Myrtis Settles first visited the Parkside neighborhood health center in Northeast Washington 10 years ago, when she was 15 and pregnant.
"They were pretty nice," she said, smiling shyly as she sat in the clinic one day last week, vigorously scratching a rash on both arms.
Settles said she doesn't know what she'll do if the D.C. Government follows through on Mayor Marion Barry's proposal to close the 15-year-old clinic, which officials say has been living on borrowed time for almost a decade.
"I'm used to coming here," she said. "It's convenient and I know the people."
The proposed closing of Parkside, located on Kenilworth Terrace NE east of the Anacostia River, is not, say city officials, a case of pulling a clinic out of a neighborhood. Rather, they say, it is a case of a neighborhood having disappeared from around a clinic.
The white clapboard building housing the clinic once served as the community center for a massive low-income public housing project. But in 1968, the year Parkside was upgraded from a maternal and child care clinic to a comprehensive health facility, the project's buildings were demolished, leaving the clinic surrounded by vast fields of waving grass.
If Parkside is closed, along with two other neighborhood health centers also slated to be closed, it would reduce the number of such facilities in the city from 15 to 12 -- and save $1.5 million in the first year alone, according to city officials.
Established during the middle and late 1960s, the centers were part of a nationwide federal and local push to improve the quality of health care in the inner cities.
Some of the clinics -- Parkside is one -- serve a full range of health needs, from prenatal care to pediatrics to family planning to general medicine to dentistry and mental health. Others are more limited in nature, serving young children or patients with tuberculosis or veneral disease.
The clinics have traditionally served 60,000 to 70,000 patients a month. Most of the patients pay with Medicaid cards, some pay cash and a small number are carried free.
The fee schedules posted in the clinics list what might be considered extremely high charges for public health facilities -- $54, for instance for an initial adult examination -- but in reality, very few patients ever pay the full amount.
For almost all the patients, the clinic is their family physician from 8:30 a.m. to 4 p.m., Monday through Friday -- as long as they make an appointment in advance -- and hospital emergency rooms fill in the major gaps in coverage.
City records show about 8,200 visits to Parkside this year, compared with 10,000 two years ago. Many of those patients now live far from Parkside and travel across the city to return to the health facility they have known and trusted for years. And that, says Dr. Raymond Standard, director of the city's general health programs, is part of the city's problem in trying to close Parkside.
"Many patients still return to Parkside even though they live closer to other clinics," Standard said.
Other clinics, therefore, are left with fewer patients than they could handle, creating what Standard says is a false sense that Parkside is needed.
Two other clinics are slated for closing in the city's budget proposal for the fiscal year beginning next October 1.
The Northwest center at 13th and Upshure Streets NW and the Arthur Capper center, near the Washington Navy Yard on 7th Street SE, are also victims of declining usage and changing neighborhood populations, Standard said.
The Northwest center has not registered a decline in use, Standard said, but the late-19th Century tuberculosis sanitarium housing the clinic has been declared unfit for continued use, and there are other clinics that can absorb the patients, officials say.
The Arthur Capper clinic sits within eight blocks of three other clinics, Standard said "and all of them have shown declining utilization." Arthur Capper, which is carved out of an old laundry room area, registered 10,600 patient visits in 1977 and is expected to have between 6,500 and 7,000 this year, he said.
But for people like Peggy Gee, the head nurse at Parkside and a staff member of the clinic since it opened in 1964, such neighborhood facilities will not be easy to replace.
"This was the place to go for health care," Gee said. "A lot of the kids that were babies then have drifted away (from the clinic), but some of them are now coming in with their babies.
"Naturally, with my having been here for the number of years I have, I have mixed feelings about (the clinic closing)," Gee said. "But from a management standpoint, I've known it was something that's down the road someplace."
Dr. Patrocino Santa Anna, the clinic's medical director, said the threat of closing "is not really something new. I came here in 1971, and as early as 1973 they talked about closing the clinic. We're still here, but this is probably it."
Standard has promised the employes of the clinics scheduled to be closed -- many of whom are dedicated to the concept of neighborhood health centers -- that they will be able to fill vacancies in other city health facilities.
Despite that, Santa Anna said "I don't think the population has passed us by. I think we're still very needed here."
City officials argue that the clinic's patients can simply transfer to the Hunt Place clinic, almost directly across Kenilworth Avenue from Parkside. That facility, which is now a maternal and child health center, will be upgraded to a comprehensive center, Standard said. Those who work at Parkside, however, feel it will still be hard to get their patients to shift to Hunt Place.
The city first attempted to close Parkside in 1975. At that time, after numerous community meetings, demonstrations and protests to the City Council, Parkside was granted a reprieve. But it was not given any separate funding, and had had to subsist on leftovers in the Department of Human Resources budget. According to city officials, there no longer are any leftovers.
Just last fall Human Resources Director Albert P. Russo cited the decision to leave Parkside open as proof that his department is sensitive to the city's health needs and community desires.
"Because we respond to client needs, that clinic (Parkside) remained open," Russo said.
Mayor Barry's proposal to reduce the number of neighborhood health centers comes at a time when he is campaigning to reduce the city's infant mortality rate -- the worst of any big U.S. city.
Cities that have reduced their infant mortality rates have given much of the credit to the prenatal care and infant care given by the neighborhood health centers that blossomed in the late 1960s.
Boston, for instance, which cut its infant mortality rate in half during this decade, has 32 neighborhood clinics -- compared to Washington's 15 -- for a population of 70,000 fewer people.