The parking lot at Durham's Lincoln Community Health Center fills quickly on a weekday morning, as cars, taxis, and shuttle buses jockey for space. Boarded-up houses and junked cars pockmark the surrounding neighborhood, where the poverty rate is clearly much higher than the 15 percent countywide. But inside the center, the mood is upbeat, and the lobby and halls teem with activity. Elderly women talk with young mothers, men swap jokes, and children watch videos and play games as they wait to be seen. The physicians and nurses in Lincoln's various clinics appear to feed off the energy, speaking a rapid-fire mix of English and Spanish as they move in seemingly synchronized fashion to address patient needs quickly and efficiently.
Far from the action, in a cramped basement office filled with medical journals, bulging file folders, and stuffed animals from her days as a pediatrician, center director Evelyn Schmidt '47, M.D. '51 has been working for hours on proposals to keep federal, state, and local funds flowing to Lincoln so the activity upstairs doesn't stall. "When you have a mission, the bottom line is just one of your concerns," she says.
For almost four decades, the mission shared by Schmidt and Lincoln has been to break through the often grim landscape facing Durham's underclass. The center provides thousands of people with primary medical care that they otherwise couldn't afford—many wouldn't even bother to seek it because of the cost. Of the more than 34,000 people who were treated at the center last year, for example, almost 85 percent lived below the poverty line and three-quarters had no health insurance.
"The general public doesn't recognize the quality of care Lincoln provides because of who they serve there," says Joyce Nichols, who has used the center for her health-care needs for thirty-five years. "The people there don't care how you're dressed or how you look or smell. They treat you with respect, and they treat you as well as or better than any other medical provider in town."
Schmidt makes sure of that. Lincoln's chief executive since shortly after it opened in 1970, she possesses a commitment to serving the poor that borders on a passion and has become the center's guiding principle in a continually changing health-care industry. Although she and her staff readily adjust to the times—Schmidt's office door features a picture of a dinosaur with the caption "Adapt or Die"—providing high-quality medical care to patients on the margins of society is the steady foundation of the center.
"Most of our patients have been pretty much left out in the cold by the health-care system," she says. "The only way we're going to succeed as a nation is if we're healthier and better educated—and I mean everybody has to be provided for." Durham, she says, is "a tale of two cities," with Duke Medical Center's world-class facilities and pioneering research taking place a stone's throw from the bleak financial and social conditions faced by Lincoln's clientele.
Under Schmidt's leadership, Lincoln has become one of the most respected health centers in the country. Amy Simmons Farber, communications director for the National Association of Community Health Centers, says Lincoln is "way ahead of the curve" on setting standards for care and implementing new technology, such as transferring paper medical records to computer and using a robotic dispenser to fill prescriptions. In 2006, Lincoln celebrated Independence Day by becoming the nation's first health center to go tobacco-free, a move that many hospitals—including Duke's—have since copied.
"They're one of the bright stars of health care," Farber says of Lincoln, adding that Schmidt makes so many trips to Capitol Hill to lobby for more funding for health centers nationwide, including the federal dollars that make up almost a quarter of Lincoln's $18 million annual budget, that she is on a first-name basis with every member of North Carolina's Congressional delegation.
"Evie is the Mother Teresa of Durham," says Fred Johnson, deputy director of the Division of Community Health at Duke Medical Center, who oversees two neighborhood medical clinics that serve as Lincoln satellites. "Lincoln is her life, and she just lives and breathes caring for the poor."
Schmidt came to her calling early in her career, while working in a private pediatric practice near Philadelphia. She made house calls in poor neighborhoods and saw children with chronic medical conditions who weren't being treated because their parents couldn't afford routine care. "I thought, 'This is crazy. All kids deserve better,' " she says.
In 1962, she earned a master's degree in public health from Columbia University and soon after became chief of pediatrics at the Gouverneur Ambulatory Care Center, a health program for the poor in the Lower East Side of Manhattan. Then, she was recruited to come back to Durham to run Lincoln. Although the New Jersey native had been so appalled by the segregation she saw in town during her days at Duke that she refused to ride buses around campus, she readily agreed to return to North Carolina for a chance to interact more directly with the community than her position at Gouverneur allowed. Over the years, she has worked with groups to promote better housing in Durham and to fight the rise in local gang activity. "Health care involves more than medicine," she says simply.
Lincoln's creation also meant that sanctioned segregation in the South was on the wane, she says, citing another element of the move she found attractive. The center was born during the integration of health-care services in Durham, when Durham Regional Hospital was built to replace the former whites-only Watts Hospital and blacks-only Lincoln Hospital in town. Community leaders felt that maintaining a clinic on the Lincoln Hospital site would keep health care accessible to many black residents, and they wrote Durham Regional's charter in a way that ensured that the local health-care system would always support the center.
Durham Regional, now part of the Duke University Health System, continues to provide close to $6.2 million in annual support to Lincoln, including services like laboratory tests, X-rays, and building maintenance. The center plugs a hole in the local health-care network, says David McQuaid, former chief executive of Durham Regional, by providing a more efficient option for primary care for uninsured patients than frequent visits to hospital emergency rooms. Such holes often drain away limited health-care resources in other cities, he says—even areas with similar community health centers.
"In my career, I haven't seen the type of community support and financial commitment to caring for underserved populations that I've seen here," says McQuaid, who worked with the Baltimore-based Johns Hopkins Health System before coming to Durham and is now chief operating officer at Thomas Jefferson University Hospital in Philadelphia.
Schmidt is the driving force behind much of that support. A five-foot-tall dynamo who leaves colleagues half her age struggling to keep up—Mary Baldwin, Lincoln's director of nursing, says she knows her boss is coming to deliver another directive when she hears quick footsteps in the hallway—Schmidt combines her vision for the community and her relentless will with a touch of guilt to remind local officials of their moral obligation to care for the poor. "She doesn't have an iron hand, but she has a voice that can flip a conscience," says Sue Guptill B.S.N. '75, chairwoman of Lincoln's board and director of nursing for the Durham County Health Department.
Guptill cites the example of Project Access, a proposed program under which specialist physicians in Durham will treat uninsured patients pro bono. Schmidt for months pointed to the need for more access to specialty care among Lincoln's clients, becoming more forceful each time until the message got through, Guptill says. "She's an outspoken advocate for people who don't have a chance to speak for themselves."
Accessibility is a primary goal for Lincoln, which has created a one-stop shop for medical services in Durham. In addition to providing adult, pediatric, dental, and mental-health care daily, the center offers weekly clinics in orthopedics, ophthalmology, and gynecology; provides prenatal care for the Durham County Health Department; and serves as the local hub for the federal Women, Infants, and Children nutrition program. The center also works with Duke to provide in-home care at local senior-citizen housing projects and operates a clinic at a homeless shelter near downtown. Schmidt says the shotgun approach helps Lincoln reach as many populations across the community as possible.
She also has worked with Duke's Division of Community Health for the past few years to expand the center's reach throughout Durham. As part of the Duke-Durham Neighborhood Partnership, which promotes university involvement in neighborhoods and public schools near campus, the division opened a medical clinic in a renovated community center in the Lyon Park neighborhood in 2003. A year later, a second clinic was opened on Broad Street in the Walltown community, and plans are in place to open a third clinic in a former elementary school in northeast Durham in the next two years. Lincoln pays the clinics a fee for each patient—together, they see more than 200 people a week—and grants from The Duke Endowment help subsidize the operations.
"We're like a circuit breaker for Lincoln, taking patients when they become overloaded," Duke's Johnson says. At the same time, the clinics provide accessibility in those neighborhoods to low-income families and the elderly without transportation. "Convenience is a major reason people come here," he says.
High-quality care is the reason many keep coming back. Nichols, the longtime patient, says she had health insurance for many of the years she used Lincoln but chose not to go elsewhere. "They treat you as a human being, not an object," she says. "You have confidence in the people taking care of you."
People like Oveta McIntosh-Vick, a physician and Lincoln's director of pediatrics. McIntosh-Vick sees a couple of dozen children and their parents every day, but she takes time during each appointment to make certain everything is all right at home for her patients. During one visit, she corralled a squirming baby for a quick examination while counseling a young, single mother intent on pursuing a graduate degree. "These people may not have much, but they're willing to sacrifice whatever they do have to ensure their families get decent health care," she says. "And that's what we're here to provide."
That mission feeds Schmidt's determination. Those who work with her joke that she seems to have gotten a second wind in recent years. "There's no indication she plans to slow down, and we don't plan to slow her down," Guptill says.
Schmidt refuses to talk about retirement, instead choosing to focus on the challenges Lincoln continues to face: a lack of bilingual staff to handle the growing Hispanic population, federal and state budget cuts, increased patient loads, and limited space, for starters. At the same time, she seizes on new opportunities whenever they appear. The recent hiring of a chief operating officer at Lincoln, for example, gives her the chance to spend time tweaking systems for better patient service.
"We've still got a lot of work to do to make sure everybody is getting the care they deserve," she says. She's barely finished the thought when a young Hispanic woman appears at her office door, looking for Lincoln's financial office. Schmidt jumps out of her chair and briskly guides the patient down the hall. When Schmidt returns, she pauses to reflect on the community she has helped to build.
"If I were starting over, I would be a social organizer," she says. "Health is more than just physical well-being. It's about being able to afford nutritious food and having safe housing in walkable neighborhoods, so that you can get outside and not worry about crime. These things are all connected."
With an economic slowdown affecting all sectors of the population, Schmidt says that clinics like Lincoln will inevitably bear the brunt of worsening conditions. "We've lost the middle class in this country," she says. "Our clients have traditionally been the ones on the bottom of the economic ladder. But we are starting to see people who used to be in the middle, but who are moving down. This isn't just poor Durham's problem. This is everyone's problem."
Burns is a freelance writer based in Raleigh.