Earl Echard's patients congregate outside a pair of nondescript brick buildings on the edge of Durham's downtown. Some suffer from serious untreated health problems; others simply haven't seen the inside of a doctor's office for years. Most are low-income; many are homeless. Echard and the clinic he runs offer help—and hope—in addition to high-quality medical care.
Three evenings a week for nearly fifteen years, Echard has staffed a combination doctor's office and walk-in street clinic next to Urban Ministries, one of Durham's largest shelters and service agencies. He takes on the health needs of the shelter's clients without compensation for his services.
It's a tall order: With only a handful of no-frills examination rooms and a staff of one full-time nurse, Echard cares for an ever-shifting and notoriously hard-to-serve population that he says "has only increased in numbers over time."
He typically treats patients "with myriad health problems and a history of substance abuse," a clientele that sometimes renders effective treatment frustrating and can often make his night clinic a gritty, rambunctious affair.
"You get the obnoxious drunks —they're usually friendly, though, and they keep things interesting," says Echard with a slight grin, describing the patients he might see on a typical evening. "And you do get the ones with a chip on their shoulders," who are combative or resistant to medical care.
Despite a litany of daily challenges, Echard chooses to emphasize occasional moments of gratification over frequent difficulties, and says he is often impressed with the individuals he serves. "There are those guys that really change," he says. "I've had patients return to the clinic and tell me that this is their tenth year of being sober. I've had others bring their sons and daughters to meet me. They're few and far between, but you do see it."
During his time in Duke's Physician Assistant program, Echard served a rotation at the Lincoln Community Health Center, a clinic in Durham providing care to low-income individuals (see Duke Magazine, July-August 2008). Impressed by what he saw, he returned to work for Lincoln upon graduating, heading a satellite clinic in North Durham. "I got into this at the end of an era of people trying to help people, and not really minding it," Echard says.
Involved with the Ministries clinic since the mid-1980s, Echard was brought on board by a friend who helped co-found the facility. He ran the clinic full-time for several years before switching in 1989 to the evening schedule he still maintains while working a day job.
And that day job? Since 1982, Echard has been employed by the North Carolina Department of Corrections as a physician's assistant and program director, a fact that may explain why dealing with the occasional drunk, rowdy shelter resident by night doesn't seem to intimidate him in the slightest.
He's worked in various capacities in both state and county prisons (most recently in the Wake County jail), and sees what some would consider an unpleasant or unsettling occupation as "a continuation of what I was doing with Lincoln Health"—caring for individuals at the margins with nowhere else to go.
Earl Echard A.H.C. '73
Community health-care practitioner
November 30, 2008