The seedy commercial strip with the liquor store and carryout deli was once anchored by a pharmacy. A Baptist congregation worships in the neighborhood's former Safeway. The Spic N Span market on the corner closed years ago, and the bakery that perfumed the air with the aroma of fresh bread is now a trash transfer station.

 

The older denizens of Hayes Street NE -- just a block off "the Avenue," as people in this part of the District call their stretch of Nannie Helen Burroughs -- remember when the businesses began pulling out or changing hands. It was when they began losing their doctors, too. Dr. James on 49th Street, Dr. Collins at 48th, Dr. Pinkney, Dr. Thornton. All were mainstays who'd brought families through sickness and injury. As they left, nobody took their place.

 

The exodus eroded the neighborhood's well-being. These days, with resignation more than bitterness, many people go halfway across the city, or miles into Prince George's County, for medical care, medicines, even fresh produce.

 

"We got more undertakers out here than anything," scoffs Elbert Sims, whose perspective spans six decades.

 

The view from Hayes Street illustrates the reality of most neighborhoods east of the Anacostia River, where an acute shortage of doctors and significant poverty factor into high rates of chronic illness and mortality. Ward 7, in particular, suffers disproportionately from heart disease, cancer, hypertension and asthma. Nowhere in the city is there more obesity.

 

Ever since the contentious demise of D.C. General Hospital in 2001, Mayor Anthony A. Williams (D) and the D.C. Council have debated how best to improve the health of communities east of the river. The discussion has been divisive rather than unifying, pitting supporters of a proposed $400 million hospital against those who urge massive investment in primary and specialty care and disease prevention.

 

Residents of Ward 7, the heaviest users of D.C. General, have been the biggest proponents of a new hospital. But in the blocks of Hayes just off Nannie Helen Burroughs and Division avenues, which never needed the government's safety net as much, opinion is more mixed.

 

The alternative plan -- the latest before the council -- could indeed bring doctors and services closer, people say. They yearn for a pharmacy within walking distance, a nearby pediatric practice or ophthalmologist, a diagnostic center where they could go for CAT scans and mammograms. Except for several centers that largely serve poorer patients, the ward has virtually no standalone medical facilities. One of the few is in a congested shopping plaza two miles away, and its success speaks volumes about the magnitude of health problems on this side of the river.

 

Open 13 hours a day, six days a week, it provides dialysis for scores of people in final kidney failure.

 

Ghost of Suburban Gardens

 

"Suburban Gardens" was a developer's name for the area when its small, semidetached houses, fronted by steep, postage-stamp yards, started going up on the edge of the District's Deanwood community at the end of World War II. Although the name faded, residents established a kind of suburban stability and cohesion, one they've maintained even as fortunes declined.

 

Several original homeowners or their descendants -- including a newborn great-great-granddaughter -- remain in the 5100 and 5200 blocks of Hayes. The seniors tend toward federal and city government retirees, more blue- than white-collar. The other generations are more diverse. Angel Williams, who is 34, commutes to Fairfax County for her school security guard job. Norris Kingsbur is a 52-year-old computer technician, self-employed.

 

Kingsbur has no regular physician, despite a painful encounter with a kidney stone that sent him to the Howard University Hospital emergency department this spring. "Eventually, I got to get" a doctor, he allows. He'd prefer an MD in the neighborhood and suspects that proximity would encourage him to pay more attention to his health and the 80 pounds he wants to lose. "Closer to home, it's better," he says.

 

Only a few households receive medical care through a D.C. program for the uninsured, and it often leaves them frustrated. One mother was told that a specific pharmacy must fill the birth-control prescription for her 19-year-old daughter; she worries something unplanned could happen in the meantime.

Others have coverage through private plans, Medicare and veterans benefits. Like Elbert Sims, they almost always travel out of the ward to use it.

 

"Pop Sims," as the neighborhood children used to call him, continues with the cardiologist in Southeast he has seen since a long-ago heart attack. He has a neurologist at Washington Hospital Center in Northwest because of more recent strokes and seizures. For a slipped disk in 2003, he received treatment at Providence Hospital.

 

"The dentist I go to is in Maryland. The eye doctor I go to is in Maryland. There's nothing on this side of the river," laments Sims, 84, sitting in a favorite recliner and turning to his elder daughter, Carol, for confirmation. "What have we got to brag about?"

 

She nods. The former warehouse administrative assistant moved home in 2000 to help with her ailing mother. When Alzheimer's and diabetes forced her mother into a nursing facility -- also on the other side of the river -- she stayed to care for her father. Yet Carol Sims, 64, routinely goes back to Prince George's, to her doctor in Bowie, to food and drug stores in Laurel and Largo, and to restaurants where, given her borderline diabetes, she can try to eat right.

 

The 70,000 people who live in Ward 7 suffer from a severe deficiency of supermarkets. In a July report to the Mayor's Commission on Food and Nutrition, researchers rated it D- for access to well-stocked grocery shelves. That and a surfeit of fast-food and carryout help explain why more than four in 10 residents were obese by 2003, according to the report.

 

Access is a constant health challenge for 65-year-old Norma Smedley. Unlike most of her neighbors, she has no car, so she especially misses Safeway's presence on the avenue. She takes a 20-minute bus ride to the nearest supermarket or waits for a sister to drive her. She catches the bus and the Metro to reach her doctors in Northwest near George Washington University Hospital, but getting to her dentist in Mitchellville, to whom she was assigned by her insurance plan, requires a ride from her younger daughter.

 

If not for family, she says, "I don't know how I would get to places I need to go."

 

After Smedley retired in 2001 as a housekeeper for the architect of the Capitol, she was diagnosed with a painful muscle and joint disorder called fibromyalgia. She should be exercising regularly; during the summer, she and Alice Chandler, a District teacher and Advisory Neighborhood Commission member who lives around the corner, walked the several blocks to Woodson Senior High and then looped the track.

 

But because of Chandler's work schedule, Smedley would be walking alone most weekdays during the school year. Given a recent armed carjacking on her street and a robbery in which she was the victim last January, she fears for her safety. Smedley has decided: For Christmas, she'll buy a treadmill for her basement.

 

Looking to the Future

 

So much has to happen to bring the neighborhood back.

 

"The lack of convenience for getting health care has affected the health of the community," believes family practitioner Melvin Gerald, whose career has focused on such "medically underserved" areas. His Gerald Family Care Center sees patients in a cramped, tired-looking office in a nursing home at Nannie Helen Burroughs and 50th Street NE. He opened it in the late 1980s. "There was a need at that time, and there's still a need," he says.

 

As an ANC commissioner, Chandler, 57, is pushing for a new hospital. "Minutes matter," she says, convinced that the kind of emergency and trauma care that once saved lives at D.C. General is still critical there. Her corner of the ward is just a couple highway exits from Prince George's Hospital Center in Cheverly, but other areas are not. She doubts that the bed-free "healthplex" proposed for D.C. General's former grounds would suffice, no matter how good its 24-hour emergency services.

 

Yet she can see merit in elements of the mayor's alternate plan. One measure could immediately benefit Hayes Street, where Chandler has lived since childhood, by directing millions of dollars to help the Hunt Place Health Center move over from a horribly inadequate location near Minnesota Avenue NE.

 

The new address for the nonprofit's primary care doctors, specialists and pharmacy? A fully renovated building where the Spic N Span grocery stood long ago.

 

For other reasons, too, Chandler says, "I'm more optimistic." A church on Division Avenue, Contee AME Zion, will target a half-dozen blocks this winter and bring Howard University medical students for weekly door-to-door health visits. Organizers envision a farmers market next summer.

 

And as part of the city's New Community Initiatives, the avenue is to be transformed by a multimillion-dollar town center. There'll be townhouses, condos and retail shops, maybe even a corner bakery. The design leaves no room for an earth-quaking trash transfer station.

 

If they build it, Chandler and her neighbors hope, maybe the doctors will come. Or, rather, come back.