In 1975, Dr. Janelle Goetcheus was anxiously awaiting a visa to Pakistan to serve as a medical missionary after working 10 years as a family physician in Marion, Ind.
In the midst of her wait, Goetcheus, her husband, Allen -- a Methodist minister -- and their three children traveled to Washington's Adams-Morgan to visit friends at the Church of the Savior. They stopped by the Jubilee Housing apartment buildings -- a low-income housing project sponsored by the church.
"The buildings were in utter decay," recalls the small, soft-spoken woman. "The hallways were filled with garbage, dead rats, dead cats. The ceilings were falling down."
When she walked into a roomful of tenants and mentioned that she was a physician, "they began sharing with me what it was like for them to get health care," she says. "That was an eye-opening time for me because I knew there were health needs overseas, but I had never heard anybody talk about health needs in the inner city."
By the time a visa finally came through, the family already had decided to move to the District. When they arrived in August 1976, she admits, "I didn't exactly know what was to come next."
Today, the 44-year-old physician is cofounder and medical director of three District clinics that serve more than 28,000 poor and homeless people each year -- Columbia Road Health Services, the Community of Hope and So Others Might Eat (SOME). She receives $26,000 a year -- a figure she hopes to pare down as her life becomes "more simplified."
Her choice to give up a lucrative career in her field comes from "a sense of obedience of God." To be "liberators" of the poor, she says, it is necessary to live among them.
The Goetcheuses and their three children -- John, 17, Mark, 15, and Ann, 11 -- live in a small apartment in Adams-Morgan, 2 1/2 blocks from the clinic. They are members of the Church of the Savior, a nondenominational congregation with a strong emphasis on social action.
Goetcheus juggles her time between the three clinics -- treating patients, raising money and tracking down medical assistance from the District and city hospitals.
As a physician to patients who are poor, jobless, homeless or without health insurance, Goetcheus says there have been times when she felt helpless.
Like the time a young herion addict lost his vocal cords after he had used all the tracks in his arm and someone injected him in the neck. Or when a 74-year-old man froze to death in the streets of Washington just before he was to return to Columbia Road to fill out an application for better housing.
The switch from treating well-fed, well-cared-for middle-class patients to patients who sometimes sleep in cardboard boxes has not always been easy.
Goetcheus recalls: "There was a gentleman who was very hypertensive and I had been treating him for several weeks trying to get his blood pressure down. In the process of one of his visits he began telling about his situation in which there were 11 people living in a two-bedroom apartment in the midst of winter and the landlords had turned off the heat. To keep warm they had been turning the oven on and pushing the infant near the stove.
"I was trying to treat the patient's hypertension without dealing with all the stresses in his life."
Her voice becomes sharp as she talks about "the myth among many persons in this country that those who are really poor are eligible for Medicaid." More than 70 percent of the patients at Columbia Road Health Services earn less than $6,000 a year, but only 13 percent receive Medicaid.
She describes men working at heavy labor jobs that do not provide health benefits. "At 50," she says, "they have bodies of 70-year-olds."
Then there is the rapid influx of Central American refugees into the Adams-Morgan area. "They arrive having been under tremendous stress in getting here," she says. "The typical story is that part of their family is still in a Central American country and usually a member of their family has been killed or is missing."
Learning the logistics of operating a medical clinic in the District, she says, "was often a time of real frustration . . . spent learning how to break through the system for the patients." Her temper flares sometimes, as it did when she preached a sermon at Church of the Savior criticizing a city hospital that she felt wasn't providing enough services to the poor. The hospital wrote Goetcheus, saying it did not appreciate those criticisms.
"We walk a very thin line here," says Allen Goetcheus, "because we must work with these hospitals." He believes his wife's usually low-key style works.
"Janelle has the abililty to be critical and yet not to threaten other institutions. But she's very clear about what needs to happen. And people are attracted to her for that. Other doctors and health professionals have thrown in their lot with her. It takes somebody to step out and say, 'I will do it no matter what,' and others will come and join."
Goetcheus says she can see herself still working in Adams-Morgan 20 years from now. She hopes to start a recovery shelter where the homeless can spend a few nights recovering from a cold before it turns into pneumenia. She and her family would live on the third floor of that shelter, along with two other doctors and their families.
But Goetcheus says she sometimes wonders how the decision to work and live among the poor affects her children. Her two boys have been mugged several times in the neighborhood. Though they were not hurt, she worries.
"There are times when the children feel our choice to live in the city and our choice to have a reduced income doesn't make any sense when they are with friends who have a lot of things they don't have," she says. "There are times when they feel neglected. And there are other times when I think they have a real sense of who we are and what we're about.
"My sense is that it will be as life-giving for them as it has been for us, but I need a few years to know whether that's true or not."