for the dialogue about to take place. The grounding assumptions that I find change the power dynamics are “everyone here is all we need” and “refrain from expecting experts or others to know best.” In both education and healthcare, there is deeply ingrained respect for and deference to expertise. Asking participants to shift out of this mindset is a challenge and requires intentional interactions outside the traditional norms and hierarchy.
The facilitators review the process and hen there is a brief check-in to get everyone acquainted. The next portion is framing and defining that day’s topic with a brief presentation, about ten minutes long.
We then review norms for the breakout groups in which the participants are about to participate:
All of us are taught misinformation about our own group(s) and about members of other groups
We agree not to blame ourselves or others for the misinformation we have been taught, and to accept responsibility for not repeating misinformation after we have learned otherwise
The participants enter the breakout rooms with some questions to guide their discussion, keeping in mind that there will be a debrief with the whole group afterwards to share any themes, insights, similarities and/or differences (as shown on the slide here). Every session ends by asking “given today’s dialogue, what do you need to learn and unlearn?”, followed by a request for feedback and a preview of the next week’s topic.
2024 Spring/Summer Season
In planning the 2024 Chats for Change season, Leona Hess, PhD, MSW, Co-Director of the Institute, invited me (the Aufses Archives’ director) to join in on brainstorming topics for discussion.
For this year, we arrived at the following groupings:
Series on Understanding Islamophobia and Antisemitism
Given the horrific increase in hate crimes against Muslim and Jewish people, it’s imperative for us to commit to deeper understanding and reflection.
Antiracism Fellow Series
This year’s Institute for Equity and Justice in Health Sciences Education Antiracism Fellows will introduce new topics, challenging all of us to critically examine pressing contemporary issues and the role of medical students.
Mount Sinai History Series
Pulling from resources in the Aufses Archives, we will uncover how Mount Sinai’s past shows up in our present, how equitable treatment regardless of the ability to pay is a relatively new concept, and how our patient populations have been recorded and reported at different moments in our hospitals’ histories.
Rejuvenate and Restore (R&R) Series
With everything going on, we can still find time for joy, future dreaming, and collective care.
In addition to these series, there were one-off chats on decolonizing global health, cybersafety, the rural vs. urban divide, and much more.
Mount Sinai History Series
The first Mount Sinai History Series took place on April 23rd, exploring the question, How Does Our Past Show Up in Our Present? by reflecting on our hospitals’ and medical school’s founding charters, articles of incorporation, and mission statements.
At Mount Sinai we often cite our origin story, the opening of Jews’ Hospital in New York in 1855, as a core element of our identity: to treat those who were refused treatment elsewhere (at the time, people of Jewish faith, and accident victims). As a health system, we are now multiple hospitals and a medical school. Pulled from resources in the Aufses Archives, we considered how the histories of these institutions shape us today. To do this, I started with a quote from the Charter of the Jews’ Hospital (which became Mount Sinai Hospital in 1866).
New York State Charter of the Jews’ Hospital in New York
January 16, 1852
We have associated and hereby do associate ourselves into a benevolent, charitable and scientific Society… to be known… by the name of The Jews’ Hospital in New York… the particular business, purpose and object of such… will be the medical and surgical aid to persons of the Jewish persuasion.
Quote from the 1852 Charter
First Mission Statement of The Mount Sinai Medical Center
1979
The focus was on the mission statements and articles of incorporation that state the reasons why the hospitals were created and what they were intending to do. I have found that these statements do resonate with our values and mission today, so I wanted to see how others felt. We asked the Chats participants, “what parts of our legacies most resonate with you?” There was a good discussion.
The second session, Unified Care?, was about how patients have historically been segregated by ability to pay and other factors. This was co-hosted by Dr. David Muller, Director of the Institute for Equity and Justice in Health Sciences Education. We are working towards health equity, we want everyone to have the same care, but there has always been a way of dividing patients that persists today. Goal was to show past practices–the general open ward layout, transition to semi-private rooms, and entirely private care–that demonstrate how we evolved into the patient placements we see in today’s hospitals.
The final session, Who Sought Treatment, took place in August and covered how hospitals have tracked and reported demographics of the patients who sought treatment. Today we are familiar with tracking patient outcomes by identities, such as race or gender–but this has not always been the case. As New York’s demographics have changed through time, so too have the data recorded about people seeking medical care. We looked at hospital reporting to see how patient populations have been recorded and reported at different moments in our hospitals’ histories. We reflected on how our practices have evolved.
As Mount Sinai Hospital was established to care for immigrants, nativity was most frequently reported. The sex, occupation, age, and other categories were also typically tabulated.
Report on patients from Mount Sinai Hospital’s 1866 Annual Report, page 24
Listed: Number of admitted and refused in a single month (over the course of the year) and age.
Report on patients from the 1866 Annual Report, page 25
Listed: civil Condition, term of Residence in the U.S., nativity, and occupation.
Beth Israel Hospital Annual Report from 1903 stated, “the nativities of the patients reveal at once the broad spirit prevailing in the management of the Hospital. Beth Israel knows no difference in creed, class or color, when suffering humanity appeals to it for aid and relief?”
St. Luke’s Hospital Annual report, 1910
Listed nationality and religious denominations, and occupations of patients.
Mount Sinai is based in East Harlem, over half of the population are of Puerto Rican and Dominican ancestry. This document shows when the hospital first became cognizant of the growing population and demographic shifts in the late 1920s. The language is not current, and we say Latino instead of “‘Spanish’ nativity.”
I am so grateful to Leona, David, and the team (Jay especially), who were incredibly supportive partners. They have a the structure of Chats for Change in place, facilitate adeptly, handle the logistics seamlessly—piloting the Mount Sinai History series could not have happened without their partnership.
This is a guest blog post by summer intern, Willa Jacob. Willa is a rising senior at Smith College where she studies Anthropology and the Study of Women and Gender.
A trailblazer in the field of social work and at The Mount Sinai Hospital, Helen Rehr, DSW, is one of the lively personalities in the Archive that jumps off the page when reading. The Department of Social Work Services at The Mount Sinai Hospital underwent great growth during her time as Associate Director and as Director from 1954 to 1980. In recognition of this, David S. Pomrinse, MD, Director of The Mount Sinai Hospital at the time, asserted, “I know that in the years to come we will value even more the service, leadership, teaching, and research of our friend and second Edith J. Baerwald Professor, Dr. Helen Rehr” at Dr. Rehr’s investiture in 1974.1
Dr. Rehr began at Mount Sinai in 1954 as the Associate Director of the Department of Social Services, second in command to Doris Siegel, MSW, and following Ms. Siegel’s death in 1971, she served as Director until 1980. She also was the second Edith J. Baerwald Professor of Community Medicine in Social Work following Ms. Siegel from 1971 to 1986.
Dr. Helen Rehr was born in 1919 in the Southeast Bronx. In one of her interviews, she affectionately refers to her younger self as a “Bronx delinquent,” “[t]he reason being is that I was always bucking things. I was a little bit hitting the streets as I was growing up.”2
She grew up in the Bronx with her mother, father, and older brother, who was five years older than her but passed away at the age of sixteen. Twice during her childhood, she visited Poland, where her parents hailed from. Her father was a waiter at Geffner’s, a vegetarian restaurant in the Bronx, and her mother began working mid-life at a bakery. Her home always had a vibrant table full of fish, perogies, and varieties of breads, rolls, and cakes that her parents brought home daily from work.2
When Rehr started at Hunter College, she moved into a single-room apartment in Manhattan. With much humor she described her move in an interview as “[r]unning away […] in the sense that one reaches a late adolescent stage, or college, and you think you want to be independent.”2 She graduated from Hunter College in 1940 with a bachelor’s degree in mathematics and a minor in economics. Although she enjoyed statistics and architecture in college, she attributed her career in social work to the fact that she was a “[Great] Depression product.” Hence, social problems were of great concern to her. Not to mention, architecture and statistics were still male-dominated fields at that time, whereas social work was much more accessible to women. In 1945, she earned her master’s degree from the Columbia University School of Social Work (CUSSW) where she would also earn a doctorate twenty-five years later.
After receiving her master’s, she worked at Sydenham Hospital, Grasslands Hospital, Bellevue Hospital, New York Association of New Americans, and the New York City Health Department before settling down at The Mount Sinai Hospital. In fact, Ms. Siegel initially had reservations about hiring her as she seemed to “move in and out of jobs rapidly,” however, the reservations were misplaced as Dr. Rehr spent the remainder of her career at Mount Sinai.3
Her last job prior to Mount Sinai, managing a quality care auditing program in the Maternal and Child Health Care sector at the New York City Health Department, was particularly important to her. “I think that professionals in the health care field have some responsibility to the public arena, and ought to do a stint of service in the public area. Now, I don’t know that I was conscious of doing it at that point for that reason, but I did.”2
Among Dr. Rehr’s greatest contributions to Mount Sinai were her surveys and research methods, and the programs birthed from them. In her own words, “[p]robably what I brought to this institution was major modality of doing studies and that those studies pretty much demonstrated where we need programs, and I would say […] we have changed the department by bringing dozens of new programs in.”3
During her very first year at Mount Sinai, in 1954, she was tasked by Ms. Siegel to do a survey of the Social Services department. At the time, the department was working out of the basement of an old clinic on Madison Avenue and 100th Street, and many of the social workers were “old-time nurses.”23 Based on her report and recommendations, they developed a five-year plan to professionalize the department. Dr. Rehr initially wanted to replace all current employees with professional new hires, but in the end, they decided to retain the nurses, offering them the opportunity to go back to school, which was made possible with grants from the Auxiliary Board. Dr. Rehr credits this move as instilling trust and stability in the department while they grew the department with professional new hires.
Around this same time with the establishment of Medicaid and Medicare, The Mount Sinai Hospital implemented a cost-plus reimbursement mechanism that enabled Ms. Siegel and Dr. Rehr to increase staff on evidence of need. As a result, the size of the department more than quadrupled, expanding from 31 employees to 128 full-time employees.2 And yet, Dr. Rehr asserted that she knew they had a professional department in the mid-1960s, when requests for services were coming from doctors across all departments and for patients irrespective of class.2
Another important achievement Dr. Rehr pioneered was the creation of the Department of Patient Representatives. She had done another study at the hospital and found a series of obstacles impacting patients’ access to care. She recommended to Martin Steinberg, MD, the former Director of the hospital, a program that would handle these obstacles specifically and facilitate “the delivery of care within the institution.” He funded the program out of the administrative office and hired Ruth Ravitch, the first director of the first Department of Patient Representatives in the world until the late 1990s.3
Dr. Rehr also contributed to her field in important ways as an educator. During her sabbatical in 1978, she taught social work in healthcare and applied social work research methodology as the Kenneth L. M. Pray Professor at the University of Pennsylvania’s School of Social Work. She also had visiting professorships at Ben-Gurion University, Hebrew University, and Haifa University. While lecturing in Israel at Ben-Gurion University and Hebrew University in 1986, she created a three-month study-abroad program at Mount Sinai with a curriculum on leadership in social work in healthcare.3 Soon after, the program was extended to Australia as well. Every fall and spring semester two students from each country have come to Mount Sinai to study from 1986 through at least 1995.
One other lasting impact Dr. Rehr’s tenure is a position for Social Work Services on the Medical Board. Ms. Siegel was the first non-medical representative to be on the Medical Board after petitioning them in the mid-1960s. When Ms. Siegel passed away in 1971, the seat was promptly removed. Dr. Rehr and Gail Weissman, the Head of Nursing at the time, outraged by this, caucused the members of the Board to vote for positions for the two departments.3 Through much difficulty, the seats for the Department of Social Work and Department of Nursing were restored to the Board.
Dr. Rehr passed away in 2013 at the age of 93. She was highly recognized for her contributions to the field of Social Work. Dr. Rehr began the Murray Rosenberg Applied Social Work Research Center and was a member of the editorial board of the Social Work Health Care Journal since 1975. She endowed the Helen Rehr Scholarship Fund to CUSSW’s Master’s program and has two professorships in her honor, The Helen Rehr Professor at the Silberman School of Social Work at Hunter College and the Helen Rehr/Ruth Fizdale Professor of Health and Mental Health at the Columbia School of Social Work. Dr. Rehr was named a Social Work Pioneer by the National Association of Social Workers, received the Columbia Alumni Federation’s Distinguished Service Alumni Medal in 2004, and was inducted into the Hall of Fame at CUSSW.
Dr. Rehr was also highly praised by her colleagues. Jane Aron, trustee and creator of the Edith J. Baerwald Professorship, declared that Rehr’s “knack of cutting through to the core of a problem, her inventiveness, her razor-sharp mind, her sympathetic heart, make her a very special woman.” This opinion was seconded by Dr. Kurt Deushle, Head of the Department of Community Medicine, who complimented her pragmatism, creativity, and determination that made her, “a professional in the best sense of that word.”1
1.
Recording of Helen Rehr investiture as Baerwald Professor of Community Medicine (Social Work). Icahn School of Medicine at Mount Sinai records, Arthur H. Aufses, Jr. MD Archives, Icahn School of Medicine, New York, New York. Published March 29, 1974. Accessed August 2022. https://archives.mssm.edu/aa096-s015-inv010
2.
Rehr H, Lyons AS. Transcript of an interview with Helen Rehr, DSW by Albert S. Lyons. Collection of Mount Sinai-Related Oral Histories, Arthur H. Aufses, Jr. MD Archives, Icahn School of Medicine, New York, New York. Published December 4, 1984. Accessed August 2022. https://archives.mssm.edu/aa107-int027
3.
Rehr H, Lyons AS. Recording of an interview with Helen Rehr by Albert S. Lyons. Collection of Mount Sinai-Related Oral Histories, Arthur H. Aufses, Jr. MD Archives, Icahn School of Medicine, New York, New York. Published April 25, 1995. Accessed August 2022. https://archives.mssm.edu/aa107-int058
The Neustadter Home was created by a provision in the 1905 will of Caroline Neustadter to serve as a convalescent center for women patients after leaving the hospital. It opened in July 1919 on the northeast corner of Central Park Avenue and McLean Avenue in Yonkers, on land once owned by Boss Tweed, leader of Tammany Hall. In 1936, an agreement was reached between The Mount Sinai Hospital and the Neustadter Home whereby Mount Sinai could send patients to the facility. Three years later, men began to be admitted as well.
The original Neustadter Home in the 1950s
The Moses Weinman wing, opened in 1949
As hospitals saw the increasing value in freeing up beds for more acute cases by discharging patients to rehabilitation hospitals, Neustadter needed to expand. The Moses Weinman wing was added in 1949, bringing the institution up to 69 beds from the previous 56. The facility also enhanced its medical care services. To reflect this evolution, the name was changed from the Neustadter Home to the Neustadter Convalescent Center in 1954. Over the years, the patient population was composed primarily of post-surgical cases. As the 1971 Mount Sinai Annual Report on convalescent care said: “So often before we have described the true function of Neustadter as a bridge that spans illness to complete recovery.” In 1969, Mount Sinai was given preferential use of the Center and eventually the Neustadter Board members and the medical staff were affiliated with Mount Sinai.
The Convalescent Center did not have a bright future, however. In a 1959 study of Neustadter, only 24% of patients could afford the full weekly charge of $84. Money was a perennial problem. Also, because the Home was twelve miles from Mount Sinai Hospital, it was hard to provide follow-up care by physicians. In 1972, the Neustadter Board dissolved and transferred their assets to The Mount Sinai Hospital. The next year, Mount Sinai sought to sell the Convalescent Center. The sale for $1 million to a local Hebrew high school was announced in 1973, but the school struggled to make the payments. The matter sputtered along for a few years, and in 1980 the property was finally sold to a realty company. In 1983, a shopping center opened on the site, including a large Waldbaum’s grocery store. The shops remain; the Waldbaum’s is gone. The Neustadter Convalescent Center has also totally disappeared.
For information on what archival material the Aufses Archives has relating to the Neustadter Convalescent Center, click here.
The Mount Sinai Hospital created its Dispensary/Out Patient Department in 1875 when it established four clinics: the Gynecology Clinic, the Children’s Clinic, as well as ones for Medicine and Surgery. Then as now, these clinics were designed to treat people with health needs that did not require a hospital stay. The Hospital traditionally had a long waiting list for admission, and this was seen as a way to help those they could before their conditions worsened. (In addition, in 1884, Mount Sinai Hospital created what it called the “Outdoor Visiting Physicians” to actually go to people’s homes to care for them there. Medicines were provided from the Hospital pharmacy.)
The Hospital was a charity organization and highly dependent on keeping costs down and maximizing donations to support its work. While there were a few patients willing and able to pay something for their care, the vast majority were treated free of charge both on the in-patient side as well as in the Dispensary. Since funds were so limited, Mount Sinai tried to take steps to ensure that their efforts were helping those most in need. One of those steps was to post a sign in the Dispensary that said, “Poor People Only Treated Here”. It eventually became clear that this sign was disrespectful to the people who used the clinic, and 140 years ago, on May 8, 1881, the Board of Directors of the Hospital decided to look into having the sign removed. Unfortunately, the Board minutes do not tell us if it was actually taken down.
The need to closely watch expenditures and try to reserve their services for the most needy continued to plague the Hospital leaders for decades. The beginnings of health insurance in the early decades of the 20th century helped, but it was really the implementation of Medicare and Medicaid in the mid-1960s that relieved hospitals of much of the burden of the costs of charity care.
The entrance to the MSH Dispensary, 1890
The Mount Sinai Hospital OPD Admissions desk in 1951
In April we celebrate both Women’s History Month and national Social Work Month. So it is fitting that we highlight a woman at Mount Sinai who was also a pioneer in social work, Miss Doris Siegel (1914-1971). Mount Sinai’s Department of Social Services (later Social Work) was created in 1907 and, since it was still a new field of service, the Department was initially managed by a series of nurses. By the mid-20th century, this was no longer the case, and in 1954, Doris Siegel was named Director of the Department. During her tenure, she updated and expanded the services of the Department, and spent time on broadening educational efforts in social work.
Doris Siegel, 1969
When Mount Sinai School of Medicine was forming in the 1960s, a new entity was created called the Department of Community Medicine (today’s Department of Environmental Medicine and Public Health). In 1968 the Social Services was moved into Community Medicine as the Division of Social Work. In this new role, the mission of Social Work was to support the School through innovative community service programs, research, and participation in medical student education. (They had been training nursing students from the beginning.) These were all activities that staff in Social Work had been doing for many years, and being an official part of the School supported and encouraged them to continue.
In 1969, social work at Mount Sinai as an academic enterprise was recognized with the creation of the Edith J. Baerwald Professor of Community Medicine (Social Work), the first endowed chair in social work in an American school of medicine. (It was a gift of Jane B. Aron, a Trustee at Mount Sinai and a long-time supporter of Mount Sinai’s Department of Social Work.) Doris Siegel was installed in the chair at a special convocation ceremony in 1969, making her the first woman named to an endowed chair at Mount Sinai. She died two short years later, but is still remembered today as a “Pioneer in Social Work.”
The Baerwald Chair remained in the Division of Social Work through the tenure of two more Directors, Helen Rehr and Gary Rosenberg. Meanwhile, the broader Department had evolved and changed its named several times. In 2017, the Baerwald Chair in Social Work became the Baerwald Professor of Environmental Medicine and Public Health.
