The recent Supreme Court decision regarding the constitutionality of the Affordable Care Act brought back memories of an experience I had in 2008. That July I volunteered for a Rural America Medical (RAM) event in Wise County, Virginia. RAM is an event organized by Stan Brock, a former television host of a nature program and a world adventurer. These events provide free medical, dental and vision services for attendees. Hundreds of doctors, dentists and optometrists perform their services free of charge over the course of three days.
The setting for this RAM event was the Wise County Fairgrounds. Wise is located in the extreme southwestern part of Virginia and is in close proximity to eastern Tennessee and Kentucky. These mountainous areas, along with parts of North Carolina are known as Appalachia, an area of low income families who lack access to health care – geographically and financially.
I had no medical or dental training, but I did have an interest in this area and its people, I had lived in southwest Virginia for eight years during my childhood and seen the jobs in the area disappear as the coal mines shut down and the standard of living gradually decline. Many of the businesses in the small town my family lived in closed and in a few years it looked like a ghost town. It was about this time that we moved away.
As I prepared to attend the RAM event, I found that the few motels in the area were fully booked, so I had to stay approximately fifty miles away. I was instructed to report to the fairgrounds by 6 a.m. each morning which meant that I would begin my journey in the dark over Clinch Mountain around 5 a.m.
There was an orientation meeting for volunteers the evening before the participants arrived. I attended this meeting and the talk that Stan Brock, the founder and main organizer of RAM, gave made a lasting impression on me. After explaining how the next three days would be conducted, he finished his talk by saying that he had been in countries in Africa and South America and other third world countries and held similar medical events there and could understand how people in these countries were experiencing these health crises given their levels of poverty, but as he emphatically stated, “This should not be happening in America.” He said that when he became aware of the lack of health care for many Americans, he organized RAM and began delivering free health services to them. Brock’s emphatic statement echoed through my thoughts as I traversed the long, windy mountain road back to my motel. I thought: He’s right, it shouldn’t be happening in America, but it is. So, what are we going to do about it?
The next morning I started my long drive over the mountain to the fairgrounds. The top of Clinch Mountain was not only dark, but foggy as well.. As I came closer to the town of Wise, I became part of a slow moving string of cars snaking their way toward the fairgrounds. The headlights looked like a string of Christmas lights strung across the mountains. I noticed license tags from Tennessee, Kentucky, Virginia and a few from North Carolina. Slowly the sun came up and burned off the fog and there was the promise of a hot, sunny July day.
The parking lot was already full of cars, vans and pick up trucks containing men, women and children of all ages. There was evidence that many of them had arrived the night before and had either slept in their vehicles or in sleeping bags on the grass surrounding the parking lot. By 6 a.m. RAM volunteers were giving out numbers which would determine when a person would be registered, seen by a triage team and directed to the appropriate medical service area. I was assigned to the Dental area and my job was to direct people to the area of service they required: cleaning, extracting or filling. I also was responsible for checking the paperwork they had been given at registration. I was amazed at the efficient organization of the process.
The Dental area was under an enormous canvas tent with approximately thirty or so dentists lined up with reclining chairs, dental equipment and assistants ready to perform the procedures needed. The scene reminded me of an extended version of MASH with all of the work being done outside using makeshift shelters and a minimum of equipment. The ground surrounding the many dentists and their chairs was covered in a tangle of wires and cables to run the electric drills and other pieces of dental equipment. The dentists, assistants and patients hopping over and across these wires looked like they were performing some sort of strange dance routine. Hundreds of people were processed through this area that first day. This was only one area where people received treatment. There was another area that dealt with a variety of medical issues; this area also included x-ray machines for mammograms and other conditions. A third area gave eye exams and produced pairs of eyeglasses by the end of the day for participants.
There were health education tents set up around the grounds. Information on various health issues such as diabetes, heart problems, cancer, diet, etc. was available. One afternoon I helped out in the tent providing information on various kinds of cancer. As a cancer survivor, I felt that I might have some information that would be enlightening or helpful . Another area of the fairgrounds had several large mobile units on display. These units were manned, or in most cases, womaned by health care professionals such as: nurse practioners, registered and LPN nurses, x-ray technicians, and social workers who traveled throughout the Appalachian area rendering services as needed to those with no other means of health care. They were there to give information about their upcoming schedules in the coming months.
As I guided people around from one area to another, I had the opportunity to talk to them Often I would first ask where they were from and I was amazed at the distances some of these people had traveled to get here and to receive help for their health needs. I found out that many people had not been to a doctor or a dentist for a year or more. One person told me that this was the only time he saw a doctor and that this was the tenth time he had been here. He had been coming since the first RAM event was held here.
I escorted one little woman, who barely came up to my shoulder from the dental tent where she had all of her teeth extracted to the pharmacy area where she would be given pain medication . She had her mouth filled with gauze and cotton, so I could understand only part of what she said, but I got the gist of it. She said that she had been in pain for a long time with her teeth and was so grateful to have them pulled. She was dragging a sleeping bag with her and a large tote bag with water and other items for her stay at the fairgrounds. She had obviously spent the night here before the gates opened. She expressed her thanks to me over and over again for bringing her to the area where she could get some pain medication. I didn’t feel that I had done very much in helping her – the dentists and the assistants were the ones who really helped her, but I am sure they received many thanks as well.
Every day was busy, very hot and extremely gratifying. The medical people who worked long hours in the heat with minimum equipment were the heroes, along with Stan Brock and the many people responsible for organizing this amazing event. The people who drove long distances over mountain roads, spent the night sleeping in cars, trucks or on the ground and waited patiently for hours to receive once a year medical, dental and vision services hopefully returned to their homes with some of their health needs met and the knowledge that there are people who do care about them.
As politicians, government officials and insurance companies try to think of solutions to solve some of the health care problems in this country, they might learn some lessons from the folks who organize and run the RAM organization. These are people who are not just caring but creative in the way they approach the delivery of health care services to those who live in remote areas and have few financial resources to apply toward health care. These are people who have defied conventional thinking when it comes to delivering health care services. Conventional medical approaches say that: health care must be given indoors; health care is available only to those who have health insurance or go to an emergency room and incur ridiculous fees paid by taxpayers; all health care must be provided by doctors; one must go to a specialist such as an oral surgeon for tooth extractions; health care professionals will not provide services for free; health care services will not come to the patient, the patient must come to the services; educating people about the dangers of smoking, poor diets and prenatal care make no difference in the costs of health care. All of these assumptions were discounted and disproved by RAM health workers. Perhaps one of the most astounding lessons learned in Wise was that 6,000 people could be treated over the course of three days. That is how many people were served at the RAM event I attended. Granted there were large numbers of health professionals providing services,but it demonstrates the magnitude of positive effect that can be accomplished with a coordinated effort carried out by creative and dedicated people.
Whether or not the Affordable Care Act is the answer to providing health care for all those who need it or just the beginning of a long term plan to redesign our health care system, the many RAM events that are still occurring across the country will continue to make a huge difference in the lives of those who have no other access to health care. I feel very fortunate to have been a small part of this effort.