When Elizabeth "Dibby" Smith first started sharing her nursing skills with Arlandria's poor, a jackhammer was carving out sink space in the next room and a plastic curtain separated her and her patient from the dust.

That was 1993. Today, Smith oversees a bilingual staff of 11 in the nine-room Arlandria Health Center for Women and Children. The little closet off the waiting room is jammed with charts of 1,800 patients; and women and children flock through the clinic, formerly three apartments in the Presidential Greens Complex just off Mount Vernon Avenue.

If the curse of the American medical system is that it leaves many gaps in coverage, the Arlandria Health Center closes that gap for a large and needy Alexandria neighborhood. The price tag for that public service is $678,000 a year, two-thirds of which is private money.

The program's growth has barely kept up with the demand, however, and the staff bustle past each other in the narrow and crowded thoroughfares of the clinic.

It's well worth the confusion, according to family nurse practitioner Krystal Shenk, who until last week was the clinic's only nurse practitioner. A couple of doctors work in conjunction with the clinic, seeing patients one day a month, but nurses and nurse practitioners are the backbone of the health center.

On a recent day, Shenk saw 4-month-old Aimee Flores for a well-baby visit and chatted with her mother, Wendy Flores, about upcoming care. Aimee might get teeth before her next visit, Shenk told Flores. She can start eating cereal in the next month or two, and then move to soft fruits and vegetables at 6 months of age. And Shenk gave her the basics of child-proofing and what to do if the baby chokes.

The clinic is an enormous help, said Flores, a Honduran immigrant who cleans hotel rooms to get by. "The clinic is very close by when there is an emergency," she said.

Flores has another child in Honduras, but she was wiser with this pregnancy and this child, thanks to the clinic, she said. With its direction, she talked to her baby in the womb, eats a healthier diet and is more careful to support the newborn's head.

In addition to Flores, Shenk and her new nurse practitioner colleague saw another 18 patients that day. Three were special-needs cases that had to be referred on: a kidney abnormality in one child, an unusual birthmark on another that required a sonogram check and a suspicious mass in an 8-year-old's testicle.

"There's a lot of good that comes out of the clinic," Shenk said. "We serve in some ways as a bridge for the families. They're not able to speak English so they come to us, and we can communicate well with them and we can communicate what other physicians are trying to say to them. There's a lot of health education that goes on here."

Clients pay on a sliding scale based on their income, but 93 percent of the patients fall below the poverty line and so pay little or nothing for service.

"We're serving some of the poorest of the poor in the city," said Susan Abramson, executive director of Alexandria Neighborhood Health Services Inc., the umbrella organization that encompasses the clinic.

Despite the intense need, Abramson worries about the clinic's future. There are grants from such groups as the Robert Woods Johnson Foundation, but future funding is far from certain. Most grants are short term, and few Alexandria residents or businesses contribute.

"We've had a very difficult time getting businesses to contribute," she said. "We do feel this is a community clinic. The community really should come together on this."

Mark Purcell, an Alexandria police detective with the sexual violence unit, has been impressed with the clinic ever since he walked in a couple of years ago as part of a rape investigation.

Despite the trauma and the frequent hesitancy in the Latino community to report crimes, a rape victim had walked right over to the clinic for help, and got more than help--she got a boost of confidence.

"I think it gave this lady enough confidence to go through with this all the way to the court, all the way to the trial," Purcell said. The rapist is now behind bars.

"I was so impressed with them," Purcell said. "When I walked in there, I saw the people in the waiting room. I just knew that if the clinic wasn't there, these people wouldn't be getting the treatment that they needed--prenatal care and care for their children."

CAPTION: Wendy Flores, left, holds 4-month-old Aimee as nurse Cheryl Jackson

CAPTION: Edy Morales, 4, enjoys a book while waiting to be weighed and have his height measured.

CAPTION: Dibby Smith, clinic coordinator, stands amid 1,800 patient charts crammed into a closet in the nine-room clinic.