It's long been renowned for excellence across the globe, but the Johns Hopkins Hospital's image is less lustrous right across the street. For years, Hopkins' medical achievements meant little to its closest neighbors, people like the Rev. Melvin B. Tuggle Jr.
Why would it? Mr. Tuggle asked. Hopkins -- the hospital and the schools that share the campus -- could not have been more removed from East Baltimore's narrow row houses, he said, if it had been a rampart-ringed castle atop a hill.
"That was the ivory tower. That's where white folk went and foreigners came," Mr. Tuggle remembered.
"The only time you heard from them was when they needed to build a garage," said Lucille Gorham, who has spent decades heading East Baltimore community groups.
But now, Hopkins' chilly image is warming, its neighbors say. And the reason is: Hopkins.
Like other urban universities and hospitals across the country -- Marquette in Milwaukee, the University of Pennsylvania in Philadelphia, Yale in New Haven, and many others -- Hopkins has decided it cannot wall itself off from the problems of the city (though indeed, in one housing experiment, it tried).
The change, begun slowly years ago, has been gaining momentum.
Hopkins long has offered a variety of health programs to its neighbors. It contributes money to community projects. It sponsors Little League teams. It helps support a recreation center. It rehabilitates housing. It has given surplus beds to the homeless.
But the programs lacked a focus. And the neighborhood viewed the campus with suspicion. Then, in February, Baltimore Mayor Kurt L. Schmoke announced an ambitious East Baltimore renewal project, a vast undertaking that would include new housing, education, medical programs, new streets, business incentives and job training for the more than 47,000 people in the project's 180 square blocks.
Hopkins -- in partnership with the city, the state, the Kennedy Krieger Institute and community and business groups -- will contribute funds up front for staff and design work, plus millions of dollars later for programs and construction.
Hopkins leaders pledge to thrash out the plan with community groups and City Hall, instead of imperiously dictating the details. They promise to listen to the wants of the neighbors and use their clout to help prod governments along.
"Some people view this as Hopkins reaching out to the community," said Dr. James A. Block, president and chief executive officer of Johns Hopkins Hospital and Health Systems. "That's not so. We are of the community."
Some other Baltimore hospitals moved to the suburbs years ago, but Hopkins stayed, rejecting any proposals to leave. Its leaders say they heeded the mission that merchant and financier Johns Hopkins described in his will, that the hospital "be a solace to the sick and an ornament to the city."
"Johns Hopkins had some very specific feelings about what that hospital should be like," said Dr. Robert M. Heyssel, who retired as president of Hopkins Hospital in 1992. "We were to take care of poor folks and well-off folks, and black folks as well as white folks. Wetook that very seriously," he said.
"This is where we live," Dr. Block, his successor, said. "This is where we work. We want the community to thrive."
That community is beset with urban problems. Boarded-up houses and trash-strewn alleys mar the blocks around the Hopkins campus. Green spaces, back yards, even street trees are few. The neighbors are crammed together more densely than residents of some public housing projects, according to consultants studying the project area.
Decay and crime
Over the last few years, some spectacular crimes -- the kidnapping of a doctor from a Hopkins garage, the rape of a medical student -- have made staff, patients and neighbors shudder.
Nearly 43 percent of the residents in the project area live in poverty, according to 1990 census data.
Thirty-six percent of the households receive public assistance. Thirteen percent of the houses were vacant and 6,200 crimes were reported in the area in 1990.
Mr. Tuggle said it was statistics like these, not noble vision, thamoved Hopkins to change its role in the neighborhood. A founder of CURE, Clergy United for the Renewal of East Baltimore, Mr. Tuggle said that Hopkins realized its very future is threatened in a neighborhood so troubled by decay and crime.
Dr. Michael Johns, dean of the Hopkins School of Medicine, said that, despite the urban problems, Hopkins has no problem recruiting the best students and faculty. But he acknowledged that, over time, "I'd say our location is going to influence some of the people who apply here."
Mr. Tuggle puts it more bluntly: "No one was going to come to study at the world-famous Johns Hopkins if you were going to get robbed or raped," Mr. Tuggle said. "No one."
Other factors also pushed Hopkins and its neighbors to work more closely. Many federal grant programs in the last few years have begun to demand that a community group be involved before an institution receives funds.
And there is new leadership at the medical campus -- including Dr. Block, Dr. Johns and William Richardson, president of Johns Hopkins University. Neighbors credit them with being more interested than past administrations in the surrounding community.
After the medical student's rape two years ago, Mr. Tuggle recalls that Dr. Johns "called me from an airplane to ask, 'What can we do?' "
And when Mr. Tuggle was preaching at the funeral of Dr. Block's chauffeur's mother, the minister was impressed to find Dr. Block among the mourners.
But some of the old distrust remains. "There is reticence on the part of the residential community concerning Hopkins' motives," said Danise Jones-Dorsey, acting director of the Historic East Baltimore Community Action Coalition, which is coordinating the renewal project. "The partnership is fragile."
Neighbors such as Mr. Tuggle -- born on Madison Street, shadowed by the walls of the campus -- say Hopkins' reputation among black Baltimoreans has historically been poor.
For neighborhood people who needed a doctor, Hopkins was just an emergency room in which black patients routinely waited for hours, while "dukes and duchesses" were being treated by world-famous specialists upstairs, Mr. Tuggle said.
'We hated this place'
The fact that Hopkins had separate black and white wards for many years only reinforced the neighbors' belief that blacks received inferior treatment. "We hated this place," former Mayor Clarence H. Du Burns recalled in a 1986 interview published by Hopkins.
For neighbors trying to hold their community together, Hopkins was a disdainful presence that reached into surrounding blocks only when it wanted to buy houses to raze for parking lots.
"There was always tension with Hopkins," Ms. Gorham said. "In those days, you always lived with this thing over your head. Because of Hopkins' great need for parking, within a year you could lose your home. You never knew where they were buying up property. You never knew if they'd move you out," she said.
"No one would stop the Hopkins from what they want to do,said 2nd District City Councilman Carl Stokes, who grew up in public housing not far from Hopkins. "It seemed to have the same condemnation powers as a government. It did what it wanted."
Residents also complained that Hopkins seemed more interested in doing research -- with the neighbors as subjects -- than in providing primary medical care.
"Say they're studying high blood pressure," Mr. Tuggle said"You get the grant. You come into the community to do the study. You go back to Hopkins and write your paper. Meanwhile, 100,000 people in East Baltimore still have high blood pressure.
"We had no one to cure the headache, no one to cure the basic illnesses of the community," Mr. Tuggle said.
Hopkins' leaders knew the talk. "From everything I've ever heard," Dr. Heyssel said, "it was very much 'the big institution on the hill,' and it was quite aloof from the community. Maybe from the people living in the community it was worse than that: It walled itself off."
Indeed, it did. In the 1950s, Hopkins built a 120-unit apartment complex for its interns and families, then enclosed the property -- nicknamed "the Compound" -- with a fence topped with barbed wire.
The apartments were torn down in 1986. But for nearly 30 years, "there it sat, in a neighborhood we were trying to come to grips with and get along with well," Dr. Heyssel said. "And here was this barbed wire.
"Things like that were very visible and had a chilling effect on the relationship with the community."
Hopkins notes that, far from being the distant institution of old, it now boasts nearly 100 community programs -- including drug treatment, mammograms, asthma treatment, children's physicals -- paid for by $52 million in grants plus $2 million from Hopkins.
But Mr. Stokes says the distrust is so deep that the hospital's efforts to reach out aren't always embraced. For example, when Dr. Heyssel set up an Office of Community Health at Hopkins in 1990, neighbors were wary.
"For several months," Mr. Stokes recalls, "they said, 'We're not working with Hopkins. We're not going to buy this. You're trying to lull us, and then you'll take our homes. You haven't cared for us for 100 years. Why should we buy this now?' "
'Piece by piece'
In redefining its role, Hopkins is following other urban campuses around the country.
In Milwaukee, Marquette University in 1991 joined community groups and businesses to start the ambitious Campus Circle project, which is buying and renovating commercial and residential buildings in the crime-ridden area around the college.
In New Haven, where Yale University's prestige is threatened by a deteriorating center city, Yale is offering employees $2,000 a year for 10 years to any university employee who buys a home in town.
In Philadelphia, the University of Pennsylvania in the 1980s began working on the West Philadelphia Partnership. The project includes jobtraining and placement programs as well as health services.
As part of its effort, Penn began a program called Buy West Philadelphia, which to date has bought about $10 million in goods from neighborhood businesses. The university also is working with about 10 West Philadelphia schools.
"They build piece by piece," said Dr. Ira Harkavy, director of the University of Pennsylvania's Center for Community Partnerships. "It doesn't happen all at once.
In East Baltimore, the details of the renewal project are being worked out in neighborhood meetings that will continue for months. Richard Grossi, senior associate dean of finance and administration at the School of Medicine, spends many evenings at those sessions, listening to the neighbors and explaining Hopkins' wants.
His relationship with the neighbors, he said, is a different one than Hopkins officials have had in years past.
"Ten years ago, I couldn't have convinced anybody at Hopkins that I should show anybody our plan," Mr. Grossi said. "Now I can say, 'Look, we want to expand our campus.' We say, 'You may not like what I have to say, but this is what we want to do.' We at least put it on the table and say, 'Let's deal with it.' "
Hopkins, like neighborhood groups, wants programs to make the area safer. Meanwhile, within its campus boundaries, the medical complex is planning to expand, with a new cancer center and underground parking at Broadway and Orleans Street and a children's hospital and cardiovascular center nearby.
In devising the East Baltimore project, Hopkins and its neighbors sometimes have differed profoundly. Lucille Gorham, the neighborhood leader, offered this example:
At one meeting this year, she studied a giant map and wondered aloud what the green strip was that encompassed the blocks bounded by Chester Street, Broadway, Madison Street and Ashland Avenue, blocks now solid with brick row houses.
Green space, she was told.
Just a minute, Mrs. Gorham said.
Many elderly people live in those blocks, amid boarded-up vacant houses. She did not want them displaced so that Hopkins could have a buffer on its northern border.
"From your side of the street, it looks beautiful," she recalled telling Hopkins officials. "From my side of the street, it divides Hopkins from the community.' "
Mr. Grossi offers a different perspective. Far from intending to build a moat north of the campus, Hopkins wants to "soften the transition" from the institution to the neighborhood, he said.
The houses along Madison are literally shaded by Hopkins' tall buildings across the street. "It's always been the back door to the institution," he said. "The residents look out on loading docks."
If the remaining neighbors could be moved to new housing and the buildings there razed, he said, Hopkins could put low-rise campus buildings on the southern portion of the block and put parkland, maybe a ball field, on the northern side.
What if, in planning, the community's needs and Hopkins' needs conflict?
"You don't resolve that," Mr. Grossi said. "We won't do it unless there's something in it for our collective best interests. We're trying to decide what can be in it for all of us."
"We want balance," Mrs. Gorham said one recent day in her office at the Middle East Community Organization. "We want Hopkins to stay, but we don't want some big rich institution coming down on a neighborhood."
Hopkins, she said, already contributes much. But there's so much more to do. One of her newest ideas: Hopkins could raze some crumbling alley houses just north of the hospital and run a 24-hour day-care center, so that employees working night as well as day shifts could have help with their children.
Dr. Heyssel said Mrs. Gorham has nudged the hospital for years. "My good friend Lucille would always stand up and say we had only put a drop in the bucket of need. And she's right. The need is very great. We can't satisfy all the need."
But Michael Seipp, vice president of the Baltimore Development Corp., believes Hopkins and the community are, at last, working together.
"There's been years of distrust and animosity," Mr. Seipp said. "But everybody's at the table. And as long as everybody's at the table, we can make progress."