1

                         JANELLE GOETCHEUS
                         November 16, 1996

                        Dr. Fitzhugh Mullan,
                            interviewer


Mullan:   Your date of birth?



Goetcheus:   September 19, 1940.



Mullan:   The date is the sixteenth of November 1996, and we're in

Christ House on Columbia Road in Washington, D.C., on a bright,

sunny, chilly November morning, Saturday morning.     Dr. Goetcheus

has been good enough to devote some of the latter end of her week
to talking about herself.    A busy week, I know, having tried to

get hold of you several times.     You always seemed busy.

     This is an extraordinary facility, and I want to come back

and talk about it, but what I'd like to do is to go back to the

beginning and talk about you, and move forward and eventually set

you here in Christ House and talk about it.     I think you're not a
Washingtonian to begin with.



Goetcheus:   That's right.



Mullan:   Where do you hail from?



Goetcheus:   Indiana.



Mullan:   Tell me about where you were born and grew up.
                                                                          2

Goetcheus:     I was born in Indianapolis, Indiana, but grew up from

age two on in Muncie from there on.      My mother taught school and

my father was an auditor.       I went through college there.   From an

early age, I had decided that I wanted to go into medicine.           I

always knew that it would be for underserved.        I always thought

that would be overseas.      My primary awareness was in terms of a

need overseas, not in major kinds of health access problems here

in this country.



Mullan:    Let's talk about Muncie for a moment and your family.

Your father was an auditor?



Goetcheus:    Yes.    He was an auditor with the state of Indiana.



Mullan:    What took him to Muncie?    They Indianans to begin with?



Goetcheus:    Yes.    They were both from Indiana.   My grandfather

was a United Methodist minister and had churches there in north

Indiana.     That's where my father grew up.   My mother grew up in

Church of the Brethren in North Manchester, Indiana.       So they

were both from Indiana and came to Muncie primarily out of my
father's work.       It was right after the Depression.   I had two

older siblings.      They moved when I was two.
     My mother had completed a two-year teaching program, which

was normal in those days.      So she began to go back to work on her

four-year degree, and then taught both in public schools until
                                                                       3

she retired and then taught another fifteen years as a first-

grade teacher in a parochial school.



Mullan:    In Muncie?



Goetcheus:    Yes, St. Lawrence.    Then she came here and lived for

the last couple of years here with us, tutoring, and then died.



Mullan:    So she devoted her whole life to teaching.    I gather

your religious background was strong.     What was your religious

life like at home?      How did the Brethren and the Methodists merge

in your household?



Goetcheus:    It was quite (of course, before my time) unusual for

a Brethren--my mother--to marry outside of the Brethren

community.



Mullan:    Tell me just a word about the Brethren.



Goetcheus:   Brethren is one of the--1 think I'm telling this

right, now, I'm not an expert--it's one of the anti-Baptist

groups that bond with Mennonites and Quakers and Brethren would

all be--



Mullan:    They were German in origin?



Goetcheus:   Right, and have what they call anti-Baptist heritage.
                                                                       4


Mullan:    Do they live in communities?



Goetcheus:    Well, some did.     Certainly Mennonites did and still

do, some of them.    She did not grow up within a community itself.

I think they had their own individual home.      The community at

large was an important part.

        The community at large, I think, was important, although

they didn't live together as a community.      But to marry outside

of the Brethren Church was a tense-filled time for her in terms

of acceptance, even though my father had grown up in a minister's

home.



Mullan:     The Brethren focused on marrying their own and

perpetuating--



Goetcheus:    Usually within.     That's my understanding, much like

you would do in Amish community or in Mennonite community where

you would marry someone with your own tradition.
        So they were part of a large downtown United Methodist

church there in Muncie, and that's where I grew up going to

Sunday service each Sunday, and Sunday school was very much a
part of my growing up, being very involved in the various youth

kinds of--



Mullan:     This was Methodist?
                                                                       5

Goetcheus: This was Methodist.    High Street United Methodist

Church in Muncie.   That's where my husband grew up, too.     He and

I were friends all through elementary, junior high, and high
school.   The primary thing was because of a number of youth

involved with that church, s o a lot of your activities outside of

school came through various kinds of things at our church.



Mullan:   The particular religious tradition and focus that your

parents brought to you to the church I would suspect certainly is

different, everybody brought something different, but my guess is

that everybody that went through that Methodist church didn't

take the teachings and message and apply them as much to their

life work as you have.   I'm jumping ahead in the story a little,

but I'm interested in your roots and the decisions that you made,

and values that you brought to those decisions and whether, in

what sense, they stemmed from both your religious tradition at

home and the church itself.



Goetcheus:   I think they were very significant.    I don't know

that I know even specifics of that, because at a fairly early

age, again and I don't know where that came from, prayer became
very much a part of my own life, even as a child.    So   it was
really in that sense, in that time spent in prayer, that I think

I began to know most fully in terms of where I was to be headed--
even the decision to become a physician.   There were other things

that were happening, as far as the school and opportunities that

way that, in terms of encouraging my interest in science that
                                                                   6

would accompany that, but certainly it was out of my own
background of faith that was part of it.   You're right, within
the church--there was a real sense, probably still is now, that

there were people who went into full-time Christian service, as

we would say, and then people who didn't--instead seeing it just

as a part as one's living, whatever one did, as their full-time

service.



Mullan:    Full-time Christian service meant what?



Goetcheus:   That usually meant, in our tradition, that for the

fellows it would be becoming a minister, and for women in the

Protestant tradition, becoming a missionary.    In a Catholic

setting, you would probably have entered the priesthood or into

religious orders or something like that.    In the Protestant

Church, you would go on to the seminary, become a minister, for
men, and for women, becoming a missionary in some aspect.    But

that was considered "full-time Christian service."   I think

there's a bit more of awareness now in terms of not so much of
that separation, but that everyone is to be about life and
living, making decisions in regard to their faith that puts them
in "full-time service" of some sort.



Mullan:    So if I understand, in the more contemporary thinking

about this, there wouldn't be the literal bifurcation into those

who devote their life formalistically to the church and those who

devote their life to other things in which there may well be
                                                                      7

Christian service.     Did you wrestle with that?   At the time was
becoming a minister an option for a woman?



Goetcheus:   I have to think back.    There were a few, I think.

Well, no, she had been a missionary, but maybe she was seminary-

trained, too.      I don't know that there were many.



Mullan:   It doesn't look like it crossed your mind as an option

particularly.



Goetcheus:   No.    At that point when I began to make those

decisions, I was really thinking toward becoming a physician.        So

I don't think I ever wrestled with whether or not to go to the

seminary.



Mullan:   So that really must have started fairly early then, that

you would become a physician?



Goetcheus:   I don't know exactly, but I probably was in junior

high.



Mullan:   Where did that come from?



Goetcheus:   I'm not sure.    One is, I'm sure, out of my own faith,

a sense of where I was being directed.     The other was when I was

in junior high, first year, they had a system where some students

were picked to go around and pick up attendance cards.      To get
                                                                     8

chosen was sort of a special thing because we got to around to
the different classes and pick up these, but anyway, because of
that, my class schedule got changed, and I was placed into a

class that I'm sure is where they had placed a number of students

who had various kinds of learning disabilities and some who

couldn't read.
     The teacher of that class was a fellow who had been a year

in a medical school.    I don't know what had happened where he had

been not able to complete it.    In those days, at least Indiana,

probably others, were on the pyramid system.     They took in more

students that what they were planning to keep.    So that even in

my class, there were between forty and fifty students who were
gone after the first year, but I don't know what all led to his

leaving.   But anyway, he was presented with a challenge, I'm

sure, with seventh graders, some of whom couldn't read, to try to

make biology interesting, and he did all sorts of things and it

just captivated me.    In fact, when I was accepted into medical

school, I sat down and wrote him a note just remembering how
significant that time, that year, had been for me in his class.
     So I'm sure that was part of it, as well as just in general

being very directed.   I was a pretty shy person and I would not

share that with many people, in terms of going to medical school.
In fact, I'm remembering recently, in our own community we were

sharing what we call our spiritual journeys, so we all get to

know each other.   We have several new members, two new

physicians, that we were all sharing with.   I remembered when I

was in high school going in to a counselor my junior year, I
                                                                        9

remember her name, Lucille Johnson, going in, and I had taken

what was then--was not SAT, but--



Mullan:    This is junior year of high school?



Goetcheus:    It was one of those, the testing done prior to

college.     I remember I had been ill that day, but I'd gone
because I knew that I needed to do it.    But I had not done very

well on that test.     I don't remember what I did, but I hadn't

done extremely well.     I remember her suggesting to me, maybe I

should consider some alternative than going to college, talked in

terms of secretarial kinds of things that I could consider.

Well, when I was back out to Indiana, probably been a couple
years ago now, and there was something in their alumni thing or

something, anyway, if I didn't get a call from her here.        I was

already back here, and she called me, and she remembered me.



Mullan:    Did she remember what she had told you?



Goetcheus:    She remembered enough to say--she must be ninety

years old now.    She was old when I was there, or you know how
high schoolers think.    She always seemed older to me.   She could

remember, and she could say to me she never thought I would

become a physician.     [Laughter] She laughed on the phone and I

laughed on the phone.
                                                                     10

Mullan:   That's extraordinary for a lot of reasons, including the

humility of it, I mean, that she would (a) remember, (b)
acknowledge, and 0 call you.   Usually people slant the stories

the other way, like, "I really saw what they really had before

anybody else.   I'




Goetcheus:   That's right.   She called.   It is true, I would not

have been someone to have gone to medical school.



Mullan:   Yet by high school, you had that fairly firmly in mind?



Goetche s:   I wanted to, so part of that was discerning th t and

part of that was going into college on a pre-med program and just

seeing--1 knew, especially for women, it had to be pretty much

all As to get in.



Mullan:   Where did you go to college?



Goetcheus:   We lived at that point only about six or seven blocks

from a college which was then Ball State Teachers College.      It's
now Ball State University.   So I walked there to go to college.

The other thing that happened in those days, it was fairly

important to know somebody, to know a physician or to have

somebody recommend you for medical school.    It was in my first

biology course during my freshman year, and I was in the lab

after class, [unclear], and the professor walked in and asked if

I would like to work.   I said I couldn't type, I couldn't do
                                                                       11

anything secretarial much of anything.      He said no, no, he'd find

things for me to do.     What I didn't know at that time, he was a
pre-med advisor.      So I worked during those years.



Mullan:    For him?



Goetcheus:     In the science department.   He was the overseer of my

work.     So when it came time to go into medical school, then Dr.
Miller could write a letter because he knew me well, in terms of
a recommendation.      One never knows how much it helped, but there

were only eleven women in a class of over two hundred that year.

We ended up--graduated with eight.



Mullan:    At Indiana University, before you went to medical

school?



Goetcheus:    Yes.



Mullan:     From Ball State, tell me a little more.     What was the

curriculum like?



Goetcheus:     It was pre-med.   It was good.   It was real good

preparation for medical school.



Mullan:    Did you enjoy school?   You were living at home, so it

much not have been too much of a change.
                                                                     12

Goetcheus:    No.   I was pretty focused in terms of where I was

headed, so I was taking the courses and trying to do as well--



Mullan:   Kids nowadays talk about living at home.



Goetche s:    Oh, no.   We have children of our own now tho all have

gone away and had much more, probably, community experiences at
college than I did because I was at home and I was working.



Mullan:   You didn't go through a rebellious period where you

wanted out?



Goetcheus:    No.   I can't remember anyway.   The other thing, as

far as the rebellious period, I was hooked in high school to a

very close church youth group where most of your activities were

focused that way.



Mullan:   Did that continue?   Was there religious organization at

Ball State or did you continue with your church?



Goetcheus:    Well, I did in the sense that I was there, but not

with a youth group.     But certainly in terms of that was my

worship place.



Mullan:   Before we talk about Indiana University and medical

school, tell me a bit more about your thinking in regard to

medicine as you anticipated it.    You indicated earlier that at
                                                                      13

some point there was this connection to international health or

missionary work, perhaps abroad.   Also you've indicated a
baseline interest in the medical sciences from an early age.
What were the values?    What were the important elements that went

into your thinking?



Goetcheus:    I'm sure that I would hear from others.   This was a

large church, so there were a number of folks that were

missionaries overseas that would come back and I would hear.      I

don't know that we had any physicians, but I would hear from
them, in terms of the need.    I remember reading [Albert]
Schweitzer.   Do you know the Schweitzer organization, by the way?

It's up at Yale now.    They've had a big conference at Yale.

There's folks all over now that have been affected by them.       I

remember reading Schweitzer, and I remember reading--1 can't even
think of her name--of a woman physician who had been in India,

who had begun Velorre Medical College.    I remember reading those
things in high school.    I'm sure those sparked an interest.     I
knew, in hearing others come back, in terms of the needs.

Mission was always very important in our own church, very

supportive of, again, primarily overseas missions.      That's one of

my regrets.   Even when I look back now, even when I was in

practice there in Indiana, I'm jumping ahead, but in my awareness

of both racial inequities as well as the need in this country

were certainly limited.    I can remember in our town, African-
Americans lived primarily over in one section.    I don't remember

during that time thinking how unjust this is or even asking, even
                                                                    14

when I was in practice, where are these people going to get
health care?    I don't remember that coming to my mind.
       After we had come out here (D.C.), there's a group called

Christian Community Health Fellowship that has begun now.      These

are health personnel that are involved in various similar kinds
of efforts, various cities around the United States and rural

areas.    But anyway, I was with a black Baptist minister who was
from Voice of Calvary down in the South, and they had one of the
first 330 connections with Health Services down with Hebron and

Jackson.
       Anyway, I remember him asking where I was from and I said,

"Marion, Indiana.    I'




       And his response was, "Well, do you know that was the
northernmost city where a black was hung."    And sure enough, it

was.



Mullan:    What is the city?



Goetcheus:    Marion, Indiana.   In fact, the Southern Poverty

Project, a law journal recently published a picture of a young
man being hung from the courthouse square, from a tree.



Mullan:    A picture of this?



Goetcheus:    Yes.



Mullan:    What year?
                                                                     15

Goetcheus:   It was in the thirties.   So my own awareness of all

of this wasn't there as I was growing up.    My awareness, in terms
of me, would have been overseas.     Then when I was in college, I

went for a summer with a United Methodist college group down to a
small little village in Mexico, Chicauasco, where we built

latrines and did some literacy kinds of things in this small

village, living in a small hut there on the site.



Mullan:   Was this a church group?



Goetcheus:   Yes.   This was through the National United Methodist

Church.   I also began to experience some Third World kind of
poverty when I was in medical school.     One of the professors had
gone with the World Council of Churches over to Zaire, which was

then the Congo, now it's Zaire.    It was during the time the war

was on.   Belgians and others were pulling out, so hospitals were

very short-staffed.   So a group of Indiana doctors got together

to start going over to this one hospital rotating.     He, one of
these professors, asked me if I would like to go.     They didn't
have a doctor to go, so as a third-year medical student who knew

nothing, went over to this hospital for three or four months.
That was a significant experience for me.     I lived in the bush

area of Zaire, 200-bed hospital with TB wards and a leprosy camp

The Zairian people taught me a lot.
     I fully thought I'd be going back.     When I left there and

flew out that day on this little plane, I thought I would be
                                                                   16

going back.    I had no idea that it would be in Washington, D.C.,
rather than Zaire.



Mullan:    Which years were you in college?



Goetcheus:     I graduated from medical school in '65.   I graduated

from high school in '58.      I went on a three-year pre-med program

at Ball State.      So I was there from '58 to '61, although my

diploma would say I graduated in '62, I guess, because my first

year of medical school counted as my fourth year of college.      So

I had to come back for college graduation after that fourth year.
So I was in med school from '61 to '65.



Mullan:    So in terms of the political tenor of the country--



Goetcheus:    Of Zaire?



Mullan:    No, no, United States.   The civil rights movement really

had not reached much of a level of visibility while you were in
college.     I was just thinking in terms of your own awareness, you
were not politically aware or involved particularly during that
time, in terms of U.S. issues?



Goetcheus:    No.   Even in talking about overseas issues, my first

introduction of that was getting out to New York, I was on the

way to Zaire, and I was this little naive--I don't know how old I

would have been, but like 22-, 23-year-old.     They were trying to
                                                                      17

talk me into not to going because the war was going on over in

Zaire, and talking with me about some of the ins and outs in
terms of our own countryls involvement--



Mullan:   ''They" being?



Goetcheus:    The mission board.    I had a couple of hours to make a

decision whether to get on that plane to Zaire or not.     Anyway,

then going and becoming aware of and seeing how they bungled
(U.S. policy) so badly.



Mullan:   In Zaire?



Goetcheus:    It was my first awareness of our involvement in other

people's history.



Mullan:   By "ours," you mean United States or western?



Goetcheus:    Right.



Mullan:   Say a word about that, because I don't know too much

about that.    There was a leader that was executed.



Goetcheus: Sombe.      He had grown up in missionary schools there,

in the Zaire Congo, and was very highly thought of.     The U.N. had

sent troops in with U.S. involvement.
                                                                          18

Mullan:   What was his name?       Sombe?



Goetcheus: Sombe.



Mullan:   Was Patrice Lumumba not in the Congo?



Goetcheus:       Yes.   He was there, but that was after that.    Sombe

was before.



Mullan:   He was assassinated.



Goetcheus:       That's right.   Well, Sombe was in jail, and died.

The missionaries who were there were so upset about the U.S.'

support of some of the corrupt kinds of things they were seeing,
that they even sent somebody back to the State Department to try

to talk with them but they wouldn't hear.         So things got very

tense.    Eventually the physician that I was with was killed

there, Glen Eschtruth.        I j u s t heard recently about his wife.

After Glen was killed, his wife came back to the U.S., trained as
a nurse, and then went right back to the same hospital where he

had been killed,        and is still there, in Zaire.



Mullan:   He was killed in political violence or random violence?



Goetcheus:       He was taken out into the bush and killed.



Mullan:    By?
                                                                    19

Goetcheus:   I don't know that anyone knows exactly.   One of the

physicians working with us and his wife, a nurse practitioner,
were in Zaire before they came here to D.C. (much after I was),

and speak of going through a lot and eventually had to be

evacuated.



Mullan:   So this experience of four months was, in fact, an

important one for you?



Goetcheus:   Oh, it was a very significant one.   I think it also

was a deepening faith thing for me.   [unclear], but certainly the
Zairian people brought me to an understanding of my own faith.

So I've always been very, very grateful for that.

     My own awareness of suffering and racism in the U.S., even

after I graduated was little.   My husband had gone up to work

post-seminary to do some graduate work up at Northwestern, and it

was during the Martin Luther King, Jr. riots in Chicago.    I can

remember coming around on that "L" and seeing all those fires,

and the subways being deserted in downtown Chicago.    But even
then, I didn't get it.



Mullan:   Before we go on to talk a little more about medical

school, the issue of your religion and your faith and your

medical work.   Was there a sense that this would be a

manifestation of your religion to become a physician and to

practice medicine?   How close was the link in your mind?   Was
                                                                      20

this your ministry or was this simply a way of life in which you

could do good work?



Goetcheus:     In terms of living and being with the underserved,

that position came first.    What vocationally I needed to take
came as a second thing, in terms of becoming a physician.     I

think I knew first with whom I wanted to be, and then the
question of how best to manifest that service, and the choice of

a physician.



Mullan:   If the ministry had been more open, as open, say, as it

is today, do you think you might have entertained that?



Goetcheus:   Well, I don't know.     I think at that point I was

pretty clear I wanted to go into medicine.



Mullan:   Indiana University medical school, early sixties.    How

was it?



Goetcheus:     Well, let's see.   There were eleven of us women when

we started out.     It was on a pyramid system.   So I saw a lot of

good people who were let go, and that was hard to see that

happen.   I probably had a different experience when I talked with

the other women who were in my class, they have many more

feelings and memories about having felt intimidated and squelched

at various points.     I was so focused on why I was there and what
I was doing, I just didn't pay much attention to that stuff.
                                                                         21

     One of my experiences I remember, (and probably wouldn't

happen these days now), was being in a physiology class and the
fellow who was teaching it--now, this was at med school--the

fellow who was teaching it was doing research and he needed some

women subjects, so the women got picked out to do this.        It was

an experiment, to measure the basal metabolic rate.         I remember

this other woman and myself had to draw straws, and she got the
hot room and I got the cold room.      So I had to put a bathing suit

on and have a rectal thermometer. My lab partners were around me
and I went in the freezer room.       [Laughter] I remember hardly

being able to stand up after we were in there several hours.

Only the women got--



Mullan:    Several hours?



Goetcheus:     Oh, yeah.    It was a long period of time.   In medical

school there were always the off-color jokes and things like

that, that probably are not as prominent now.      But I knew why I
was there in medical school and I just didn't get into it.        I

think some of the women who are more vocal, in terms of speaking

out, felt much more of the wrath of those around them.        I was
sort of a quiet person, so I just didn't say much and didn't get

into it.     But I think it was there.



Mullan:    How about encouragement or discouragement on the part of

the faculty and the environment for the ideas you had about what

you want to do with medicine?
                                                                    22

Goetcheus:     I don't remember.    I think I always felt

encouragement in that way.     The counselor, the physician to whom
I was assigned,      that faculty person was always very supportive.
And having the opportunity to go overseas came while in medical

school.   Smith-Klein-French pharmaceutical company also had

externships where students could go overseas.

     However, I didn't feel encouragement about doing general

practice.     In those days it was the LMD, the local medical
doctor, who was always considered the low person on the totem

pole in terms of intellect.       When I was a senior, there were two

people in our class that were allowed to go spend a semester with
a family physician, and that was my only experience.



Mullan:     You chose that?



Goetcheus:    Yes.



Mullan:     Only two chose it or only two were allowed to do it?



Goetcheus:    Only two.    It was an experiment.   Only two were

allowed to do that.


Mullan:   Meaning that there would have been more who would have

been interested?



Goetcheus:     I would imagine.    I don't know that, because

everybody at that point went into specialties.       That itself was a
                                                                     23

significant experience, a small town in northern Indiana where I

lived with the physician and his wife.     He was in private
practice there, got up and made house calls.     Everything he did,

I did.



Mullan:   How was that?



Goetcheus:   Oh, it was wonderful.   It really opened my eyes to a

different way of looking at medicine.      In those days, too, it was
by lottery what kind of rotations you might get.      I remember I
had a month of neurosurgery and a month of plastic surgery where

I did a lot of burn dressings.    I had no ortho, I had no urology.
It was all--



Mullan:   Hit or miss.



Goetcheus:   Yes.   So I think that's changed.   I think there's

much more of a sense of preparing folks to become potentially
generalists if they want to now than what it was in those days.
But in those days, everybody went into a specialty.



Mullan:   This was the low point for general practice.     Family

medicine hadn't been born.   How did you find this G.P.?



Goetcheus:    They had already selected.   There were two that were

selected.    One was right outside of Indianapolis and the other

one was in northern Indiana.   I think they knew both of these
                                                                     24

people, had good feelings for both of them.     So I didn't know

before.     They had volunteered, I assume, to do this.   I think
that these rotations have continued on.



Mullan:     Was this a life-directing experience for you or

reinforcing? How did you feel about it?



Goetcheus:     It certainly opened my eyes in terms of the

possibility of going into general--there was no family medicine

there, so there wasn't even a choice as far as going to a family
practice residency.      So I think it was significant for me in

terms of that, because up to that point, I was thinking of

pediatrics.     I began to see I really liked this direction.



Mullan:     What decisions did you make?



Goetcheus:     Then my husband was coming into the picture here, and

so he was in seminary.


Mullan:     Were you married at this point?



Goetcheus:     No.   We were married the day before I graduated from

medical school and the day he was ordained as a United Methodist

minister.     He was ordained that afternoon, we were married that

evening, and I graduated from med school the next morning.



Mullan:     Where had he been in school?
                                                                   25

Goetcheus:    He was still in school at Northwestern at their

seminary called Garrett Theological Seminary.


Mullan:     So you courted cross-state?



Goetcheus:    We grew up together. All through this and growing

up, we had been friends, but didn't really start to date until
junior year of medical school, for me, and he was at that time

maybe first year of seminary.
     So anyway, he was in seminary when we were married, and so I

went back up to Northwestern.    But I made the decision--in fact,
everybody at that point was going through a rotating internship.

Even if you went into a surgery residency or whatever, you went
through a rotating internship, and that's what I did.



Mullan:   Whereabouts?



Goetcheus:    At Evanston Hospital, a Northwestern affiliated

hospital.



Mullan:   How was that?



Goetcheus:    That was being on call every third night.   I thought

I was to be on call every fifth night, but they didn't entirely

match, and I ended up for the first five months on call every

third night, which sometimes put me on 36 and o f f 12.   It was

also a wealthy hospital, located in Evanston, and so it was a lot
                                                                     26

of observing rather than actually hands-on as much.    And just
having been newly married, the hours were difficult.



Mullan:   You rotated between services?



Goetcheus:   Yes.



Mullan:   Sounds like a so-so experience.



Goetcheus:   It was so-so.    It wasn't terrible, but I still was

lacking in terms of general medicine kinds of understanding when

I 1eft.those two experiences.



Mullan:   What next?



Goetcheus:   My husband was involved in several postgraduate

programs, so our next years were directed by that.    He went down

to get a master's in religious communications at Butler
University, where they had a seminary.    Then he came back after
that master's to do some graduate work at Northwestern.    What
year would this have been?    We went back down to Indiana.   So I

graduated in '65. By '67 we were back down in Indiana, where we

were to be until we came out here.    He was teaching in a small

Christian college there as head of the speech department and had

a religious drama group.     That's where I started into practice in

Marion, Indiana.
                                                                         27

Mullan:   You'd done one year or two years at Evanston?



Goetcheus:    One.    One year of rotating internship.



Mullan:     Then to Marion?



Goetcheus:    No.    Let's see.   We went down to Indianapolis.    Our

son was--I've got children coming during this time.       So we went

down to Indianapolis. When I was in med school, one of the ways
I worked my way through med school was to go out to a psychiatric

hospital--it would be like a St. E's [St. Elizabeth's], a

psychiatric institution, a terrible place, awful, and I worked on

the children's unit for nine months until our son was born.        That
in itself was an eye-opening experience, too,       It's been closed

since.    Some of these children were on adult wards.     It was just
awful.    The only purpose I can think of my being there, I was so

mad about that, that finally the children were moved off the

adult ward, but it was an awful place.
     But then our son was born and we were headed back up to
Northwestern.       During that time I worked at the University of
Illinois at their health service for the medical school.       That's
where I had that experience of seeing all the riots going on

close by.



Mullan:     Hold on just a second.    Let me turn the tape over.



[Begin Tape 1 Side 21
                                                                     28

Mullan:    This is tape 1, side 2 of Dr. Goetcheus.



So this was a time when Martin Luther King was killed.



Goetcheus:    Right.   Seeing the riots and the flames shooting up

around.



Mullan:    The import of that f o r you was, as I understand it--



Goetcheus:     I think it was just, again, a growing awareness.     We

still were headed overseas.     That was our plan.    There was
certainly an awareness, and a growing one, but in terms of having

an effect on our decision to stay here rather than to go, no.

     So when we came back down to Indiana then, this would have

been '67.     In those days, as you know, emergency rooms were
staffed with rotating staff physicians.     If you were on a staff

at a hospital, one of your duties to be on staff was to staff the

emergency room.    Well, people were beginning to get a little bit
nervous.     Physicians were getting a little bit nervous in terms
of having a urologist run a code in the ER.     So one of the

physicians there in Marion came to me and asked if I would ever

consider coming into the emergency room there.       They just wanted

to begin with a few hours on the weekend.     Some physicians were

afraid they were going to lose their patients, as this was one of

the ways they got new patients.    So there was a double-edge kind

of thing.     So there was some resistance in doing this.   Anyway, I

came in, acceptance grew, and finally there was group of five
                                                                      29

physicians.    But what it did for me was, this was the only

hospital in the whole county, Grant County--


Mullan:   Marion County?



Goetcheus:    No.     It was Marion, Indiana, but the county was Grant

County.   So it was the only hospital in that county.      So it was a

very busy place, and I'm sure lots of folks didn't have any

primary care.       But what it did for me was, I always say that's

where my residency occurred, because it gave me an opportunity

not only to be practicing, but, because when I needed a

cardiologist, a cardiologist came in, and I was learning all

during that time and the CCU was there, and all of those kinds of

experiences were tremendous learning kinds of things.
     Then I went for a year with a group of family physicians.

We had three children by then, and so I was working set hours so
I could be home when the children were little.



Mullan:   This was after the emergency room?



Goetcheus:    Well, I'm trying to think what year.     I was doing

some of that even when I was doing the ER.       These family

physicians were in an office where there were also OB physicians,

so I went into the OB and did office GYN for a while and also did

private practice within their office.       It was their practice.

That all, as I say, was all very, very good because when I was to

come here to Washington, I was to be in practice alone.         So that
                                                                      30

experience led me to feel fairly comfortable with most medical
kinds of situations, so I could walk in here and walk into a low-

income health service and be alone and handle a good deal of the

stuff that I was seeing.



Mullan:   What was next?    This would have been '68 to '70.



Goetcheus:   We were there.    My husband was teaching then.   We

were talking with the mission board.     Everything we tried

overseas didn't work.      [Laughter] Everything.   We should have
gotten the message pretty early, but we didn't.      The last thing
of which was heading overseas to Pakistan.     There was a hospital

that was there, and my husband was going to teach there in

college in a [unclear]. At that point, I guess we started out in

'74 and we were waiting on a visa.     It was during the oil crisis,

and the U.S. was having difficulties with these countries.

Anyway, the visa--we waited months for a visa--we were American,

we were Christians, going into a Muslim country--all the

obstacles.
     So in the process of waiting for that visa we came out here

(D.C.) to visit, and that was a life-changing experience.



Mullan:   Tell me about that.



Goetcheus:   That was coming here just for a weekend.     We came to

visit this small ecumenical community called Church of the

Savior, that had been very involved with the neighborhood in lots
                                                                       31

of different ways, the most recent of which was when we had

arrived, they had just acquired the first apartment building,
which is just two blocks away here, called the Ritz.       Jim Rouse

[phonetic], who passed away recently, had also been a part of the

community and had helped this community spark an interest in

terms of housing.



Mullan:   This is Jim Rouse the developer?



Goetcheus:   Yes.   He had become involved with Church of the

Savior.   Out in Columbia, Maryland, which he built, there was a

community called K          community that is patterned after

Church of the Savior.    Church of the Savior has a focus of what

jargon would be "inward and outward journey."        The inward part of

that journey is various disciplines, spending an hour each day in

prayer, being a part of a small group, which is called a mission
group, which has a focus around a particular [unclear] or

whatever, but a small group of people who are focused on that
ministry and yet are together as a group in terms of
accountability, how your week has gone, highs, lows, how your

spiritual disciplines are coming along.    Anyway, everybody
involved is considered a minister.    Everybody is to listen to

whatever it is that they are to be about, and that's considered

holy, whatever.     It all involves in terms of somehow reaching out

to one's neighbor, whoever that neighbor is [unclear]

    Anyway, he had been involved with K          ,   and therefore

with Church of the Savior, and he sparked an interest as far as
                                                                       32

housing.    He helped them purchase this first building called the
Ritz.     It was terrible, typical run-down inner-city building, the
roof leaking, and the garbage all through the basement.           It

spelled, had a terrible smell, and fully occupied.        I mean,

people in every one of those apartments.       So they had just

purchased the apartments, it hadn't been renovated when we were

taken into it.     The tenants in the building were just beginning
to get together.     They hadn't, but there was a group that had

just got together the day that we were taken through.       So just

out of hospitality, we were introduced, and somehow it came out

that I was physician.     So several of the people began telling me

about trying to get health care here.        It was just a very
deepening experience for me.

        We went away that weekend and were never quite the same.       We

went back to Indiana still not sure what to do.       We were waiting

for this visa to come, and we began to explore if there would be

any way to come out here.    My husband was a United Methodist

minister, there were oodles of United Methodist ministers here in

the area.     There's a seminary here at Wesleyan.    The nearest they

could put him would be out in Cambridge, Maryland, which was too
far.     So just nothing looked like it would come together to bring
us out.     There was no particular health ministry going on here.

       But in the process, the visa didn't come.     They finally gave

up on it, but we got invited to go to Indonesia.       We would have a

hospital, my husband was going to do religious drama there in the

seminary.     So it all sounded wonderful.    There was schools for
                                                                    33

the kids and all that, but we could not let go.    We were feeling

very directed to come out here.



Mullan:    Your husband had a similar feeling about it?



Goetcheus:    I think probably at that point, I was much more clear

on it.    What he was clear on was my sense that--see, it's hard
for me to talk about this without getting into faith kinds of

things, but I think he was very, very certain that it was God

that was directing this.    Now, in terms of the clarity of being

willing to risk it all, I think that would have been more mine,

because we didn't know what we were coming to and we had three

little children, and neither one of us had jobs coming out here.

[Laughter] So we looked looney and we felt looney, and trying to
tell our friends, our parents, go back to the same church where

we had been, to say, "Sorry, we're not going to go."

     "Well, what are you going to do?"

     "Well, we're going to come out here and see what we're

supposed to be about."


Mullan:    So you passed on the Indonesia opportunity?



Goetcheus:    Yes.   So we decided just to come, and we came out to

see where to live and all that.    The first two years, we were

sent back up to Columbia, Maryland, because they have a lot of

interfaith work there, and it looked like my husband's interest

in religious drama, that a number of the churches in Columbia,
                                                                       34

they share--you may have a number of Protestant, maybe even

Catholic, that share the same worship space, and so they were
going to get together and do religious drama.       That never really

came.     So I went to the emergency room there while we were

visiting, and they happened to need a physician.      A physician was

there who didn't want to work on Monday and Fridays, only

Tuesday, Wednesday, and Thursdays.       So I could work two long days

on Monday and Friday and have the rest of the time to help with
the children and begin to move into this.

        So what we did first was go back into that same apartment

building two blocks away from here and start just doing a part-

time health service there.    We brought in sheets and put up those

dividers and put exam tables in there, and just started doing--1

don't remember, it was a minimal amount of health care there in
that building.



Mullan:    When you say "we," who?



Goetcheus:    Well, in this model there would be a mission group,

so it was a small group of people.



Mullan:     So you joined a group?



Goetcheus:    Yes, joined a mission group and began to dream this.



Mullan:    Was this a new group?     You had such a specific agenda,

you ended up back in the Ritz?
                                                                    35

Goetcheus:    Yes.     I didn't know at that time it would be the

Ritz.     It was a small mission group that was meeting around
health issues.       The thought then at that point was to do a
telephone-type of crisis kind of thing.



Mullan:    Was this Columbia-based or D.C.-based?



Goetcheus:    This is D.C.    We were coming into Church of the

Savior.    We were living out there because of the emergency room
and thinking Al's work was going to be out there, but we were

coming in here to be part of the community.      So it was D.C.-

based.    So that led then to this two-bedroom apartment down the

street.    We outgrew that and moved to a two-bedroom apartment.



Mullan:    You moved to a two-bedroom apartment?



Goetcheus:    Yeah, down the street.



Mullan:    With three children?



Goetcheus:    Oh, not us.    We moved, too, but I'm talking about the

health service.      The health service moved to a two-bedroom.

Kellogg Foundation came in.      Do you know a person by the name of

Granger Westberg [phonetic]? Granger Westberg was a Lutheran

pastor.    Ever heard of the Parish Nurse Program?    It's an

interesting one.       It's where they put nurses on staff in

parishes, churches and all, and they become kind of a health
                                                                     36

worker.   Most of them are not in low-income kinds of things.

Most of them are in traditional kinds of work.    Anyway, that grew
out of his outreach later on.


Mullan:   Did he have anything to do with Kellogg?



Goetcheus:   Kellogg had come to him because he had started a

model in which you have a physician, a nurse, and a pastoral
council working together in a holistic team.     They funded these.

There must have been around seven of them going before we were
there.    There was a great deal of emphasis upon looking at the
person "holistically."   So that prior to coming for the physical,

the person filled out a number of things in terms of all the

stress issues and such that were in their lives.     When they had

their physical, they sat down with the whole team and looked at
their health in a wider perspective.    Kellogg funded them for a

number of years.   There are still a few of them going,

particularly in the Chicago area.



Mullan:   What do they call them?



Goetcheus:   Kellogg called them holistic health centers, and then

each of them had a [unclear]. There's one in Hensdale

[phonetic], there's one in Woodridge.    There's some conference

that's held every year where those folks are still--but Kellogg

was the one that made that possible.    I had known Granger through

his work in Chicago a little bit, and he came out here and
                                                                     37

visited when we were thinking of wanting to expand our work.
Then he went back to Kellogg, and that's how we began Columbia

Health Service.    Kellogg provided the first money for--this would

have been in '79--for Columbia Health Service, which was a two-

bedroom apartment down the street.     We were the first one not
located in a church, in the marketplace.      We started out with

that same model: pastoral council, physician, nurse.     We added a

social worker to it.



Mullan:    This was Kellogg-sponsored or assisted?



Goetcheus:    Right.   What we found was, unfortunately, we were all

white, and our patients were African-American and the poor.        That
was a very intimidating thing to sit down with the whole group,

let alone the kinds of questionnaires that we were being

[unclear]. So we began very quickly to adapt it to our own

setting.     The people themselves, in terms of participating in

that, and even now here or at Columbia Road--because we have two
social workers there--I think there's a real sense of holistic
part of that.     It's not in the sense where we sit down as a whole
team with the patient.     It was too much.   Anyway, that's how

Columbia, the first three years, went, was because of that

Kellogg grant.



Mullan:    You were the only physician?



Goetcheus:    At that time.
                                                                    38

Mullan:   Who were you seeing?



Goetcheus:   People here.   Besides the Ritz, other buildings began

to be purchased.    There are now nine low-income apartment
buildings in the area, purchased by the group now called--it

wasn't then--but called Jubilee Housing.    So there are nine low-

income apartment buildings.    So persons that were living in the

Jubilee apartment buildings and then other poor people who were

living in the neighborhood.    That was in '79.

     We get into the first part of the eighties when the war in

Central America and El Salvador was going on, and so a great

influx of Latinos here in the area, our patient population

changing tremendously, now going to making sure that our staff

had bilingual capabilities and could reach out to those folks.

We moved from a two-bedroom apartment to where we are now across

the street in '89 out of a need of more space.    Other physicians

began to come.



Mullan:   The Jubilee apartments, now nine in number, lesser in

earlier years, are essentially places for low-income, many of

whom have been homeless?



Goetcheus:   I wouldn't say the largest number.   These are

primarily for families.     There are some singles, but most of them

are for families.    One has been adapted for elderly, Sierra

Circle.   They're not, but the rest are for families.   So there

are some homeless, but the largest percent are not.
                                                                       39

Mullan:     People of low income.



Goetcheus:     Very low income.



Mullan:     Most of whom have not had any kind of regular medical

services.     That was the core of the practice as it developed?



Goetcheus:     Right.   Anyone here in the neighborhood, if you were

poor, you could come.      Even now that's the criteria for us.   In

fact, we can't take any new patients right now, but the way you

become a new patient at Columbia Road is the social workers talk
with you first to make sure you're poor, if you have other

resources.



Mullan:     The nature of the medical problems and how you related

to things like hospitals and Medicaid?



Goetcheus:     That was a real learning experience.   Do you know a
health service called Community Hope?



Mullan:     Yes.   Tell me about it, though.



Goetcheus:    When we were still in the Ritz then, I had met the

folks at Community      Hope, and they had just purchased the

building where they are now on 1417 Belmont.      If the Ritz was in

terrible condition, you should have seen the Community Hope

building.     It was unbelievable.   There was only one person, Rita,
                                                                         40

 there.   The only electricity, there was a light that would hang

down with a bulb on it.       Her family was there.       She became a

receptionist, and now she's with the partnership.           She has an
executive position with the partnership.         But anyway, she was in

that building.       So we went into what now is their chapel, and we
set up a little health service.      This had been back before we

ever put the two-bedroom one down here.         How did    I get on

Community Hope?



Mullan:   Talking about developments.



Goetcheus:     Okay.   S o I was seeing patients right away from both

here and the Ritz and Community Hope that were coming in.



Mullan:   Now that's far away?     I'm not sure.



Goetcheus:     No.   It's just here at 1417 Belmont.       It's right

between 14th and 15th on Belmont.      So you're right across from

the Meridian, part of Malcolm X Park.      So   you're about five
blocks away.



Mullan:   What year are we in?



Goetcheus:   I know why we went there.     It was one of the two

early buildings was there.      They had purchased one called the

Cresthill (phonetic). This would have been probably in '77.
                                                                      41

       So right away I needed specialty care.    I needed upper GIs,

lower GIs, and no place to get them.    I needed to be on hospital
staff.    I went to Georgetown, unwittingly.    Unwittingly for two

things.    One is they would never allow, now they do, but they

would have never allow a family practitioner.     Although I wasn't
even a family practitioner, this was before even any of that, but

they would never allow a generalist on the staff, let alone, when

I was honest about it, my patients would be uninsured.      So they

sent me to Dr. Land [phonetic]. He sent me over to Providence.



Mullan:   Who was Dr. Land?



Goetcheus:    He's passed.   He was head of their--this was in '77

or something, so they had begun a family practice program.      He

had sent me over to Providence.



Mullan:    Providence Hospital?



Goetcheus:    Providence Hospital.   I met with Sister Irene.   She

was very welcoming, no problems as far as being uninsured.
That's where I started on staff.     [unclear] patients.   Even with

that, trying to get through to get X-rays and all that was a

major problem.    So then I tried D.C. General, and there was no

way.   At that point, the only way I could get an upper GI or

whatever diagnostic procedure I wanted done on an out-patient

basis was to go through that emergency room, was to literally
                                                                        42

send the patient in with a slip into the emergency room saying I
need an upper GI.


Mullan:   For Providence?



Goetcheus:    No.   I had no route to get diagnostic work out-

patient at that time, except to go through the D.C. General
emergency room.     We tried to get direct into the clinics, had no

success at all getting into the clinics.      We do now, but this was

early days.    So it meant sending someone to the emergency room,

having the emergency room doc schedule them while they were there
getting scheduled for a medical clinic, hoping that the reason
they were sent in the first place to get an upper GI would get

there at the appointment, whenever that was, hoping the person

would then come back for the upper GI, and hoping I would ever

get the results.     So it was extremely frustrating.

     So those early days, in terms of all the obstacles to care,

in fact I got into trouble with D . C .   General at that time.   The
guy who eventually became very involved with the beginning of

Health Care for the Homeless, Bob Johnson, who was madder than a

snort at me because I preached a sermon.       I preached a sermon one

time over here at Potter's House--it really wasn't a sermon, it

was during a worship service, but I just shared all my

frustration.



Mullan:   Potter's House is?
                                                                      43

Goetcheus:     It's a coffee house that's adjacent.    That was one of

the outreaches of Church of the Savior.       It's adjacent to
Columbia Road.     I just shared my experiences with trying to get
patients through that D.C. General system, and someone sent a

copy to Bob Johnson.     He was so mad at me.   Did you ever know Lou
Diamond?     He was head of medicine over there.    He's with some

private group now, but anyway, he was head of medicine there on

the Georgetown side of it.     They were so upset.    All I was doing
was sharing all the experiences that patients had had.



Mullan:    It probably helpful, was it not?



Goetcheus:     Oh, no.   It was very threatening.    I got nasty

letters from them, but as the years went on, he was helpful in

getting Health Care for the Homeless going.



Mullan:    This was Bob Johnson, who was a hospital administrator,

who has since moved on.



Goetcheus:     Yes, he's moved on.



Mullan:    I know Bob.



Goetcheus:     In those early days, but then we became friends and

he was helpful, and Lou Diamond.      I think he tried very hard at

D.C. General.     There was just no openings in terms of trying to

set up, as he would say, a private practice kind of model in the
                                                                    44

middle of D.C. General where the emphasis was on continuity.     He

had it all planned out where Georgetown would do that and have
your medicine clinics set up that way, but he never got the

support.



Mullan:    In terms of the experiences between 1979, when did you

actually move there?



Goetcheus:   We moved in August of '76.



Mullan:    The Columbia Health Service actually opened in '79?



Goetcheus:   Yes, and before that we were at the Ritz, with Hope,

and started going over [unclear].



Mullan:    But between then and now, there have been many

developments, and you listed off numbers of institutions which

have been spun off of your efforts and the general efforts in the

community.   Maybe if I just gave you an open mike and asked you
to summarize in short form the developments over the years,
because the whole history of all these institutions and your
involvement with them is, I'm sure, very extensive.    For our

purposes, if I can just get a precis of the developments, because
then I do want to talk about your work now and how you see the

system and your life now, but in order to fill in between the

mid-seventies and the mid-nineties, if you could give me just a
                                                                       45

fly-over, filling in the important institutions that you have
either spawned or worked in over that time.



Goetcheus:    We started going over to SOME.



Mullan:   Which is So Others May Eat?



Goetcheus:    Yes, it's a soup kitchen.     Just took a small room

adjacent to the [unclear]. That's where we began seeing lots of

homeless persons.       That led into the experiencing of desiring a

place at Christ House, because that's where we were seeing folks

that we were turning right back into the street.



Mullan:   So the SOME experience was which year, roughly?



Goetcheus:    I can't remember what year we started that.     Probably

'81.



Mullan:   So you had Columbia Health Service as the first.



Goetcheus:    Yes.



Mullan:   Then the work at SOME.



Goetcheus:    Well, C        Hope.



Mullan:   C          Hope, which we talked about, which was next.
                                                                       46

Goetcheus:    Then SOME, and then Christ House came out of that

experience.



Mullan:   How did that happen?    A word about Christ House.



Goetcheus:    By that time there were three physicians: myself, Don

Martin, David Hilferton [phonetic]. We were all sensing the need
for a place that homeless persons could come and could recover.



Mullan:   Mid-eighties, there were three physicians, and it was

Don Martin.    He was based?



Goetcheus:    Both of us were both going to SOME and here.     I was

going to SOME, C         Hope, and Columbia Road until David came,

and David didn't like doing all this jaunting all over the place.
So he took C         Hope, and that freed me up then.    That's when

Health Care for the Homeless was starting.       So the same time

Christ House was beginning, then Robert Wood Johnson and Pew gave

the 25 million across the United States to begin Health Care for

the Homeless.



Mullan:   That would have been 1986, ' 8 7 ?



Goetcheus:    No.   The grant came out in '84.    It came here in '85.

So the Health Care for the Homeless began on the back porch.         It

was a back room.    There were desks in there.    That's where the

teams came back because at that time we couldn't stay out in the
                                                                      47

shelters.     [unclear] was one of our places, that was before it
was renovated and it was just--I don't know if you ever saw
[unclear] before, but it was an experience.     We didn't have water
and we carried in water to wash our hands there, and rats, etc.

So anyway, the teams would see patients and they would bring

charts back and do their work.      Then that led to Christ House.

Christ House opened in December 24th of 1985.
     The only other thing during those years was that early on at

Columbia Road, the city had come to us and said, "Would you begin
a pre-natal program?"    They offered fifty thousand, and that was

much more than our salaries at Columbia Road, but even in those

days, you could never get an OB for that.      So we hired two nurse

midwives and put them on staff at Providence.      Then we had two OB
physicians, one who came--her husband was here, Oscar Hamilton

[phonetic], and then an OB that followed her along with the nurse
midwives still connected into Providence doing some, but the

people that were high-risk at Holy Cross, but primarily at

Providence.
     Then Patuxent came to us, which had combined the program
with the Upper Cardoza program [unclear], put those together and

formed [unclear]. So that's when we took our staff, combined it

with [unclear], besides Maria.



Mullan:   Was Maria at Cardoza?



Goetcheus:    She was at Cardoza.    So we did that.   We linked it

into Providence, moved it down the street to their [unclear],
                                                                      48

hunted for a facility here and moved it down there.     Maria

[unclear]. That was happening.      I don't remember what year,
though.



Mullan:     It's amazing the number of institutions that have grown

out of this.    The [unclear] Center is a wonderful place today,

folks focused on maternal/child health.    December 24, 1985,

Christ House opened.    What was the vision here?



Goetcheus:     The vision was to have a home where folks who were

homeless and who were sick to simply come and recover.      It was
also very much a place where we wanted to live.     We all lived

here.     David lived just a few blocks away.   Don lived down the
alley, and we lived a block away.    We'd moved into the city in

'79, when we left Columbia, and came in here.      That was a major

transition in our lives at that point, with the three children

and their own transition. Anyway, we all lived in this

neighborhood, but we all very much wanted it to be a home for
people and part of our kind of faith journey, we wanted to learn
to be with people and not just to do for people.     So part of the

decision was that we would come and we would live here, too.

        So it's been a learning experience for all of us through the

years.    Much sicker people.   We thought we knew pretty well who

would be coming, because we'd been seeing a lot of homeless

persons, knew the type of problems we would have, but certainly

much sicker.     I think that's been as the years have gone on
                                                                    49

because people are kept in the hospital a much shorter period of
time.     They're back out on the street [unclear].



Mullan:    But the idea of Christ House is it would provide not

only residential, but residential facility for the sicker member

of the community?



Goetcheus:    You had to be homeless and you had to be sick. We
picked out the sickest ones to come because we had a limited

number of beds.



Mullan:    How large of a facility?



Goetcheus:     On the second floor are thirty-four beds.



Mullan:     That second floor is?



Goetcheus:     It's a nursing floor, the one you came up on.   There

are thirty-four there, where the nurses are.     There's twenty-
four-hour nursing care.     Originally this was not part of the
dream.    We thought these top floors would be for medical students

and others who were coming to volunteer.    We eventually knew we

wanted to use these rooms for men who had been on second floor,

but were not ready to go out and live independently, had had a

stroke, were demented, whatever reason, that needed to stay here

longer.     So we got a house down the street for volunteers called
                                                                          50

the Manning House.      It's right across from Joseph's House.     So

that's why there are a couple of [unclear] here.



Mullan:    So there are transitional [unclear].     How many beds?



Goetcheus:    There are eight beds.    For a while, the folks that

were here, the men, were here for at least a year because we'd

have to have them here.     We'd have to be trying to find

apartments in the neighborhood where we could get them to.

That's when we put the new place across the street.        It just
opened in January.      That's thirty-seven apartments, and that is

for chronically ill homeless persons.      Those f o l k s who came in,

[unclear].



Mullan:    What is that called?



Goetcheus:    Kairos.   K-A-I-R-0-S.   It means a special time in

someone's life, a time of change.      It's just been opened in
January.


Mullan:    There's how many?



Goetcheus:    Thirty-seven apartments.   The other thing that was

happening is that we began to see much more HIV people.



Mullan:    In Joseph House?
                                                                     51

Goetcheus:     [unclear].



Mullan:    I'm just trying to get the institutions.



Goetcheus:     We started seeing a lot more HIV.   A lot of things

have happened around this table.     We sat around this one evening

and David was here.



Mullan:    David Hilferton.



Goetcheus:     We made a decision that we needed to get a house just

particularly for them.      The numbers were going to be so great of

HIV.    David came back to us and said that he and his wife and

kids, if we could find a house, he and his wife and children

would move, and we began putting HIV folks in.      That was Joseph's

House.    So Sister Marcella, who lives upstairs, went out here,

walking her dog, and found a house in the neighborhood over here

on the corner.
       None of these things have we ever had money for when we

started.     We had no money when we started Christ House.   We began
sharing the vision and figuring out how we were going to do all
this stuff.     So we might go into foundations and see what we

could get to pull it together enough.     Anyway, that's how

Joseph's House--and three of the men, the first three men--what

year did Joseph's House begin?      I can't remember how old it is

now.   Anyway, Howard [unclear] this past weekend.     There were

three men who were living with us here on this floor who moved.
                                                                      52

When David moved over, then three men moved over.      He was the

sickest of the three men and we thought he would probably pass
first, and he just passed.



Mullan:   This would have been in 1990 or something?



Goetcheus:   I'd have to guess it was around six years ago.



Mullan:   So there's Joseph House, which is HIV.    There's Mary

Center, which is maternal and child health.     There's Kairos,

which is the chronically ill homeless.



Goetcheus:   Permanent.    That's permanent housing.   If they want

to stay there, they're welcome.



Mullan:   Chronically ill, permanent.    There is the Christ House,

which is homeless, sick, non-permanent.     The Columbia Road Health

Services continues?



Goetcheus:   Yes.    There's five of us there, but it's various.

It's not five at a time.



Mullan:   Five physicians?



Goetcheus:   Yes.     It's Don Martin and Bob [unclear], he teaches

at Georgetown.      They are all family physicians, except a

pediatric nurse practitioner.
                                                                        53

Mullan:   And Jubilee Housing?



Goetcheus:     That's not.   That's much before.   There's a whole

number of outreaches of Church of the Savior around this

neighborhood--Jubilee Jobs, there's a number of children's,

there's a garden center which is a Montessori school, FLOCK,
[unclear]. Did you ever hear of an institution called Junior

Village?.     It was here.   It was an orphanage years ago.



Mullan:     So Jubilee Housing continues with its own projectory?



Goetcheus:    Every one is a separate non-profit type of thing.



Mullan:     The network of health related institutions, is there a

framework under which they all work, or is each one independent?



Goetcheus:    They're each independent, they're each non-profit.

Like Health Care for the Homeless has its separate board, Christ
House has its own board, Columbia Road has its board.         They're

all separate non-profit.



Mullan:   The Health Care for the Homeless as an institution is

maintained an administrative and service life that's grown

outside of this community.



Goetcheus:    Oh, very much so.   We were j u s t the beginning

overseers.
                                                                     54

Mullan:   Tell me about that, because you've been involved in

that, in terms of your current job.



Goetcheus:   In '85 when we began, there was a board.     Our vision

was always that the money would be used to put health services
within the shelters.    The board might know this, but we knew that
we had Columbia Road, we had SOME, we had C       Hope.    What we

needed was to go directly into the shelters.   The first shelter

we went into was on Emancipation Day in February of '85.      It was

in a coat room.   You know these shelters were in old school

buildings.   So we had a coat room and we built another little
room onto it, and that was our first health service for Health

Care for the Homeless.



[Begin Tape 2 Side 11



Mullan:   This is Dr. Goetcheus, tape two, side one.    You were

saying about Pierce?



Goetcheus:   That Pierce Shelter was the first shelter we went

into.



Mullan:   Let's close for a moment on the homeless.    As I

understand it, homelessness was less a phenomenon or less an

appreciated phenomenon through, say, the 1970s.   But by the mid-

1980s as you worked in this community, and this community

mirroring others around the country, homelessness had become a
                                                                     55

very prominent and disastrous feature of community life.
Describe that a little bit.    Where did it come from?   Did we not
appreciate it before or was it getting worse?



Goetcheus:    My sense would be that the numbers were increasing.

I'm not an expert in that area, but the housing stocks were going

down.     The old kind of what we knew then as SROs, the old
boarding houses and all of that--



Mullan:     SRO being single residency--



Goetcheus:    Right, but the where people used to go into these and

get very cheap rooms and stay, all that kind of housing was going
so there were more people out on the street.     Drugs were coming
in and adding to all of this.    So I think the numbers were

increasing during that time.    Here in this city, in terms of

raising the consciousness or the voice, you had a person like

Mitch Snyder, who was coming in here, who was just really not

letting anybody forget what was going on here.     So that was part

of the consciousness-raising here in this city.     I don't know

here in D.C. what the numbers looked like really in terms of the

number of homelessness in the seventies as compared to '85, but

my sense would be because of all sorts, one of which was because

of the housing, the number of housing units decreasing, the more

the homeless.
                                                                      56

Mullan:   As I understand it, at least two important external

things happened to assist those who were interested in health
care problems.      One was the Robert Wood Johnson grants started,

you describe in '85 or '86, of which you were a recipient, and

they continued for some time and then phased out.



Goetcheus:   Yes.



Mullan:   But then the federal government got involved.



Goetcheus:   McKinney Act.    And that wasn't just health care.

That was various housing and all.



Mullan:   It included health care.



Goetcheus:   And it included Health Care for the Homeless.



Mullan:   Do you recall when did that start?



Goetcheus:   The Robert Wood grant was for four years, so it

kicked in--1 don't know.      I guess since this was '85.



Mullan:   Late eighties.    And you were recipients of funds for

that?



Goetcheus:   Right.
                                                                   57

Mullan:   And it continued?



Goetcheus:   Right, as well as some city money.   There were

originally nineteen cities, and each city had to decide how they

would continue on, and every city's model looked a little bit

different in terms of how they delivered the health care and how

they continued on with it.    Here in D.C., it was through the

McKinney money, which still is the major source of our money, and
it was through some local money which had diminished through the
years, particularly now.



Mullan:   The Health Care for the Homeless organization grew in

the city and now has a responsibility for broader health care.

Tell me about how that developed and how that's functioning

today.



Goetcheus:   In terms of 330 involvement or other?   HIV stuff came

in, so we began to get HIV money, and that led into some things
that weren't just primary care.    It led into a drop-in center for

homeless persons.   It led into another respite area like Joseph's
House, a small house.   So that was another aspect that grew out

of Health Care for the Homeless.   Then the number of shelters we

started going to, those increased in numbers as we added

additional shelters.    Then what happened with the homeless

families here in the city, they were out at a 1,000-bed shelter

out on Capitol City Inn, a terrible, awful, awful place.   Then
                                                                    58

the city put the homeless families in Pits, which is also awful,

awful place.


Mullan:   That's Pits, P-I-T-S?



Goetcheus:     Pits Hotel, when you're coming up Fifteenth Street

right at Belmont, and look over there.    They put all those

homeless families.     They paid an inordinate amount of money.

They could have put them up at the Watergate and paid less, and
they put them up at the Pits.     So we had health services there

and there was one other hotel down at Fifteenth and Rhode

Island--General Scott.    Anyway, but what happened, they decided

they were not going to no longer have hotels.     They'd put them

out in Southeast in public housing projects.     So that led us

going out to traditional kind of health services to reach

homeless families.     So we're out of a public housing project

called Woodland Terrace five morning a week.     Then we went into a

church and then moved that one from the church into a
professional building right at Martin Luther King Avenue where

there's a big chair, but it's only part-time.     So we had been

doing some not-in-shelter kinds of things when the 330 came, and

that came this past year.



Mullan:   Tell me about the 330 happening.    It's the community

health centers in the District that were in bad shape.
                                                                       59

Goetcheus:   Right, and had been in bad shape a long period of

time, as long as I can remember--C       Hope was right down the

street--as long as I can remember in terms of being able to

access those health services for the people that we were seeing,
often uninsured, who had [unclear]. So I know from that
standpoint through the years of trying to make any kind of a
cooperation with them, it was very difficult.     So I knew a little

bit that they had lost a number of physicians and that kind of

stuff.
     But anyway, the feds knew us because of involvement, because
we were a 330 program, and because we had to go through
inspections and all that, and just because we're here in D.C.      So

I think that led to their--when they knew that they no longer
wanted to fund them, coming to Health Care for the Homeless,
which was a real struggle for the Health Care for the Homeless
board to know whether to do this or not because they knew it had

the potential of being so overwhelming that it could really

affect our ability to sustain ourselves in our 340 program.       So

there was a lot of soul-searching with regard to whether or not
we would take these on.   Anyway, ultimately made the decision to
do it.



Mullan:   Your role has been as medical director for the Health

Care for the Homeless operation as a whole.     When did that start?



Goetcheus:   From the beginning.   Since '85, that's my primary

work, is with Health Care f o r the Homeless.   I mean, I live here
                                                                    60

at Christ House and, yes, I'm here, but that's part of my life.
My patients are here and I'm over at Columbia Road, but I'm only
on at Columbia Road a couple half-days a week because the rest of

the physicians can carry that for me now.      I need to go in there

to maintain contact with people and with homeless people who live

there who come over to see me over there.   But my day to day,

where I am during the day is the Health Care for the Homeless.



Mullan:   That's principally administrative?



Goetcheus:   No.   I take one day--I'm trying, we 11 see what

happens--I'm taking Wednesdays now and I'm at Cardoza and just do
administrative meetings on Wednesdays.    I'm trying that.



Mullan:   But the rest of the time principally clinical.     Clearly

you enjoy the clinical work, you've stayed at it, the
administrative side of things?



Goetcheus:   Huh-uh.



Mullan:   "Huh-uh" means you don't enjoy it?



Goetcheus:   I'm not good at it.   I'm good as far as being able to

vision and dream, but in terms of really getting down to

organization and getting all the lists and getting that all, that

would not be a gift for me.   Writing would never be a gift.    I
can tell stories of daily experiences, I can do that writing, but
                                                                     61

I cannot do the things that a really good administrator needs to

be.   So that's not a gift.



Mullan:   You had mentioned a decision made by your family and

others to live where you work.    Tell me about both what went into
that and how it's been.     It must be a very difficult decision

when you're working in a tough neighborhood.



Goetcheus:   There are two parts to that.   One was early on in

terms of moving in before Christ House and bringing the children
into the neighborhood.    This was back when the neighborhood was a

much poorer neighborhood.     The decisions that we worried about,
safety issues for the children.    The children, when they were in

Columbia, Maryland, thought they were in heaven.    There was every

recreational thing any child could ever want.    So to move in was

a very major decision for us, and especially when they began to

have some trouble here in the neighborhood.



Mullan:   The kids began to have trouble?



Goetcheus:   Yes and at that time we would ask ourselves, "What

have we done?"   If you talk to the children now, I think you will

hear 90 percent will be a very positive thing for them, a real

appreciation of the gift it was for them to be there.    But even

then, they'll start to tell their war stories and then I'll be

able to [unclear].   So anyway, that decision was hard, but what

we were convinced about, or what we thought we were at the time
                                                                      62

was, I was more worried about what was happening to them in
Columbia, Maryland, than I was over what might happen to them
here.     I was more worried in terms of the values.   They were so

apart from seeing the daily suffering that we were seeing, and

they were so apart from getting to know the people that we knew

and that were so enriching.    That's one of the joys of my being

here.     The guys who walk in here, they're like family to me, and

I'm grateful for them.     It's wonderful.   And we wanted them to

have those kinds of experiences.
        So we felt schizophrenic.   We felt like we were preventing
the children from really knowing their richness of the people
that we knew, and we wanted them to have those same

opportunities.    And that meant living here.    It's very hard to do

it and bring kids in once or twice a week, at least for us.     So

anyway, that led to the decision here.
        The decision to move into Christ House was an easy

transition for the kids and everybody else because we had already

done it.    But the decision here, again, was to be with people.
We wanted it f o r ourselves, as far as our own journey, but also

we felt it would important.    See, behind this, I can't tell the
story of Christ House--there's actually a faith community, and in
that faith community are homeless people and others and we're

together on a--



Mullan:    A faith community is?
                                                                      63

Goetcheus:     It's the heart of Christ House.    Anybody wouldn't

know that, but like every Thursday night there's a dinner and
it's lovely.    We always get stuff that the men will like.     But

always meet downstairs, and then there will be a simple liturgy.

And then there's usually a gospel group that will come in and

[unclear].     This group is six of our guys, homeless guys, that
did the group.     I had to go out to a shelter event and I missed

it.



Mullan:   The singing group?



Goetcheus:   Oh, yeah.   One's a guitarist.      He's [unclear]. He's

now with us upstairs, he's not been here too long, but he'll move

over to the [unclear]. He was the guitarist and the other five
guys, these are guys who have been in prison, just awful kinds of

things, and all are sick.    One's going for a carotid

endarterectomy this week, I'm scared to death over it, and he's

already had two strokes. Anyway, they're all in leadership

positions now, some of these.     I didn't even talk about that, how

these guys [unclear] responsibility the decision of who comes in
that building or not.    The leadership all happens through the
men.   But anyway, these guys were the ones who sang.      But there's

a faith community behind that that brings this all together.



Mullan:   A faith community is the group that meets.
                                                                       64

Goetcheus:    It grew out of a model of Church of the Savior.    So

there are gathering times, like on the Thursday night when we're
all getting together.



Mullan:    This is a group of people who formally constitute this

community?



Goetcheus:    Well, on Thursday night it's for everybody.

Everybody comes for dinner.    It's just dinner downstairs down in

that big dining hall, and you then you can stay or not stay or

not stay, and then there's some sort of a singing group.      That's
the thing on Thursday night.    On Sunday morning it would be a

more formal service.    We're Catholic, we're Protestant, we're all

sorts of things.     It's like an AA meeting, there's a Eucharist at

the end.     It's a very ecumenical kind of a thing.   We use a black

Catholic hymnal that has all the old Protestant songs that most

of the men knew, having grown up in Baptist churches.      But beyond

that then, there are these small groups.



Mullan:    I'm just trying to understand these faith groups.



Goetcheus:    I know.   It's so hard.



Mullan:    But it's very, very interesting and important to

understand for telling the story.       The faith community, I'm not

sure I have the right term, but the Church of the Savior mission
                                                                     65

group concept, in which there are a handful of six, eight, ten
people?



Goetcheus:    Ours is only five, the mission group I'm in.



Mullan:     That's based here?   What is the relation between the

mission group, as in the one you're in, and what you're calling

the faith group or the faith community?



Goexheus:     When someone wants to move ,nto membership to be a

part of the faith community, and this commitment is made on a
yearly basis, you can drop out of membership if you don't want to
keep the disciplines or prayer or whatever, but when you do that,

you go through a preparation for doing that.      That means there

are classes: Old Testament, New Testament, prayer.     There are six

classes you go through.    We've [unclear] because they're not

Church of the Savior kind where you wrote papers and all, sort of

like a mini-seminary.    Even ministers, my husband, all went

through, but we had to do that because a lot of the men don't
read.     So we used these and taped the lessons and that still

happens.



Mullan:     So that's preparation?



Goetcheus:     That's preparation.   Then after you've taken four of

those courses, you can go into a mission group if you so choose.

Those mission groups are around certain [unclear]. Our mission
                                                                     66

group--do you know Family Place?      It's another one of these.    All

of our mission groups are centered around things that happen here

at Christ House.   Most of them began with things out in other

places.   Anyway, the one I'm a part of has to do with welcoming

new people, and so the guy who runs the [unclear] downstairs, he
is also on the board of Christ House now.      He, myself, and two

others are in that mission group and we're together on a weekly

basis.    Then there's so many levels of community.

       Then the residential community who live here also gather for

a meal every Tuesday night.      They're sharing dinner, there's

accountability in it.     That's at the heart of Christ House, but

nobody would know that, but that involves men and growing in

community with the men and how you bring out the men's leadership

here and empower them to be the leaders for their own community.



Mullan:   To wind down here, general questions I want to ask, just

finish out on the kids.    How have they done?    What are they doing

now?



Goetcheus:   Well, they're wonderful.     Our oldest went law school.

He went to Catholic [unclear] for grad school, and he is a Senate
legislative counsel now.       [unclear], he's doing Medicare and

lives here in the area.



Mullan:    In the community?
                                                                        67

Goetcheus:    No.   His wife teaches first grade in Montgomery.     Our

middle son is a food manager for a large Lutheran retreat center

out in the Cascade Mountains.     He's been there four years.     And

our youngest is a nurse at D.C. General and is going back taking

chemistry now, trying to decide whether or not she wants to go

through med [unclear] or whether she wants to go into nurse

practitioner training.      She's in the emergency room at D.C.

General.



Mullan:     That's great.



Goetcheus:     She's here at Christ House with us.   She's the only

one who lives here.



Mullan:    You lived through a period in this city of a lot of

change and, one would think, a certain amount of social

deterioration.      I don't know whether that's fair, but I'd be

interested to know what your observations are on the life of the
city and how you feel about the outside players--federal
government, city government, philanthropic community, how they

have related to the inner-life of the city you have been so

involved with.



Goetcheus:     In terms of the social deterioration, I think it

certainly has worsened in terms of access issue for health care

for all people.     I think it's worse now than any time I can
remember.     I think there's less access now and I think it's going
                                                                      68

to get worse.     I don't see anything ahead that's going to change

anything.     [unclear] people out on the street.   Like I [unclear]
one of these families on Wednesday night, generally younger

folks, crack-addicted.    They're lining up for the soup [unclear]

and hopeless.     I only see worse things ahead, and worse things
ahead for them, in terms of accessing health care.

     In terms of the city, our foundations, or all that,

foundations are being inundated because the government money is
drying up.    Then they're getting a lot more applications so they

have to try to divvy it up around.    Foundations want to [unclear]

get going, but they don't want to do general budget stuff.      So

we're seeing non-profits really struggle to stay alive.

     In terms of government stuff, of course here in the
District, that's a story in and of itself.     We lost all of our
funding here at Christ House locally.    Health Care for the

Homeless is struggling because it sort of can't pay its bills,

and therefore those payments don't come in.     Whatever happens,

[unclear], jargon is public-private cooperative.      I don't think
non-profits can do it, never handle the need.       It's always going

to have to be a cooperative effort between the government,
foundations, and non-profits.



Mullan:   You've seen D.C. government establish itself as a quasi-

independent force and then kind of, at least in the eyes of some,

fall apart.     How do you feel about that?   You've been a

theoretical recipient of their benefits, and yet it's not been a

pretty picture.
                                                                       69

Goetcheus:    Part of it is I ache.    The part that makes me ache is

that in knowing the history of racism in this country and knowing

the history of this city in terms of empowerment for African-

Americans who have been so oppressed, and now to see that power

yanked away from them is very sad and doesn't recognize all that

this, what particularly white citizens of this country have done

to oppress people.     So the [unclear] I feel very sad about.



Mullan:   As in the control board asserting itself?



Goetcheus:    Yes.   That's the one part.    I also know that people

are suffering there.     So I know the need.   Even when we get

involved in [unclear], when things were so terrible at the

shelter, we were part of being expert witnesses and going down
and testifying against the city and all that.      But that's

necessary in terms of you can't allow people to continue to

suffer.   You can't allow the kids in schools to continue to

suffer.   But there's a gleam in some folks' eyes, as far as--



Mullan:   "We told you so" kind of thing?



Goetcheus:    Yes, or a sense that, "African-Americans couldn't do

it.   Now we're going to have to take it back."     So it's

[unclear]. What we've reaped in this city.       How young is this

government?    It's not very old.     D.C. was the slave-trade capital

of the whole East Coast.     They paraded slaves up and down in

front of the Capitol Building.      The Europeans used to be so
                                                                   70

embarrassed when the Europeans would see all this happening.

Then to see and to know that history through the years, how they
went through the false shepherds [phonetic] and all those aspects

of it, the council being appointed, the corruption, I don't know
what we're getting, because by history what the federal

government did here was terrible.    I mean, as corrupt as could

be.   Then finally getting to an elected mayor, which was a major

thing for African-Americans to be able to have that kind of an

opportunity.    Now that we're back into a predominately white,
it ' s--
      The other one, and I can hardly even talk about homelessness

[unclear] the whole jail stuff and what's happened with the

[unclear] justice system and the jails, numbers increasing, the

impact that's going to have on social [unclear].



Mullan:    Appreciating that the outcome of that is more shredding

of social life and people who are bereft of skills, what is your

front-end approach to that?   What ought we do, given rate of
violent crime, and crime, and drug-related crime, and so forth?



Goetcheus:    Whenever anybody ever asks me how to end

homelessness, I always say start with the children.      So if I had

X amount of money, that's where it would go.


Mullan:    [unclear].
                                                                        71

Goetcheus:   If we don't, we're in trouble.     We're already in

trouble and it will get worse.      Someone told me Marion Wright
Edelman, the Children's Defense Fund, just issued something that

showed Washington as the worst city in the nation for a child.



Mullan:   You've seen the neighborhood change a fair amount.

Poverty and related issues were largely an African-American

phenomenon twenty years ago.       Today this community has got a

large percent Hispanic and then there are others, at least in

terms of upper Cardoza, I'm aware that there are many different

groups.



Goetcheus:   Vietnamese.



Mullan:   Right.    Residential1   they are not necessaril I in this

community, are they or are they not?



Goetcheus:   Vietnamese in Mt. Pleasant area, a large number.       I

think we saw several transitions, one with persons coming from
Central America from the war and very poor Latinos here, multi-
family dwelling kinds of things.      Then what we've seen most

recently is the gentrification of it.      So folks with money coming

in and buying up.    You can't touch any property here.    I suppose

the cheapest house you could get here in the area would be around

$400,000 to buy.    Your rents for an efficiency here in this

neighborhood, other than Jubilee Housing, but in a normal

efficiency--we rented a two-bedroom apartment, we had four of the
                                                                     72

men in a two-bedroom apartment down the street, Park Plaza.       It's
an okay apartment, but it's not anything fancy.     Twelve hundred

dollars.     So we've seen all this property bought up, renovated,

sold, renovated again, resold.    So the number of poor are

decreasing in this neighborhood and they're being pushed out.
There are areas that the whole neighborhood will become a

Georgetown type of setting.



Mullan:    Is that proceeding rapidly?   What does that mean for the

institutions that you've got implanted here?



Goetcheus:    Well, as far as Christ House, that's okay because

folks come to us.    There is a homeless shelter at La Casa

[phonetic], but the homeless shelters tend to be more downtown so

people come to it, so it won't affect us here.     The health
service, it may well affect us.    It will be whether people can

get to us.    We're on a good bus line there at Columbia Road.      In

terms of upper Cardoza, not a good bus line there.     So I think
people could get to those health services even if they were being
pushed out as they are over east of the river and south east of--
oh, my, that's a whole other story.      I've been in lots of poverty

kinds of situations. At least maybe part of it's being new over

there, but these are African-Americans, many of them older folks

who haven't had health care.    Here in this area there will be one

block of poverty and then all these new houses all being

renovated, but there it is just continuous rows of people who are

very, very poor, living in bad conditions.     It's a whole
                                                                     73

different feel for me in Southeast.   It's a forgotten area of

Washington.



Mullan:   Throughout your work, certainly here in D.C., you've

been a minority.   You've been a white working in either African-

American or Latino, or other minority community.    And that's been

in a time where it's been increasingly difficult, as compared to,

say, the civil rights movement when whites working among blacks

was relatively easy.   We've got all kinds of racial tensions.
How has that progressed for you and how do you feel about that

now?



Goetcheus:    In terms of Christ House and Columbia Road, we've

really struggled with that, because we're primarily white.    The

thing we have to struggle with is salary level, because the
salaries here and at Columbia Road are low, and the only people

who come here to be with us, in terms of being employed here, are

primarily white or on some sort of religious faith journey that
they want to do this work.    That markedly limits it, in terms of
our having paid staff who are minority.    The only people we pay
on regular market-value salaries would be our medical assistants.

We pay higher than what they would get in a regular setting.

       It was less so through Health Care for the Homeless, because

those were federal salaries, but, as you know, even for

physicians, those are low, and again we struggled with it and

have had j u s t to say, like in Southeast, "We won't hire a nurse

unless it's an African-American nurse."    Sometimes that's hard
                                                                     74

for the amount of money we can pay, even on a federal thing.        So
we've been very aware of it, and I think it's hard when we go to
even my involvement as a medical director.     I think it would be

much more preferable to have a medical director who was either

Latino or African-American in this city than someone who's white.

So we do struggle with those issues and not always very

successfully.



Mullan:     Primary care has become much more a trendy concept now

than it was a few years back, certainly when you were struggling

to do your externship in medical school where only two in the

class did it.     It's been important, I would gather, at least your

background has been important to your work, but many continue to

feel that specialty services are the way to go and maybe doctors

shouldn't be in primary care at all, we should have nurses and

specialists. As you've watched the issues of primary care and

the issues of health policy swirl around your work here, how do

you feel about that?



Goetcheus:     I heard Jesse Barber say that the poor don't have

enough of anything.    They don't have enough specialists, they
don't have enough generalists.    So I think there's a need for

both.     In our setting, I think it has been helpful that we had

generalists, especially when we worked with homeless families or

were on the van or wherever, that whoever walked in to that d o o r

could be seen, no matter what age.    So we could put a physician

there, and whether it was a minor health problem or whether it
                                                                    75

was someone with congestive heart failure or whatever, or no

matter what age the person was, we had someone there to handle
the problem.    You may ever only get one shot at that person when

they come in.    So I think that's been important.
We also have mid-levels who work right alongside the physicians.

We have physician assistants and nurse practitioners who work

right with us and are very independent.     But in that setting, you

commonly see people who, because they have not had access to

health care, don't come in just with the sore throats, but come

with 10 different health problems.     It takes a while to figure

out what all those problems are and then how to begin to address
them.     So I think there's a real need for both physicians, as

well as mid-levels and specialists.    There's just not enough of

any type of practitioner who wants to work in these types of

setting for the need.



Mullan:    How do you see the future developing for the medical

care sector?    You've lived up close and personal through AIDS,
through homelessness, through increasing epidemic of drug use,

through increasing related problems like multiple drug-resistant

TB, I would imagine--



Goetcheus:    Yes, that brings to mind a whole other thing of

advocacy stuff.



Mullan:    Let's pause on that.   How so?
                                                                       76

Goetcheus:   That's how we lost our funding.



Mullan:   You did lose your funding.   From?



Goetcheus:   The city.



Mullan:   Because?



Goetcheus:   Because we made people mad over talking about TB.



Mullan:   Inadequacies of it or just raising the issues?



Goetcheus:   Oh, it's a long story, but yes, we had been raising

the issues for some period of time.    There was an internist--have

you met Ken Singleton? He's an African-American physician who is

with Health Care for the Homeless, and now he's full-time in

upper Cardoza.   Ken was very versed with TB policy, and we were

very worried about MDRs (multiple drug resistant) TB.       So he went

out to the National Medical Library and gathered up everything he

could find that had been written about MDR TB.       Then we took it
down and showed D.C. Public Health officials.       We tried to say,

"Look what's ahead."     At that time the TB sensitivity studies

were not being done so we didn't even know really whether we had

MDR or to what extent.     Then some task forces were established

which were not really empowered.

     We were also finding homeless persons with TB discharged out

to the shelters.     We began to yell about that.    The city's
                                                                     77

response was to try to do a TB screen in the shelters here in the

city.     The whole thing was so ill-planned.   The medical society,

thoracic society all came out prior to the screen and said, "This
is silly.    Don't do it."   But they wanted the publicity.    The

thing that finally broke, that really made them angry was the

mishandling of a patient with MDR.    He was misdiagnosed while in

Lorton Prison, told he had a simple pneumonia, rather than MDR

TB.   He was released became homeless and eventually was admitted
to G.W. Hospital.    G.W. was great, but then he'd go out

repeatedly and use drugs and then he'd come back in.     He was an

active TB patient and finally they just said, "NO way."       They
called over to the public health officials.

        I was down at CCNU shelter when the phone call came, and

this public health official wanted to bring this patient down to

the shelter infirmary. And I knew he had active TB.      He was a

sputum-positive, MDR patient and they were bringing him down to

the shelter.    When I began to raise objections, the fellow said

to me, "Well, we have no other place to put him."     So at that
point we talked to G.W., who said, "Speak out."     So we did talk

with the media, with the result of being pulled out of the city

budget.    We weren't reduced, we lost the whole thing, which was
40 percent of our budget here.    Fortunately in the District at
that time, there was HUD money coming in, so we applied and

that's where we now receive 40 percent of our budget.

      But anyway, so with advocacy issues, it's a fine line, but I

think it's part of a physician's duty in a community to think

about the community's health, and part of that is advocacy.
                                                                      78

Invariably that's going to put you at conflict with people whom

you have to work with.     That's always been a struggle for me.
What do I do?     I know I need to work with D.C. General.    Okay.
So how much do I go after sometimes when I know that in terms of

quality of care issues--how much do you that?     How much do you go

after a TB clinic here that at times has no X-rays, at times has
no developing fluid? A guy was out on an elderly unit at CCNV
shelter--a 1,400-bed shelter, who had--well, it's a long story--

but he'd had abnormal chest X-rays we'd told the TB officials

about.     They said, "Oh, no.   It's just a little TB."   Anyway,

they did get sputum on him.      He'd been in the shelter all during

this time.     Sputums came back positive.   They called and said,
"Just keep him in the shelter."     We say, "NO way,'' and so we
start going through the commissioner's office--but what do you go

after when you're trying to work with people?     And how much do

you expose?

     Our experience thus far is even when we've gone to the

media, the media exposure hasn't made that much difference.
Everybody is, I think, so numb, you can't say too much anymore.
Amy Goldstein from the Washington Post wrote the articles not
long ago about the increased TB rates here in D.C., and all the

awful things at the jail, but we've become numb to respond.

     Advocacy, I forget how we got onto it, but advocacy is a

part of any physician's--



Mullan:    How has how you saw the future unfolding for medical

care?     Do you feel hopeful?
                                                                      79

Goetcheus:    In terms of access?



Mullan:   In terms of access, is the country going to get serious

about the unserved, uninsured?



Goetcheus:    I think it will for the middle-class because there'll

be enough yelling about that.    I think it's begun.    I think
that's why we're hearing it now.      It's got in a corporate level,

insurance rates and people moving from one job to another and all

of those issues.   So I think that's why it's at the forefront.

It has nothing to do with the poor.     We've known this about the

poor for years and years.   We've always known that in terms of

minority health rates, you can take any mortality, morbidity rate
and double it for minorities.

     For example, that report that just came out on cancer this

week--mortality rates among minorities.     The American Cancer

Society held hearings, it's been several years ago--showing

increased mortality rates among the poor.      It may have gone down
for some, but it's not gone down for the poor.     My worry on
health reform.   Yeah, it's going to be talked about, in terms of

working middle-class folks, but what happens to the quality of

care that happens to the poor?      I don't see many people talking

about them.



Mullan:   Does that mean you feel that things will remain the same

or get worse?
                                                                       80

Goetcheus:    Oh, I think they'll get worse.     People are sicker

now, also more HIV and more substance abuse.       That part will get
worse.    Even the hospitals now, hospitals have generally been

generous, like G.W.    G. W. did all of the lab work for Health
Care for the Homeless for years totally free.       Receive a call,

within a month it's gone.    I mean, it is totally gone.



Mullan:    This is the result of a sale?



Goetcheus:    This was prior to the sale, but this was when they

were financially struggling.    So all the hospitals are struggling

for their own viability and therefore don't have resources and

energy to reach out to uninsured.      So access points that we had

in the past, we no longer have.
     Did I mention about the Archdiocese Health Care Network?

It's 350 specialists.    Do you know Dr. Pelligrino?



Mullan:   Yes.



Goetcheus:    I don't even know what year.     He's been wonderful

through the years and has helped me think through advocacy kinds
of things.    I remember years ago, going and crying in his office
when I was with this mess with D.C. General.       It's difficult to

be an advocate and to work with an institution.



Mullan:   Let me turn the tape over.
                                                                     81

[Begin Tape 2, Side 21



Mullan:     Dr. Goetcheus, tape two, side two.



Goetcheus:     He was on Columbia Road's board and he knew the kinds

of access problems we were having getting people in to
specialists.     He went to Cardinal--who was then an archbishop--

Hickey, and said, "There's a real need here in the community for
a physician's network.''    We had tried it through inner-faith
groups, we had tried it through the D.C. Medical Society to get a

group of physicians that would see patients in their office,

specialists, and never could really get it going.     Cardinal

Hickey wrote every Catholic physician in the Greater Metropolitan

Washington area.     He invited them to his residence for a dinner,
beautifully catered dinner at his residence, and during the
dinner, got up and spoke in terms of the need and connected it

with one's faith journey and doing that.    And out of that came a

small group of physicians who spent a year planning the network.
The worry was if anybody put their name on that network, they
might be swamped, and therefore if their name got out, they

wouldn't want that.
        So we spent a year, and Dr. Pelligrino was the leader on

that.     Anyway, out of that now is around 350 specialists who

volunteer.     If we need an orthopedic consult, we go through the

network.     There's an office with two people, a Catholic sister

and one other, and we fax that information down to them when we

need an orthopedic physician or we need an ENT or whatever
                                                                      82

specialist.   The children, too, they have pediatric sub-
specialists now.    We're looking for a dermatologist right now.
Anyway, it's been a wonderful resource.



Mullan:   What's the [unclear] archdiocese?



Goetcheus:    Volunteer Health Care Network.   But it's a very

ecumenical group.    We started through the archdiocese, but it

really has been by word of mouth.      It has spread.   It's not just

here in D.C., it also serves people in Maryland and Virginia.



Mullan:   So that continues to work?



Goetcheus:    Yes, and they are swamped.   That's a whole other one

where they are swamped.    They are seeing increased load because

of more referrals and always having to keep up with, as

physicians retire, whatever, move on, then trying to fill those

vacancies, and never enough of certain kinds of specialties.



Mullan:   You've done colossal service over a tough and toughening

period.   As you reflect back over the twenty-plus years you've
been in this community now, how do you feel about your work--

medical, social, spiritual?



Goetcheus:    In terms of the work itself, I think I feel a sadness

in the sense of so much unnecessary suffering.      In terms of the

happiness part of that, I guess would be at several levels.       One
                                                                     83

is being part of a community of people that have been a real
support, and then also just being with the people.     Even on a
daily basis, just being with people here at Christ House or

patients or whatever, that's a very enriching experience for me
and it brings me lots of joy in just being there, and getting to

know all of them.   But also a sadness.    People often say, "Well,
what have you seen happen?."   We've scattered health service all

over the place and it doesn't make any difference.      Things get

worse and you're not going to see--or we don't.      We haven't seen

anything get better.    It gets worse.   Problems have been getting

worse.



Mullan:    That's sort of a dour note to end with.    Is there
anything we have not touched on that you would like to talk a

little bit about?    One loose end, twenty years ago, your husband
was having trouble, they needed a doc, but he was having trouble

finding a job.    I presume he's found many jobs since then.     What

does he do?


Goetcheus: Initially he was on staff at the Potters House--a

ministry of Church of the Savior.   Also developed religious

drama.    But then he became the director and is the director of

both Columbia Road and Christ House.     So half of his time, he's a
pastoral counselor at Columbia Road Health Service, and then also

provides leadership for the faith community that is a part of

Christ House.    We don't have a pastor as such, but if there is

that kind of a person, he is the pastor.    He also oversees the
                                                                     84

fundraising, the budgets, all the administration of both Columbia

Road and Christ House.


Mullan:   You spend most of your time, your daylight hours,

anyway, laying hands on.    How do you feel about that?   Is it an

important part of what you do?



Goetcheus:   I very much enjoy practicing medicine and I want to

be a good physician and I want to be up on things.     I want to
practicing good medicine.     In fact, I get really upset if I think
poor people are getting poor quality of medicine.    I want to know

that they have good access, they're getting quality medicine,

that they've got somebody twenty-four hours a day they can get if
they need to get, and all those kinds of things that go into good

primary care, I want them to have it.     I want to be that kind of

doctor for them, but I enjoy practicing medicine.



Mullan:   Are you able to stay abreast?



Goetcheus:   Oh, I hope so.   I'm a part of the American Academy of

Family Physicians and do the 150 hours of continuing education.

Being around other physicians, too, helps in terms of keeping up,

and the physicians here also are keeping up their continuing

education.



Mullan:   You took your boards at some point?
                                                                     85

Goetcheus:    No.   That's another whole story.   In my time there

was no family practice.     There were no boards, there was nothing.
So there was one opportunity where they opened the Boards up for
practitioners.      This would have been probably in the early--1

don't know when it was--one time.     Anyway we were headed

overseas, the kids were young, and I thought, "Well, there's no
reason for me to do this."     And I didn't do it.   I wish I had.

I've gone as a delegate to the American Academy of Family

Practice for the last three years.     This is the first year I

haven't gone.
     On the floor is always a debate whether or not to open up
those boards and whether or not to allow other people to take

them.     They will not, I don't think, because one of the reasons

is, and I feel it, too, would be now you'd have young physicians

who have gone through a residency program who feel very strongly
about not wanting to dilute family practice by opening up and

letting anybody take the boards, which I wouldn't want to dilute

it either.     If it were going to dilute it, I wouldn't do it.



Mullan:    But you certainly count yourself a family physician and

are active even in the organization.



Goetcheus:    Yes, have been, and the Academy folks have been

wonderful in terms of being supportive and I appreciated that.

The local academy here is a strong group of activist physicians.

I didn't know it even existed until a few years ago.
                                           86

Mullan:   Good.   We'll s t o p at that.



[End of Interview]