A trip to the doctor used to be a big production for Paris Gilchrist.
To start, she had to take a 30-minute bus ride from her home on 60th Street NE to a stop at 8th and H streets NE on the other side of the Anacostia River. Then Gilchirst, who is 53, had to walk four blocks, often in the dark, because the doctor's office did not open until 5:30 p.m., carrying her 50 pounds of excess weight.
"I'd walk in, and there was always a room full of people. I was always afraid," she recalled. "I didn't know if someone was going to walk in and hold the place up."
Gilchrist last made that trip two years ago. Now when she wants to go to the doctor she simply walks across East Capital Street to the East of the River Health Center, a private clinic providing health care in an often forgotten area of the city.
The clinic opened two years ago in a two-floor area in the Capital East apartment complex at Southern Avenue and East Capital Streets in Anacostia. The hallways are bright, but not glaringly so. The colors are cheerful. The floors sparkle. The staff smiles.
The list of problems brought to the clinic leaves little doubt that many of its patients are poor, and bring with them those medical problems most often seen in persons whose daily existence is a struggle for survival.
Some patients suffer from obesity, some from malnutrition, some from both. Others suffer from diabetes and hypertension.
Many of the clinic's patients were dissatisfied with the health care they received elsewhere, such as the woman who went to the clinic about two weeks ago to complain of fainting and crying spells.
"They told me I had diabetes and hypertension," said the 55-year-old woman, who asked that her name not be used.
"I found out I had sugar when I had my first baby 38 years ago at D.C. General. I went to a clinic there and they gave me some pills. But I stopped going to the clinic because they weren't doing me any good. I was dizzy and having crying spells." So for years her problems went untreated.
Then she walked from her home on 50th Street NE to East of the River."I like that clinic because they don't keep you waiting," she said. "You go to D.C. General with an appointment and they keep you waiting all day.
"The doctors (at East of the River) are better, much nicer, much nicer. It's cleaner, too. They gave me some medicine and I feel much better. I haven't had the crying spells" or the dizzy spells, the woman said.
"Obesity is the No. 1 nutritional problem" seen at the clinic, said Dr. Irving C. Williams, the pediatrician who serves as medical director of the facility. "Poor dietary habits are affecting the children now, although they won't manifest themselves until later. Poor dietary habits have their manifestation in adulthood. It may be as obesity, it may be hypertension, it may be as endocrine disorders.
"The various problems we see in adults have their origins in childhood," he said. "Arterial sclerosis is a prime example of something that starts in childhood and we don't recognize until the person is 35 or 40 and has a heart attack."
Prior to the establishment of East of the River in 1976, the approximately 216,000 residents of Anacostia were either going to one of five city clinics, to the Greater Southeast Community Hospital, to D.C. General or to downtown health facilities for their medical care.
While the opening of the new clinic hardly solves all the health care problems in an area served by an estimated one physician for every 5,900 persons - the federal government says an area with more than 3,500 persons per doctor underserved - it did mean that many citizens who were going downtown, or nowhere, now go to a clinic nearer their homes.
Ruth Berkley, who lives within walking distance of the clinic, is one of those who left the city health care system to go to East of the River.
At the facility two weeks ago with her children, Lakicia, 18 months, and Sam, 9, she said "it's closer. I had to ride the bus" to D.C. Department of Human Resources' clinic, a 15-minute ride. "This is closer and cleaner. I have a couple of friends who transferred up here from their clinics," she said.
Sam, who was about to have a stitch removed from his lip by Irving Williams, pronounced East of the River "the best."
Frances Hickson, who has to travel about 15 minutes by bus to get to East of the River, said she has a shorter trip than she would have to make to get to a DHR facility.
"This is my first visit with him," she said, gesturing toward her 7-year-old son, Tyrone, who was waiting to have his feet examined by Williams, "but I've brought my two daughters here since last year."
The woman said she chose East of the River because it's "much closer" than the nearest DHR clinic, "The two girls (who are 15 and 16) come for medical attention. I've gotten very good service from the first time I first walked in the door.I grew up in this neighborhood," said Hickson. "This is new, it's clean and it's nice."
The clinic has about a dozen separate examining rooms, brightly colored chairs in the waiting areas and walls covered with bright, imaginative posters stressing the importance of nutrition, eye care and other forms of health care.
Seventy-five percent of the clinic's patients are Medicaid recipients and the bluk of the facility's funding is a $665,887 U.S. grant
Dr. Raymond Standard, chief of the city's community health and hospitals administration, calls East of the River "a very essential adjunct to programs that are operating in District government."
Standard, an East of the River board member, was instrumental in helping bring together in the early 1970s the community groups that worked toward founding the clinic.
"There were many people out there in the community who were just not availing themselves of the health care that was available," said Standard. "The only reason the grant was funded (by the federal government) is that there were not enough facilities in the area" for those who wanted to use them.
Now, said Williams, the clinic "is getting up to 70 patients a day," and the clinic is open from 9 a.m. until 5 p.m. Monday, Wednesdays and Fridays, from 9 a.m. until 8 p.m. Tuesdays and Thursdays and from 9 a.m. until noon on Saturdays
Patients who need hospital care are referred to Childrens Hospital National Medical Center and to Greater Southeast Memorial Hospital.
"Many of the patients have indicated they do not want to go to D.C. General," said Williams. "It would be easier for them because it's straight up the road. But because of their experience, long waiting lines, lack of continuity and impersonal" atmosphere, they have expressed a preference for Greater Southeast, which Williams said he thinks is "better."
Most of the children, he said, were getting regular health care prior to the opening of East of the River. "But we are finding that many of the children don't have adequate immunization," a problem found throughout the city, although it has a much better childhood immunization program than many areas of the country.
"We haven't run into a large number of drug related problems," said Williams. "There aren't a large number of cases coming in. But from what I gather there are still a large number of teen-agers who are on various types of pills."
Williams said he has tried to study some of the dietary problems and found "that unfortunately children have certain likes and dislikes and even if the parents sometimes prepare a balanced meal, the children don't eat it and the parents don't insist on it.
"A mother brought a child in recently and said 'she's got a poor appetite.' I'd say "tell me everything you ate today and everything you ate yesterday.' This sort of gives me some idea of what the situation is," said Williams, who for six years ran a similar clinic in Boston.
"Well, the parent might say 'I prepared vegetables, I prepared meat, I had fruit,' and so forth. But what did the child eat? Well, she doesn't like vegetables, so she may have had a piece of meat and then some cookies and ice cream and that's not good. When you have children who can selectively decide what they should eat, they will not eat vegetables.
"Something else of significance we see is pregnancy among teen-agers," said Williams. "We're seeing it throughout the Washington area," and throughout the country, where it has been referred to as epidemic.
Most of the teen-agers opt for abortions, said Williams, and that is what he favors, "primarily because we think of the fact that these are children trying to care for children, or babies trying to care for babies, and they cannot do it.
"Most of these babies would be born small, with a likelihood of retardation or cerebral palsy," he said, referring particularly to the babies of poorly nourished teen-age mothers, many of whom smoke and drink and use drugs during their pregnancies. "We think it adversely effects the baby, as well as the mother."