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.

• return to page one of this article.