Public health care, says Mayor Marion Barry, is "our worst area."

A visit to John Algee, a doctor at the Benning Heights Neighborhood Health Center in Southeast, shows why.

"There aren't enough nurses," a bone weary-looking Algee explained one morning. "I need a lab tech to help with EKGs . . . . Sometimes we have to bring our own Band-Aids . . . . Once, there was no medicine at all for hypertension."

"It's a labor of love," said Algee, a 26-year veteran of District-operated health clinics. "But some days I almost want to throw up my hands and cry."

At a time when teenage pregnancies, infant mortality, drug abuse, sexually transmitted diseases, cancer deaths and family violence have reached alarming levels here, the front-line neighborhood health clinics for low-income residents have been hobbled by a steady erosion of resources.

"We're overburdened with poverty," Barry said recently in discussing the city's beleaguered human services operations. "I think people use the health clinics and {hospital} emergency rooms as the physicians of last resort. They wait until they get sick" rather than engaging in preventive medicine.

At the Anacostia health center, one of the city's busiest, obstetrician Maurice F. Naccache said he sometimes has trouble obtaining birth control pills and vitamin tablets for his patients. The air conditioning breaks down every summer, he said, and pregnant patients "walk right in and just walk right out again, it's so stifling."

A few blocks north of Union Station at the Walker-Jones clinic, maternity patient Valerie Morris, 23, an office worker with no health insurance, recently waited almost two hours to see a doctor. The clinic isn't open at night, so Morris had to take time off from work -- without pay -- to keep her appointment.

Staff members in clinics across the city say that at one time or another, they have run out of essential pharmaceuticals and other supplies -- gloves, tubes for drawing blood, alcohol disinfectant, towels to wipe off babies, sheets, patient gowns, Band-Aids and even toilet paper.

Elizabeth Scott, a pharmacist at the Arthur Capper clinic in Southeast, produced a stack of "Due Outs" -- drug orders not in stock at the warehouse.

"Sometimes patients go from clinic to clinic" trying to get their prescriptions filled, Scott said.

Today, there are chronic staff shortages, budget-imposed hiring freezes and reduced service hours. Some administrators spend part of their week seeing patients. Only one clinic, Congress Heights in Southeast, offers evening hours -- but just once a week.

Patients who seek appointments at the clinics usually wait three weeks or more to get in, and then face backups in often cramped and aging facilities. Many services are free, but some, depending on income, cost $20 to $80.

Coinciding with the decline in resources and the mounting public health crisis is another troubling trend: Fewer people are turning to the clinics for treatment than in the past.

Since 1984, the number of patient visits has declined nearly 22 percent, from 263,000 total patient visits in fiscal 1984 to 206,000 visits in fiscal 1989.

In a city where 114,000 residents have no health insurance, an estimated 46,000 individual patients visited the neighborhood clinics in 1988, the most recent figure available.

The latest figures available show a sharp decline in patients seeking dental work and treatment for disabled children, tuberculosis and venereal disease.

City officials and health care experts attribute the drop-off to factors including service cutbacks, inadequate hours and deteriorated clinic conditions that have discouraged some from coming.

The maternity caseload has risen recently, but the sharp decline overall in patient use is having alarming -- and expensive -- consequences.

Missing Out on Preventive Care

Instead of seeking primary or preventive care in the clinics, many of the city's poorest residents bypass them altogether and turn to the emergency rooms of D.C. General and other hospitals. There, at an average cost to the government of $160 to $190 a visit, most receive medical care they could have gotten in the clinics for $65 to $90.

The D.C. Hospital Association estimates that hospitals here provide more than $100 million annually in free care. According to one study, about 40 percent of hospital admissions, excluding trauma and OB-GYN cases, could be avoided if patients were treated earlier in the clinics.

Worse, some residents wait too long to get medical help -- until simple problems have become serious ailments.

A poll by The Washington Post found that only 28 percent of those surveyed or their family members have ever used a city clinic. Based on what they knew firsthand or had heard, 29 percent of those polled rated health services good or excellent, while 20 percent rated them not so good or poor. About half of the respondents said they didn't know or had no opinion about clinic services.

But the declining patient load has not lessened the burden on clinic workers. Longtime employees say there was a time in the 1960s when they were practically bumping into each other. Now, the clinic corps has been sliced to a staff of 322 workers for the city's 22 neighborhood and specialty outpatient health care facilities.

Since 1986, the clinics have had a net loss of 43 employees.

"We're holding things together with bubble gum and Band-Aids," said Georges C. Benjamin, the District's public health commissioner. "But you can't imagine how much worse things would be if we weren't here."

The clinics' troubles are part of a growing health care crisis in this and other cities. But the impact on the District, a majority black city that leads the nation in infant mortality and cancer deaths, has been particularly devastating.

The long-term consequences are grim, according to Benjamin, a former emergency and trauma care administrator at D.C. General. "Unhealthy children do not learn, and unhealthy adults do not work," he said.Quality Despite Problems

Clinic employees, while ticking off the problems that make their work difficult, say the quality of care is good.

"They see the nurse and doctor, they get all the tests, they get their medicine," said Naccache, the Anacostia obstetrician. "Sometimes it may take a while, but ultimately they will get what they need."

Benjamin's predecessor, Reed V. Tuckson, concurs. He quit as public health commissioner early this year, citing his frustration with the city's health care budget. But Tuckson worries that negative publicity will further discourage potential patients.

"The problems are real," Tuckson said. "But people who are without health insurance and the medically indigent can receive competent care at the clinics and should use them."

Except for some specialty services, D.C. clinics are open from 8:15 a.m. to 4:45 p.m., weekdays only. Unless it is an emergency, getting an appointment may take three to six weeks, depending on the service sought.

Clinics that offer pediatrics and OB-GYN care make a special effort to schedule new mothers and pregnant women for appointments within two weeks after they call, and the Hunt Place clinic in Northeast has a "Walk-In Sick" service: no appointment necessary for anyone 21 years of age or younger.

If transportation is a problem, patients are given taxi vouchers and bus tokens.

Maternity patients, on their first visit, see a social worker and a nutritionist as well as a nurse and doctor. There is no charge for prenatal or pediatric care if the family makes less than $20,000 a year. Pregnant women and new mothers also have access to the federally funded supplemental food and WIC (Women, Infants and Children) programs, located at many clinics.

Some clinics have special arrangements with hospitals or private groups. Children's Hospital has a contract to provide pediatric care at the Adams-Morgan clinic. Providence Hospital delivers babies free for 60 maternity patients referred to it by the clinics. Greater Southeast, Georgetown and Howard University hospitals offer free and low-cost mammograms.

And at Hunt Place, a Howard University sorority operates the Stork's Nest, which gives clothes and baby supplies to women who keep their prenatal appointments.

Benjamin has high praise for clinic employees, calling them caring, capable and innovative. But he acknowledges that the clinics no longer offer the same level of comprehensive, so-called one-stop shopping health care that was the hallmark of their creation.

Among the most pressing problems:

Staff shortages, most evident among nurses, nursing assistants, doctors and medical clerks, have hurt morale and challenged the patience and abilities of clinic workers.

Physician Marlene N. Kelley spends Monday and Tuesday mornings tending patients at the Walker-Jones clinic, then spends Wednesday evenings across the Anacostia River at Congress Heights, the only city-run clinic that is open at night.

The rest of the week, Kelley copes with her real job: director, since 1983, of the D.C. Ambulatory Health Care Administration, which operates the clinics.

"When I took the job, I asked to stay on at the clinic," where some of her patients have been with her since 1969, Kelley explained recently. "But at the time I didn't have anybody I could put in my clinic slot -- and I still don't."

Basic comprehensive care -- general medicine, OB-GYN services and pediatrics -- is available at just eight of the health centers. Clinics that once had full-time specialists now share these employees with other clinics. When a doctor gets sick or takes vacation, patients often go without service or are referred elsewhere.

One patient polled by The Post complained of taking her children for a scheduled clinic visit and finding that the pediatrician had called in sick and all his appointments had been canceled.

Social workers, once a standard resource for the non-medical support needs of indigent patients, are now a luxury at many clinics. And health care outreach, intended as an integral part of community-based medicine, is a shadow of its former self: Out of nearly 200 field nurses who used to work in the clinics, fewer than a dozen remain.

"We used to have our own field nurse, but now there's just one public health nurse to handle the census tracts in Wards 2 and 3," said Marjorie Dixon, a nurse practitioner at the Southwest clinic.

Most clinics no longer have access to on-site "stat" laboratory and X-ray services, which means physicians -- and patients -- have to wait longer for a complete diagnosis.

Helen Ransome, the lab technician at the Capper clinic, prepares dozens of blood, urinalysis and culture samples a day but must send them to a city lab. At Hunt Place, pediatrician Albert Hsu said it can take a couple of hours to get back X-rays and up to two days to see lab results "so you know what you're dealing with."

Dental services are limited. Dentist Candace Mitchell said her bilingual Adams-Morgan clinic stopped fitting dentures months ago and now sends its mostly Hispanic patients to another facility -- where employees don't speak Spanish. Root canals are performed, but patients have to go elsewhere for crowns because the District dental lab is being renovated.

Many of the clinics are in cramped school buildings, converted, poorly ventilated warehouses and other aging quarters. Nurses tell of bringing heaters from home in winter to warm the examining rooms. One registered nurse said her brain gets fuzzy and her temper short from insufficient oxygen. Call for Greater Availability

Among patients interviewed, the biggest complaints were about long waits for service and the clinics' failure to provide evening or weekend hours.

D.C. Council member H.R. Crawford (D-Ward 7), whose committee oversees the Department of Human Services, has asked health officials to draft a plan for keeping clinics open some nights -- a move that staff members fear will stretch their ranks even more. As it is, the city's Wednesday night clinic operates largely with a volunteer staff.

Kelley said most of the supply shortage problems have been fixed. She said her office is waiting for the go-ahead to fill at least some clinic vacancies. Long-range plans for the clinics -- whether to close some and consolidate or relocate others -- are on hold until after the fall elections.

In the meantime, nurse Dixon, a 20-year pediatrics veteran, and others complain that there is too little staff for the huge job at hand. Dixon worries that patients don't get a thorough briefing about their medical problems if the staff is rushed.

"Say a patient comes in and he gets worked up and diagnosed and he has diabetes," she said. "He will get his insulin, but he may not get diabetic teaching. So he won't know what to watch out for if he has foot problems or gets too much insulin."

Health officials say they have lost budgetary ground to other city services, particularly the war on crime. Commissioner Benjamin said the situation will only get worse until the city and the nation make health care "a front-burner" issue.

Leetha Butler, for one, is a believer. The 60-year-old cook suffers from high blood pressure and recently left work complaining of blurred vision. She went straight to D.C. General's emergency room but didn't see a doctor until after midnight. She was supposed to come back for a visit the next day -- but was mistakenly given an appointment six weeks in the future.

A concerned neighbor brought her to the Benning Heights clinic and Dr. Algee, who diagnosed her near-stroke condition and put her on medication.

"I didn't even know the clinic was here," said Butler, who lives within walking distance of the center. She said it probably saved her life.