THE HOMELESS HOW SHOULD WE GO ABOUT HELPING THEM? TEAR DOWN THE BARRIERS TO SHELTER

I am a physician who has practiced in Washington for the past 12 years. Many of my patients have been homeless. When I see and think of the gates around Metro stops, my memory is of a 45-year-old Vietnam veteran who was a patient of mine last year.

After Vietnam, he became mentally ill and within a few months ended up on the street. His place to sleep was at the bottom of the Farragut West Metro stop. When those gates clanged shut at night, he went up and out to the park across the street, where he slept on a park bench. In the mornings when he tried to stand, his feet would feel numb, and he had difficulty walking. Eventually he went to an emergency room and was admitted with frostbite of both feet.

The day after he was discharged he came to see me at the shelter health service. Parts of both of his feet were black and gangrenous with oozing discharges. He carried with him a small brown paper sack of bandages that he had been given when he was discharged. He was told to change his own dressings. Subsequently, he underwent surgery to have both feet amputated.

Each winter, I see persons who lose fingers, toes, feet and as with a man last year, both legs. By mid-November of 1988, I already was treating a man who, because of frostbite, had had amputation of parts of both feet. On Inaugural Day, a woman who had been frostbitten came to the shelter health service. She was trying to walk on her heels. As I unwrapped the bandages on her feet, I found rotting flesh. The odor was putrid.

During the past year, the Health Care for the Homeless mobile medical van treated 1,501 individuals living on the street (just within the small radius of the downtown area around Lafayette Park and the Metro stops). As with the gentleman who was sleeping at the bottom of the Metro, many suffer from mental illness and are very vulnerable. Because they are also very physically ill, having gone without health care most of their lives, they become very susceptible to frostbite.

As an increasing number of sick homeless persons keep coming (more than I can possibly see), a growing part of me believes that the way I could help them most as a physician would be in helping to pull down those Metro gates -- and the other barriers that prevent shelter for the vulnerable homeless -- if for no other reason than to try to make known the needless suffering and deaths of so many of the patients I see daily.

-- Janelle Goetcheus is the medical director of Christ House, a Health Care for the Homeless Project.

Articles appear as they were originally printed in The Washington Post and may not include subsequent corrections.