Posts Tagged ‘Oakland’

Caldecott Tunnel opening – 1937

posted on October 25, 2013
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Lone car on the brand-new highway from the Broadway Low Level Tunnel (now the Caldecott Tunnel), 1937

by Lincoln Cushing, Heritage writer

The Caldecott Tunnel channels one of the major highways that wends its way east from the San Francisco Bay Area through the Berkeley Hills. A much-anticipated fourth bore is due to be finished in late 2013. But few today know that Henry J. Kaiser’s construction firm was part of the consortium that built the original two tunnel bores.

The 5,820 foot-long tunnels opened to traffic on December 5, 1937 and cost around $4 million dollars.

Read this blog next week for the whole story.

Short link to this item: http://ow.ly/qbDZE

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Vintage film of Henry Kaiser companies building the Bay Bridge

posted on September 10, 2013

Lincoln Cushing, Heritage writer

Bridge film screenshot2
Still from Kaiser companies documentary about building Bay Bridge, 1933. Click on photo to play film.

As we recently described in two previous posts, Henry J. Kaiser and his construction companies participated in several significant aspects of building the San Francisco-Oakland Bay Bridge: securing government funding for the project, building piers on the East Bay side, providing concrete for the other bridge components, and initial painting of the bridge. We provided details and published photographs.

But nothing quite tells a story like a vintage movie does.

The Kaiser Permanente Heritage Resources archives contain hundreds of original films, and we recently digitized an 11-minute silent documentary showing the early stages of the bridge project, including the assembly of resources for pile driving and caisson building.

You’ll see workmen in felt hats scrambling over derricks, and a woman in a fur stole smashing a bottle of something nonalcoholic (prohibition didn’t end until December) to launch a mighty barge.

Bridge film screenshot1
Still from Kaiser companies documentary about building Bay Bridge, 1933

This footage includes numerous vehicles, including the  sprightly custom-built tugboat Bridgit, two special barges – the Edward H. Connor (Chairman of the Engineering Committee) and the Henry J. Kaiser (President of Bridge Builders, Inc.), and even a dirigible. How cool is that?

We share this gift from 1933.

Short link to this story: http://ow.ly/oKLEs

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Henry J. Kaiser and more on the building of the San Francisco-Oakland Bay Bridge

posted on September 6, 2013

By Lincoln Cushing, Heritage writer

Part 2 of 2: NEW! silent film of bridge construction

As described in our previous blog, Henry J. Kaiser and his construction companies participated in several significant aspects of building the original San Francisco-Oakland Bay Bridge: helping secure funding for the project and handling the piers on the East Bay side. Perhaps less glamorous but certainly no less important were two additional projects – providing concrete for the other bridge components beyond the East Bay piers and painting the bridge. In addition to the role of Bridge Builders, Inc. (the consortium assembled with Henry Kaiser and partners in 1931-1932 to bid on work on the Golden Gate Bridge) several other Kaiser-related entities were part of the Bay Bridge.

 

Field and Office Organization of Bridge Builders, Inc
Field and Office Organization of Bridge Builders, Inc: (Front Row, Left to Right) Charles Cameron, Carpenter Foreman, Sec. 4; M. L. Wagner, Superintendent, Sec. 4; C. B. Jansen, General Superintendent; J. Thompson, Superintendent, Sec. 4A; Ray LeWan, Carpenter Foreman, Sec. 4A; Orval Auhl, Assistant to General Superintendent; Frank Harrison, Engineer of Design; William Nosman, Office Manager; AI Holmes, Chief Timekeeper; Russell Quick, Cost Engineer; Hugh Pendleton, Field Engineer. (Back Row, Left to Right) Assistant Superintendents H. Brandt and A. Windom, Sec. 4; B. Durfee, Sec. 4A; J. Kuhn, Sec. 4; B. Begg and J. O’Leary, Sec. 4A; Frank Connor, Fleet Boss; Harry Lutz, Master Mechanic. Charles Nourse, Master Electrician; Jack White, Concrete Expediter; Fred Ramsey, Auditor; Joe Deveney, Material Clerk. Photo from Western Construction News, July, 1934,

Providing concrete for the bridge in addition to East Bay footings

Subcontracts were awarded to Kaiser Construction (AKA Henry J. Kaiser Company) for barge rentals and mixing concrete for pouring – a significant “subcontract” involving some 1,250,000 barrels of Portland cement  and a substantially larger amount of aggregate. This was accomplished through a complex web of interlocking companies.

  • Henry J. Kaiser Company — formed June 22, 1933, to subcontract for work on the Bay Bridge. HJK Co. was never directly a contractor on this project, but they did build a “central batching plant” on Yerba Buena Island that distributed concrete needed throughout the project.  It was a success – a summary report by Eugene Trefethen to the Director of Highways, Southern Pacific Mole Bay Bridge Unit, boasted:[i]

“The best evidence of the soundness of their decision is to be found in the unprecedented speed with which the Substructure has been completed, low cost…and the unparalleled results obtained by the State of California in the strength and consistency of all concrete batched and mixed by the method finally adopted by the Henry J. Kaiser Company.”

  • Trans-Bay Construction Company – Contract #2, West Bay substructureTrans-Bay was a consortium composed of General Construction Company, Seattle; Morrison-Knudsen Company, Boise; McDonald and Kahn, San Francisco; Pacific Bridge Company, Portland; and J. F. Shea Company, Portland. In addition to these contractors, an undated contract between TBCC and HJK Co. outlines the details of their relationship regarding the provision of mixed concrete for the bridge.

  • Concrete Products Sales Company; formed in Oakland May 22, 1930. Documents between CPSC and Henry J. Kaiser Company affirmed that HJK Co. had been carrying on Bay Bridge concrete operations in its own name but was actually as agent for CPSC. CPSC employed HJK Co. to continue as its agent,[ii] and on November 22, 1933, a formal agreement was signed between CPSC and HJK Co. Henry J. Kaiser himself would be listed as president of CPSC and A.B. Ordway his second in command. After the bridge was finished, CPSC sold its business to W.A. Bechtel Co., Henry J. Kaiser Co., and the Southern California Roads Company.

  • Clinton Construction Company– Contract #5, Yerba Buena Island tunnel and anchorage; Contract #8, Oakland approaches. Clinton Construction was founded around 1916, and among their many regional projects were California Memorial Stadium at U.C. Berkeley (opened 1923) and the Richmond Civic Auditorium and Arts Center (Richmond Memorial Convention Center) in 1949. CCC subcontracted much of the work on these two large bridge contracts, far more than was the case with the major contractors. On November 30, 1933, a contract was signed between CPSC and CCC detailing the sale of mixed concrete between the two companies. Some of the provisions of that contract included:[iii]

Article 7. Transbay to pay $4.59 per cubic yard for all concrete of normal cement content of 1.5 bbls. per cubic yard of concrete. Variation of 1% either way is permitted.

Article 12. Transbay to use every effort to unload concrete promptly as soon as Kaiser’s barges are tied to anchorages to prevent delay to Kaiser’s barges.

  • Davis Brothers and Sheik; an agreement dated November 20, 1933, between CPSC and DB&S outlined subcontracting details of the barges, towing arrangements, and mixing plant.

 

Painting the bridge

Bridge Builders, Inc. also won “Painting contract #9” for part of priming the fresh metal of the bridge. This used 143,000 tons of paint; the last two coats on the West Bay Towers and “cable pasting” plus 4 coats on cables and accessories. This was completed January 11, 1934.

Advertisement for sale of surplus Bay Bridge construction equipment, Western Construction News, July 1934.

By July 1934 Kaiser’s role was done and they were selling off equipment. The Bay Bridge opened to the public on November 12, 1936, and Henry J. Kaiser would continue to make history in the Bay Area and beyond.

Short link to this article: http://ow.ly/oE5Qs


[i] Documents about the Henry J. Kaiser Company and the Oakland Bay Bridge, 2/17/1935; BANC83-42c-4-9-2.pdf

[ii] “Essential dates involved in Bender v. Clinton Construction Company, et. al,” circa 1933. BANC83-42c-3-13.pdf

[iii] “Agreement between Transbay Construction Co. and Henry J. Kaiser Co. regarding Bay Bridge construction,” circa 1933. BANC83-42c-3-13.pdf

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Henry J. Kaiser and the building of the San Francisco-Oakland Bay Bridge

posted on September 3, 2013

By Lincoln Cushing, Heritage writer

Part 1 of 2: See part 2NEW! silent film of bridge construction

Graphic from "Spanning the Bay" column in the Oakland Tribune, 1934
Graphic from “Spanning the Bay” column in the Oakland Tribune, 1934

With the new eastern span of the San Francisco-Oakland Bay Bridge finally completed, it’s interesting to note that the industrialist founder of Kaiser Permanente played a major role in the creation of the original bridge, which has served the region for more than 75 years.

Henry J. Kaiser and his construction companies participated in at least four significant aspects of building the bridge:

  • Helping secure U.S. government support and funding for the project.
  • Construction of piers and footings on the East Bay side.
  • Providing concrete for the other bridge components beyond the East Bay piers.
  • Initial painting of the bridge.

Support and funding for the overall bridge project

In early 1934, Earl Lee Kelly, California Director of Public Works, sent a letter to Henry J. Kaiser asking for help in getting federal funding for the Central Valley Water Project. The letter begins:

“I understand that you intend to leave shortly for Washington, and knowing of the fine legislative work which you did concerning the Boulder Dam, and the assistance that you gave us in your connections in Washington with securing of the money for the San Francisco-Oakland Bay Bridge, I would greatly appreciate it, when you are in Washington, if you would again render the same valuable assistance to the California Water Authority that you have in the former instances where you have secured funds for California, which means so much to the people of our State.”[i] (bold added)

Kaiser’s involvement at the national level was crucial because the bridge was to be paid for through the Reconstruction Finance Corporation established in early 1932. The Great Depression quashed the usual options for funding such a project through conventional revenue bonds. The RFC was originally intended as a financial industry bailout, but passage of the Emergency Relief and Construction Act offered expanded opportunities for cities to fund projects. Between August 1932 and April 1933, California sent numerous delegations to Washington, D.C., to negotiate the terms of the loan.[ii]

Henry J. Kaiser caisson barge, circa 1933. Photo courtesy Caltrans archive.
Henry J. Kaiser caisson barge, circa 1933. Photo courtesy Caltrans archive.

East Bay piers and footings

The major elements of the bridge construction were divided into seven contracts.  Different members of the “Six Companies” (the original construction consortium that worked on Boulder/Hoover Dam) were affiliated with the Trans-Bay Construction Company (also called “Transbay”) and Bridge Builders, Inc., and competed with one another for Contracts 2 and 4, with one group winning Contract 2 and the other group winning Contract 4. The fact that these companies bid against one another in this project illustrates the transient nature of these project-specific arrangements.

Bridge Builders was a consortium formed in 1931-32 with partners to bid on work on the Golden Gate Bridge. For the Bay Bridge, Bridge Builders consisted of a slightly different group of affiliated companies:  Missouri Valley Bridge and Iron Company, Kansas City; Raymond Concrete Pile Company, New York; Dravo Construction Company, Pittsburgh; Bechtel-Kaiser-Warren Company, San Francisco; and the Utah Construction Company, San Francisco. Henry J. Kaiser was the president of Bridge Builders.

On April 28, 1933, the State of California signed Contract #4 with Bridge Builders, Inc., for the East Bay Substructure – the 21 piers between Yerba Buena Island and the Oakland shoreline. This was no simple task, and included digging E-3, “the deepest pier known to man,” located 1,400 feet west of Yerba Buena Island and embedded 242 feet below the surface of the bay. This contract was completed December 24, 1934.

Next blog:  Supplying construction concrete and painting the bridge.
Short link to this article: http://ow.ly/owxIZ


[i] Letter from Earl Lee Kelly, California Director of Public Works, thanking HJK for legislative help, 1/10/1934; BANC83-42c-3-8
[ii] Historic American Engineering Record, San Francisco-Oakland Bay Bridge, HAER no. CA-32

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Innovation in health care – and hospital construction

posted on August 26, 2013
Tower construction on top of existing Oakland Hospital, 1969-08-18
Tower construction on top of existing Oakland Hospital, 1969-08-18

by Lincoln Cushing, Heritage writer

How do you update a hospital facility without cramping needed services?  When the Kaiser Permanente Oakland hospital needed to expand at the end of the 1960s, they built their current modern tower on top of the previous structure – and patients didn’t have to go elsewhere for care.

Short link to this item: http://ow.ly/ohf8F

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SF Bay Area photographers honor workers who bridge the bay

posted on July 18, 2013
Workers building the eastern span of the San Francisco-Oakland Bay Bridge, 2012; photograph by Joe Blum.
Workers building the eastern span of the San Francisco-Oakland Bay Bridge, 2012; photograph by Joe Blum.

By Lincoln Cushing, Heritage writer

Photo exhibits honor workers who built the original Bay Bridge and modern-day eastern span replacement

The San Francisco-Oakland Bay Bridge was one of the engineering marvels born during the depths of the Great Depression in the mid-1930s.

Thousands of people were put to work building the infrastructure we still benefit from today.

Henry J. Kaiser and his industries were significant players in at least four key aspects of building that bridge:

  • helping secure U.S. government support and funding for the project
  • constructing footings on the East Bay side
  • initial painting of the bridge, and
  • providing concrete for the other bridge components beyond the East Bay footings.

Kaiser Permanente has roots in ironworker history as well, going back to the first president and CEO of the Health Plan and Hospitals, Clifford Keene.

Photographic record of bridge building expands

Noted Bay Area labor photographer Joe Blum has documented the entire construction of the new eastern span of the Bay Bridge, which is scheduled to be dedicated this fall. Blum’s exhibit of these photos, “The Bridge Builders,” features 80 large-format color images that highlight and honor the workers who’ve brought the huge project to fruition.

The show is hosted by the San Francisco Arts Commission Galleries Art at City Hall Program and can be seen on the ground floor of San Francisco City Hall. The free exhibition runs through September 27 and is open to the public.

A second Blum exhibition, “A View from the Bridge: Black and White Photography by Joseph A. Blum,” will be on display August 3 through October 3 at the Harvey Milk Photo Center in San Francisco.

"Men Working on I Beam," 1935. Photo: Peter Stackpole, collection of Oakland Museum of California.
This 1935 photo by Peter Stackpole is titled “Men Working on I Beam.” San Francisco-Oakland Bay Bridge construction photos on display at the Oakland Museum of California through January 2014.

 

Another exhibition, “Peter Stackpole: Bridging the Bay,” features 20 photographs documenting the original Bay Bridge construction in 1935. Stackpole was a pioneer in the use of the then-new imaging technology – the compact 35mm camera. The show runs at the Oakland Museum of California through January 2014.

Short link to this story: http://ow.ly/n5ROs

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Labor unions offer early support for nascent Permanente Health Plan

posted on July 16, 2013
"Kaiser launches 747th - and last- wartime ship," article in the Oakland Tribune, August 13, 1945. Expanding the shipyard workers' health care plan to the public would be the birth of the Kaiser Permanente program.
“Kaiser launches 747th – and last- wartime ship,” article in the Oakland Tribune, August 13, 1945. Expanding the shipyard workers’ health care plan to the public sparked the birth of the Kaiser Permanente program.

by Lincoln Cushing, Heritage writer

As World War II neared an end, the Permanente Health Plan was looking at a dramatic shift in its member base. Wartime shipyard closures loomed, and the future of the plan during peacetime would hinge on attracting new members in the community.

Given Henry J. Kaiser’s support for labor, it was not surprising that labor unions were among the early member groups. Bay Area workers – Oakland city employees, union typographers, street car drivers and carpenters – embraced the Permanente Health Plan and its emphasis on preventive medicine.

One of the first and largest unions to endorse the plan was The International Longshoremen and Warehousemen Union.

On June 7, 1945, the Stewards and Executive Council of the ILWU’s Oakland unit voted unanimously to make coverage in the health insurance plan of the Permanente Foundation a part of its future negotiations with employers.  The executive council also requested that employers pay for the plan’s premiums.

We want our Permanente!

An article in the ILWU’s The Dispatcher explained:

“. . . Permanente operates on three principles: prepayment . . . group practice of medicine (the hospital has 84 doctors on its staff, many of them specialists . . . and adequate facilities.)”

Related to adequate facilities, the article noted that a group practice health plan like Permanente could afford the latest medical equipment, which individual, fee-for-service physicians did not have.

Preventive care takes center stage

“The most important provision of the plan . . . is that the first two visits to the hospital are included in the insurance.”

“A spokesman for (Permanente) explained that the hospital was interested in really affording the worker medical security. If the patient had to pay for the first two visits, he would be deterred from using the plan until an ailment became necessarily serious.”

“The hospital’s facilities are open to all groups with no segregation of patients because of creed or color,” the article reported.

Within five years, by 1950, ILWU president Harry Bridges had brought all 6,000 union members working up and down the West Coast into the Permanente Health Plan.

The union’s agreement with Permanente leader Sidney Garfield, MD, included opening a medical facility in San Pedro near Long Beach. Up to that point, the health plan had only one Southern California hospital, which provided care for the workers at the Kaiser Steel Plant in Fontana.

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Brisk daily walks keep retired KP CEO Jim Vohs in the pink

posted on September 21, 2012

By Ginny McPartland
Heritage writer

Jim Vohs created this outdoor portrait of his red-headed grandsons in the autumn red leaves in his front yard. This framed portrait hangs in his home.

I had the pleasure one day this summer to take an early morning brisk walk with Jim Vohs, retired Kaiser Foundation Health Plan and Hospitals CEO. Formerly a marathon runner of some note, Vohs enjoys the physical benefits of walking, as well as the time it affords him for reflection. He subscribes to KP CEO George Halvorson’s belief in the power of walking. “Every Body Walk!” is the mantra of Halvorson’s current campaign to get people moving.

I had heard through the grapevine that Vohs, who retired in 1991 and is in his 80s, was an avid walker. So I called to see if I could talk to him about his daily walking routine. He invited me to walk with him at 7 in the morning a few days later. On the phone, I asked: “What if I can’t keep up with you?” He said: “I can adjust to your pace.”  OK! I was up to it.

I met him outside his Piedmont home at the appointed hour. The charming gentleman came out of the gate wearing beige casual pants, white walking shoes, a stylish sweatshirt – and a nice, welcoming smile. My first time to meet him was smooth and relaxed. We began to walk the gentle hills around his neighborhood at a clip talking as we went. He shared with me his thoughts on retirement, his time as leader at Kaiser Permanente, and his views on exercise.

This cartoon appeared in Harper’s in December 1978. Fun-loving friends added “J.V.” to the male jogger’s shirt and presented their version to Vohs. Cartoon and prayer by famed writer of “The Right Stuff (1983)” and “Electric Kool-Aid Acid Test (1968)” Tom Wolfe.

He confided that he used to look down his nose at walkers, considering them “wimps” who weren’t serious about their fitness. He later showed me a cartoon from Harper’s magazine featuring a runner with the initials “J.V.” on his chest who recited Tom Wolfe’s “The Joggers’ Prayer”:

“Almighty God, as we sail with pure aerobic grace and striped orthotic feet past the blind portals of our fellow citizens, past their chuck roast lives and their necrotic cardiovascular systems . . . past their inability to achieve the White Moment (jogger’s high) or slipping through The Wall . . . help us . . . to be big about it.”

Today, however, Vohs has changed his mind and believes walking can be the best kind of exercise, indeed for everyone. “What are the benefits of walking for you? I ask him. “Everything that George (Halvorson) says in his missive on walking,” he replies, referring to Halvorson’s weekly letters to KP colleagues.

The number of benefits of walking 30 minutes a day is astounding. They include: lowering the risks of diabetes, stroke, hypertension, breast cancer and its recurrence, colon cancer, prostate cancer, hip fracture and gallstones. Such a regimen can also boost high density cholesterol, lowering the risk of heart attacks and stroke.  Walking helps people to lose weight and makes them feel better psychologically. The list goes on and on.

After our 30-minute walk, we returned to the Vohs home, and he invited me in for breakfast and to meet his wife, Eileen. The fare consisted of decaffeinated coffee, bananas, blackberries, yogurt and muesli. Basically, very healthy, it goes without saying.

The display case for Vohs’ KP service pins was also made of Koa wood by his Hawaiian friend. Koa wood, found only in Hawaii, is prized for many uses, including fine furniture and guitars.

Jim Vohs was the CEO of Kaiser Health Plan and Hospitals from 1975 to 1991. He is credited with many accomplishments at the helm of KP, including initiating an active Board of Directors Quality of Care Committee, expanding the Health Plan into new geographical regions, supporting a rigorous Affirmative Action policy, and defending the core values in times of change. The annual Vohs Award for Quality was established in his name when he retired in 1991.

In reflecting on his KP career, Vohs says he wishes he would have thought of the health plan’s current focus on healthy lifestyles as exemplified by the Thrive advertising campaign, started in 2004. He was  opposed to advertising when it was first suggested in the 1980s because he did not want the not-for-profit Kaiser Permanente viewed as just another commercial organization and says he only agreed to it if the people featured in commercials were actual KP members or staff.

Keeping KP from becoming a commercial enterprise was a no-brainer for him. “We started out as a nonprofit organization providing care that people could afford. I fought against us becoming a profit-making business. That’s not who we were (are).”

Mail Room Clerk Travis Bailey and KP President Jim Vohs show off the March of Dimes TeamWalk trophy — a bronzed shoe worn by baseball star Willie McCovey — from 1985. KP Reporter cover photo by Jaime Benavides, July 1985.

While KP CEO, Vohs was heavily involved with local communities and charitable organizations and urged KP staff across the regions to participate in public events.  In 1985 and 1986, he served as Alameda County chairperson for the March of Dimes’ TeamWalk and marshaled 900 KP walkers in 1985 and 1,000 in 1986.

With Vohs in the lead, the KP team raised $35,000 in 1985 and $60,000 in 1986. Vohs is quick to note that the March of Dimes walk – 32 kilometers for more energetic participants – wasn’t a promotion of walking. “That was different. We were walking to raise money, not for fitness.”

The KP walking team attracted staffers from all over Northern California. As the top team, KP won the traveling trophy, which was a bronzed shoe originally worn by baseball star Willie McCovey. “Once again we proved we’re number one.” Vohs said at the time.

Of his athletic pursuits, Vohs is most proud of his success as a marathon runner. He competed in the Avenue of the Giants 26-mile marathon, which only accepts 1,000 qualified runners, and two full-length Oakland Marathons when he was in his 50s. He stopped running a few years ago when he developed plantar fasciitis, a condition affecting his feet. He continues to play golf, walks the course and carries his own bag.

This clock of Koa wood was made for Vohs by a friend and Hawaii Permanente Medical Group physician. He treasures it and keeps it on display in his study.

After retirement, Vohs maintained a KP office for about five years and continued his participation on a number of boards, including the Federal Reserve Bank in San Francisco, the Oakland Coliseum, Holy Names College and the Oakland Port Commissioners. “My wife (Janice) said I failed retirement,” he offered, half joking. “She said it was like I was still working because I went into the office every day.”At a certain point, he vacated the office to spend more time at home.

Vohs has four daughters, among them a couple of runners who have entered the Bay to Breakers with him over the years.  He also has nine grandchildren. Grandpa Vohs snapped a beautiful photo of two of his grandsons playing in the autumn leaves in a season that has long passed. The boys’ thick red hair blends with the leaf baskets’ contents to create an impressively artful photograph. Vohs has a large framed print of the scene hanging in his family room.

In his study, Vohs displays two special mementos from his KP days – a hand-crafted clock and a display case for his service pins, both made of Koa wood by a Hawaii Medical Group physician and friend. The case shows all his pins from his Kaiser Permanente career under glass. The last one marks his 40 years with the company.

 

Vohs and his boating friends have a running joke about this papier mache-covered shoe and the memory of a mishap when their boat was swamped.

Another prized object is a tennis shoe preserved with papier mache to remind him of a water excursion with friends that ended with a swamped boat. He and his fellow boaters have a running joke that involves sneaking the shoe back into each other’s possession.

Sadly, Vohs lost his wife of almost 50 years to cancer about 10 years ago. He remarried recently after renewing his acquaintance with Eileen Galloway, a college friend, at a UC Berkeley alumni reunion. Eileen sometimes walks with Jim, but mostly she likes to walk later in the day and a bit slower.

“I want to enjoy myself and appreciate my surroundings,” she said. “And I don’t want to get out of bed at dawn.”

http://bit.ly/OJODcQ

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Empowered women shape modern maternity care

posted on June 19, 2011

By Laura Thomas

Heritage correspondent

First of two articles

Nurse tends newborns in the Oakland Permanente hospital during World War II

Seventy-five years ago, two-thirds of American women gave birth at home with no painkillers, often attended by a family doctor, as the tradition of relying on midwives and practical nurses was falling away.

The practice of modern obstetrics was on the rise and the trend toward the majority of births occurring in hospitals was just around the corner as the American Medical Association met in Kansas City in May 1936 and hotly debated the benefits of new childbirth analgesics and how far to go in relieving the pain of childbirth.

According to Time Magazine, Dr. Gertrude Nielsen of Norman, Okla., denounced such pain killing innovations as twilight sleep – a combination of morphine and scopolamine – and a synergistic anesthesia accomplished by injecting a mixture of morphine and Epsom salts into the muscles and introducing a mix of quinine, alcohol and ether in olive oil into the rectum.

“An analgesic that is perfectly safe for both mother and child has not been discovered,” she told the convention. She asserted that fear of childbirth contributed to pain and called for prenatal education to reduce fear: “That is the modern physician’s duty.”

Part of the tumult over the issue had been provoked by articles in the press describing these new drugs and their use. Dr. Buford Garvin of Kansas City observed: “American obstetrics seems to be becoming a competitive practice to please American women in accordance with what they read in lay magazines.”

Childbirth trends change dramatically in the 1960s and 1970s

We could fast-forward to the 1950s when hospital childbirths had become the norm, the pain of the experience was reduced by epidural anesthesia and women relinquished control over the process to the physician. When Dr. Sidney Sharzer joined Permanente in Southern California in 1956, he became an early proponent of change.

During prenatal consultations Sharzer encouraged women to consider breastfeeding, advice which ran counter to the then-popular American pediatric practice of giving “modern” formula.   At the University of Toronto, where he received his degree, breastfeeding was still considered preferable: “It provided early immunity and was just the right formula in that there were no problems with digestion and it was the right temperature,” he said.

Formula was seen as a convenience, especially for many women who remained in the workforce after World War II, and it allowed fathers to take part in infant care. It was also heavily promoted by the cereal companies who manufactured it. Most of Sharzer’s patients were bombarded “with a lot of propaganda, or advertising, as we call it,” he said, and resisted his advice. “If you bottle-fed, you were liberated. And, in those days, you were not going to whip out your breast at a shopping center.”

“Liberated” women demand natural childbirth

Mother and baby "rooming in" in Kaiser Permanente's Walnut Creek hospital 1953

Ironically, it was the “liberated” women of a later era who demanded a more natural approach to childbirth and support for breastfeeding. Those whispers from the 1930s questioning drug use were getting louder.

“The mid-1960s and early 1970s saw a wholesale consumer revolt against highly structured, hospital-centered prenatal care,” Sharon Levine, MD, Northern California Permanente Medical Group executive, testified before a U.S. Senate committee in 1995. “Rooming in became commonplace. Home deliveries returned. Nurse midwives, who had all but disappeared from the American health system, became increasingly commonplace.

“Maternal-infant bonding became recognized as an essential part of postnatal care. Breastfeeding of infants made a dramatic resurgence,” she said in her testimony against a law to dictate length of hospital stay for new mothers.

Some innovation had already occurred at Kaiser Permanente. In the mid-1950s at Permanente founding physician  Sidney Garfield’s behest, the “rooming-in” program began at new facilities in San Francisco, Walnut Creek and Los Angeles. In these early “dream hospitals,” the nursery had been built adjacent to the maternity rooms with slide-through drawers for the babies to be passed in from the nursery through a soundproof wall.

The baby-in-the-drawer configuration allowed a mother to pull the baby into her room to nurse and hold her child as long as she desired. “It keeps mother and baby closer together. Nurses are able to help the new mothers learn better how to care for their infants,” said a Kaiser Permanente newsletter of the era. Most hospitals of the time kept newborns separate from their mothers, under the care of the nursing staff, except for feeding times. 

Bringing dad into delivery room

Around 1961, when he took over as chief of service at Harbor City Hospital, Sharzer made a couple of bold moves. He decided to bring fathers directly into the birthing room, and he began to encourage women to use the “prepared childbirth” techniques. He was inspired by British doctor Grantly Dick-Read’s book, “Childbirth without Fear,” which advocated the use of breathing techniques to minimize pain and increase the joy of the experience.

Lamaze breathing techniques were introduced in the U.S. by Marjorie Karmel after she gave birth in France assisted by Dr. Fernand Lamaze, who developed his techniques based on Dick-Read’s. She started an organization in 1960 – now Lamaze International – that currently focuses less on birthing methods and more on achieving a natural childbirth without drugs or technological intervention.

Sharzer remembers his struggle to get these ideas accepted: “The consumers were pushing for it and it was the right thing…husbands should see what their wives are going through.” At the time, fathers were ushered into a waiting room or went home to await a phone call and while some were thrilled to be invited to watch the process, others were less so. The nurses would good-naturedly chide a reluctant father. “They’d say he was a lousy husband to desert his wife at a time like this. They would appeal to his better nature and then insult him,” Sharzer said.

Outside of Harbor City, it was an uphill fight. When Sharzer first suggested the notion to his colleagues at the five other Permanente Southern California facilities, he was voted down 5 to 1. There was a lot of hostility from both doctors and nurses who assumed the fathers would try to get in the way by second guessing the medical staff, he said. But even their resistance couldn’t stop the forces of history. Fathers were finally allowed in delivery rooms at all Southern California facilities by the end of the 1960s.

Sharzer moved on to West Los Angeles in the 1970s and became assistant medical director: “It gave me the opportunity to be innovative.” There, he was able to inspire younger and more progressive doctors to go along with the trend toward treating childbirth as a natural process.

Natural birth after C-section?

Sharzer questioned the long-held “once a cesarean, always a cesarean” policy after he observed countless women scheduled for cesarean arrive at the hospital late in labor and give safe births. “If it’s that dangerous, how come these women come in and two minutes after they hit the bed, the baby comes out naturally?” he said.

Doctors feared that the vertical incision made through the large uterine muscle would rupture during contractions and for years women who had had a cesarean were discouraged from having subsequent vaginal births. But an innovation – the transverse incision made across the lower belly – was introduced that reduced the likelihood of rupture and more doctors began to experiment with allowing women to try vaginal births, under close monitoring.

A five-year study of vaginal births after cesarean deliveries in multiple hospitals showed that reverting to a natural birth process could be successful for many women. “Kaiser Permanente conducted the definitive study concluding that vaginal birth after a prior cesarean section is possible and safe … vaginal births are generally safer and less expensive for the mother and infant,” Permanente’s Dr. Levine told senators.*

Sharzer recalls:  “A doctor had to be present all the time and there was a lot of resistance” among the general obstetrical crowd, but at Kaiser Permanente, vaginal birth after cesarean, known as VBAC, was easier to implement because a doctor was always on duty in the maternity ward. “In our setup, it was very good and we were one of the early ones to do VBAC.”

Nurse practitioners deliver prenatal care

In those years, Sharzer also helped establish the first program in Southern California for training nurse practitioners at Cal State Los Angeles and when they graduated, he hired them to work under supervision assisting the doctors with prenatal care.

Retired since 1993, after delivering some 7,000 babies at Harbor City and West Los Angeles, Sharzer attributes the tremendous change in maternity care since 1960 to the Civil Rights Act of 1964: “It also changed the philosophy of equality…and that applied to women in our society.  It had a lot to do with female power.” 

That piece of legislation guaranteed equal rights to women as well as African-Americans. But women, especially those active in the civil rights and anti-war movements, found themselves relegated to supportive roles to male leadership and many split off and created the feminist movement, founding the National Organization for Women, among others. Health care and childbirth became a major arena in women’s struggle for equality and power over their lives.

Next time: How Kaiser Permanente responded to member demands for shorter postpartum hospital stays.

*Flamm BL, Newman LA, Thomas SJ, Fallon D, Yoshida MM. Vaginal birth after cesarean delivery: results of a 5-year multicenter collaborative study. Obstet Gynecol 1990: 76(5 pt 1):750-4.

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Celebrated farmer urges Kaiser Permanente doctors to further healthy food traditions

posted on April 5, 2011

By Grace Emery

Heritage correspondent*

Joel Salatin, celebrity farmer. Photo by Rachel Salatin.

When I heard that famed farmer Joel Salatin had come to Oakland to speak with Kaiser Permanente (KP) doctors, I felt like this event almost constituted a brush with celebrity. I wrote my senior thesis on food movements in the Bay Area, and my longtime interest in food politics had introduced me to Salatin and his work to bring sustainable food to America’s tables.** While some may be puzzled at the idea of a “famous farmer,” I leapt at the chance to write about a veritable hero of the food politics world, and I was anxious to learn more about where KP doctors and Salatin crossed paths.

Thanks in part to Michael Pollan’s discussion of Salatin in “The Omnivore’s Dilemma” and his appearance in the 2008 popular documentary “Food Inc.,” Salatin has become a renowned advocate of sustainable food and farming, and somewhat of an icon in the healthy food movement.

During his visit, Salatin, who raises beef, pork, and poultry at his Virginia family farm, Polyface Inc., spoke of the challenges small farmers face at the intersection of healthy food and politics. Locally grown food is often healthier and more sustainable, but small farmers struggle when selling their products to large institutions, preventing the large-scale adoption of a local food system.

Salatin started his visit with a stop at the birthplace of local food sales—the farmers market. Preston Maring, MD, a KP physician in Oakland, Calif., founded the first Kaiser Permanente farmers market at the Oakland Medical Center in 2003, and today there are more than 35 KP farmers markets in several regions, demonstrating Kaiser Permanente’s commitment to total health through nutrition.

After a visit to the market, Salatin spoke to a group of KP physicians on the topic of “Local Food to the Rescue.” His message served to both validate the work Kaiser Permanente farmers markets and hospital cafeterias are already doing, and to inspire Kaiser Permanente officials to supply hospitals with even more locally sourced food.

History of healthy eating

Kaiser urged wartime shipyard workers to eat healthy, even grow their own vegetables, as this 2009 poster illustrates. Design by Pam Zachary, KP Multimedia Department.

Kaiser Permanente has long focused on the link between healthy eating and prevention. Before Kaiser Permanente was synonymous with health care, war workers flocked from all parts of the U.S. to Richmond and Oakland, Calif., where they helped to build ships in the Kaiser Shipyards during WWII. Henry Kaiser quickly realized that to build ships at a fast pace his workers had to be healthy and strong, and that meant they needed to eat nutritious foods. He saw that well-nourished workers translated into less absenteeism, more productivity, and happier employees.

In a 1943 memo written by Cecil Cutting, MD, a founding Permanente physician, there is a clear emphasis on the importance of nutrition. With healthier meals, Cutting hoped to “bring about greater vitality, greater psychological effect and consequently increased productivity.”

In “Ships for Victory, author and historian Frederic Lane discusses the Maritime Commission’s initiative to improve in-plant feeding at America’s shipyards in 1943. Many shipyards received additional funds to provide more hot meals and make sure workers had access to healthy food in the workplace. In the Kaiser Shipyards on the West Coast the emphasis on good nutrition even spilled over into the Kaiser-run child care centers where children were fed three square meals, and mothers could pick up prepared meals when they collected their children at the end of the work day.

After the war when Kaiser established a health plan open to the public, nutrition and prevention were among the core principles. “Kaiser health planners supported concepts of holistic preventive care,” writes Rickey Hendricks in “A Model of National Health Care: The History of Kaiser Permanente.”

A focus on healthy food comes to Kaiser Permanente hospitals

Nutrition education was big in the WWII Kaiser shipyards, as highlighted in this poster created in 2009. Design by Pam Zachary, KP Multimedia Department.

A 1972 article from the publication “Institutions/Volume Feeding” highlights Kaiser Permanente hospitals’ progressive commitment to providing patient meals with higher nutrition at a lower cost.  Hospital dieticians were consulted so that every meal had optimal nutrition and calorie content for a patient’s needs. Kaiser Permanente even began to serve meals with an accompanying pamphlet that explained the nutrition information of the meal so that patients could “begin to learn more about the foods that they eat” while in the hospital.

Quality nutrition was at the center of meal planning, and administration felt that when it came to cost “it was of the utmost importance to separate patient feeding from other food-service activities necessary in a hospital.” While the development of an efficient system came about slowly, Kaiser Permanente never strayed from a focus on the healing power of healthy meals.

Oakland: an epicenter of progressive food movements

In my thesis research on the bay area, I was surprised to find that the city of Oakland has also long been a center of progressive food movements. In the 1970s, the Black Panther Party provided a free breakfast program and other “people’s community survival programs” in Oakland, serving residents hot meals with a side of political activism.

The effort of the Black Panther Party members to address hunger in their community was seen as revolutionary and empowering. Soup kitchens and free breakfast programs drew attention to the fact that the local food system was not currently meeting the needs of the West Oakland community. In “A Panther is a Black Cat,” (1971) author Reginald Majors explains that rather than wait on city officials, residents intended to subvert the power dynamic of the community by taking matters in to their own hands.

The free breakfast program for school children went hand in hand with revolutionary ideals and food became an expression of political power. Majors explains, “The Panthers would be betraying their own beliefs by not pushing a little political orientation along with the grits, bacon, and eggs” they dispensed each morning.

Today there are several West Oakland farmers markets in action that echo these themes of racial empowerment. My thesis focused on several of these markets, like “Mo Better Foods” and “Phat Beets Produce,” which provide both locally grown food and social empowerment within a community many residents believe to be historically disenfranchised.

Kaiser Permanente’s continued progress and inspiration

Given Kaiser Permanente’s nutritional history coupled with Oakland’s revolutionary food movement past, Joel Salatin could not have delivered his somewhat radical message to a better group in a better location. Kaiser Permanente initially focused on healthy food in hospitals, and then on bringing local, sustainable food to the community through the Kaiser Permanente farmers markets in Oakland.

What follows logically is a bridging of those two ideals: bring even more local and sustainable food in to hospital meals. Kaiser Permanente hospitals already bring in over 600 pounds per week of sustainably grown vegetables on patient entrée plates at 21 Northern California Kaiser Permanente Hospitals, and Salatin hopes his talk will encourage them to expand that trend and do even more. When he visited Oakland in January, Salatin said:

“The idea of bringing local food right into the façade of a hospital — there couldn’t be a better match. . . If anyone should lead the way in bringing this nutrient-dense food, food that heals people, heals the soil, heals communities, it should be the hospital. Every sphere of its existence should be healing.”

*Grace Emery is an intern with Kaiser Permanente Heritage Resources. She is a graduate of Whitman College in Walla Walla, WA, and is pursuing a career in public health.

**Grace Emery, “‘Feeding Ourselves’: Power and Participation in West Oakland Food Movements.” Senior Political Science thesis for Whitman College. Winner of the 2010 Whitman College Robert Fluno Award for Best Politics Thesis.

For more about Joel Salatin’s visit to Oakland Kaiser Permanente, http://xnet.kp.org/newscenter/aboutkp/green/stories/2011/021511joelsalatin.html

To learn more about Kaiser Permanente’s green programs:

http://xnet.kp.org/newscenter/aboutkp/green/factsheets/healthyfood.html

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