The area east of the Anacostia River often is seen as separate from the rest of the city. It has few health facilities and physicians, yet it is plagued with more of the city's health problems, such as infant mortality, teen-age pregnancy, drug abuse and mental illness.
For 11 years, East of the River Health Association has taken on the health problems of that part of the city and has given health services a new emphasis.
Teaching people to take care of themselves is the approach of this community health center, which sits near the Maryland border at 5929 East Capitol St.
Unlike traditional health centers, East of the River is a place where teen-agers help teach other teens about pregnancy prevention, where senior citizens instruct other seniors on the proper use of medication and where doctors and dentists go out into the community to treat the handicapped and elderly.
"We get involved in self-sufficiency," said James Speight, executive director of the center, "teaching people how to take care of themselves.
"We may do some hand-holding, some teaching, but the end result is enabling them to do that which is in their power," he said.
In addition to providing general health and dental services, the center also tackles many social problems, such as services to seniors, and emergency food and housing needs.
"When a mother and a child have the ability to come and get all the care they need, that is a real plus," Speight said.
Speight attributes community participation to a dedicated and caring staff.
"When people see we care, they are more cooperative," he said.
"They have inspired me to be all that I can be," said Alethea Small, a 15-year-old volunteer at East of the River. Small has a year-old son, attends junior high school and finds time two or three days a week to work at the center.
Small, who was encouraged by her mother to volunteer at the health center, said her work there has inspired her to pursue a career as a lawyer.
The center not only provides teen parents such as Small with prenatal counseling, nutrition and parenting classes, but also conducts weekly seminars for thousands of students in elementary, junior and senior high schools on pregnancy prevention. The center also provides counseling in AIDS prevention.
Each year, a new group of students is instructed by the health association. To help prevent teen pregnancy among the participating students, report cards are checked periodically to monitor grades. "We have noticed that there is a relationship between low grades, self-esteem and pregnancy," said Marjorie Kinnard, the center's program director.
East of the River's main goal is prevention. The center prefers teaching people to take care of themselves, and that philosophy is woven throughout its programs. However, the center often confronts many of the social problems of the poorest sections of the city.
Last year, the center provided therapy to more than 80 youths described as "at risk." Many of these children demonstrated such behavior problems as depression, hyperactivity and withdrawal. They came from households maintained by single parents, substance-abusing parents or foster parents. East of the River's task was to help the children establish emotional stability and a sense of identity.
Another part of the center's outreach efforts is a series of seminars designed to provide growth and development education to teachers and parents of preschool children to help them manage disruptive classroom behavior.
East of the River has found that once people see that its staff goes out of its way to serve the community's needs, they also want to become involved.
"Our Wellness Center is a perfect example," Speight said. "Twelve senior citizens have been trained as peer counselors to conduct seminars for other seniors on the proper use of medication."
More than 500 older persons have been served since East of the River opened the Washington Seniors Wellness Center in May 1985.
Interns from local medical schools work at East of the River. "We make opportunities available for medical students in a community-based setting," Speight said. The center also provides a training ground for students in Eastern High School's health profession program.
Although the health association continues to provide these types of services, it often finds itself short of operating funds. Federal cutbacks and increased unemployment leave more people in need of free care.
Funding for the center comes from patients who can afford to pay on a sliding fee scale. Some are compensated for by the federal government. The health center earns some money through contracting professional services to institutions. Additional operating support is provided by the District government, medical suppliers and contributions from community organizations.
"But we don't wait for funding to do something," Speight said. "If there is a health need, we try to tackle it."