Rural Medical Camp Tackles Health Care Gaps
A photo gallery of the rural medical clinic in Wise, Va. (Becky Lettenberger/NPR)
It was a Third World scene with an American setting. Hundreds of tired and desperate people crowded around an aid worker with a bullhorn, straining to hear the instructions and worried they might be left out.
Some had arrived at the Wise County Fairgrounds in Wise, Va., two days before. They slept in cars, tents and the beds of pickup trucks, hoping to be among the first in line when the gate opened Friday before dawn. They drove in from 16 states, anxious to relieve pain, diagnose aches and see and hear better.
"I came here because of health care — being able to get things that we can't afford to have ordinarily," explained 52-year-old Otis Reece of Gate City, Va., as he waited in a wheelchair beside his red F-150 pickup. "Being on a fixed income, this is a fantastic situation to have things done we ordinarily would put off."
For the past 10 years, during late weekends in July, the fairgrounds in Wise have been transformed into a mobile and makeshift field hospital providing free care for those in need. Sanitized horse stalls become draped examination rooms. A poultry barn is fixed with optometry equipment. And a vast, open-air pavilion is crammed with dozens of portable dental chairs and lamps.
A converted 18-wheeler with a mobile X-ray room makes chest X-rays possible. Technicians grind hundreds of lenses for new eyeglasses in two massive trailers. At a concession stand, dentures are molded and sculpted.
Desperate For Health Care
(Coburn Dukehart / NPR)
The 2009 Remote Area Medical (RAM) Expedition comes to the Virginia Appalachian mountains as Congress and President Obama wrestle with a health care overhaul. The event graphically illustrates gaps in the existing health care system.
"We're willing to sleep in pickup trucks or cars and deal with the elements to at least get some kind of health care," Reece adds. He earned a six-figure income working for an international industrial supply firm until an accident five years ago left him disabled. Joining him for dental, vision and medical checks are his wife, daughter, son-in-law and three grandchildren.
"Tomorrow, I'm going to see the doctor to get my ear and my nose fixed!" grandson Jacob shouts excitedly. His nose appears battered and his ear has an oozing scab.
(Becky Lettenberger/NPR)
Before the gate opened, Loretta Miller, 41, of Honaker, Va., got four hours' sleep behind the wheel of her parked minivan. She was No. 39 in line for her eighth RAM expedition. Her visit last year saved her life.
"They done an ultrasound and told me that my gallbladder was enlarged and was ready to burst and it could kill me," Miller recalls. "They told me if I hadn't got help when I did, literally I could have died."
(Coburn Dukehart/NPR)
Medical, dental and vision help is often elusive for the 2,700 people seeking treatment during the three-day RAM event. Just over half of the people attending this year have no insurance at all, according to a survey of the patients conducted by RAM. Forty-seven percent could be considered underinsured, given unaffordable copays or gaps in coverage provided by Medicare, Medicaid and conventional insurance plans. Only 11 patients have dental insurance, and just seven have vision coverage.
"There's no doubt about it. There is a Third World right here in the United States," concludes Stan Brock, RAM's founder. Brock has organized similar medical expeditions in Asia, Africa and South America. "Here in the world's richest country, you have this vast number of people, some say 47 million, 49 million, that don't have access to the system and that's why [this] is necessary."
About 1,800 volunteers provide the medical, dental and logistical help, including hundreds of doctors, dentists, nurses, assistants and technicians.
Almost 4,000 Teeth
Miller is ecstatic when her number is called. The divorced hairdresser and mother of two is uninsured and in pain. But she had taken the time, even with little sleep, to put on makeup, braid her blond hair and dress in a white lace tunic. She walked briskly through the gate for what would turn out to be five hours in dental chairs, given the extraction of an abscessed tooth, three fillings and a root canal.
More than half of those seeking help sign up for dental exams and procedures. They fill the more than 70 dental chairs while hundreds wait their turn under tents nearby. Hundreds more out in the grassy parking lot hope they'll get their teeth cleaned and fixed before the event ends.
Dental health greatly affects general health, says Dr. Terry Dickinson, who directs the Virginia Dental Association and the RAM dental effort at the Wise fairgrounds.
"The infection in the mouth certainly has been shown to have an effect on systemic diseases," Dickinson explains. "So it's really critical that these folks be able to get infected teeth out and infection treated in the mouth because it's going to help them with their overall health."
The extent of infections is staggering. Dickinson and his team pull 3,857 teeth in 30 hours of work spread over 2 1/2 days. Some patients lose all their teeth. A 4-year-old had cavities filled in every tooth.
Who Is Responsible For Health Care?
Terrible teeth, obesity, smoking, high blood pressure and diabetes are common among the people seeking help here. That raises an important question. Are they at fault for their poor health?
"There's enough blame to go around for everybody. I think patients certainly have to have personal responsibility for what they're putting in their mouth, but we are also trying to create a better access care system. How are you going to get providers, whether it be dentists or physicians or anybody else, into these areas where economically these communities are struggling?" Dickinson asks.
That's a reference to the costs of medical and dental schools and the debts that graduates incur, which can be $100,000 and more. There's pressure to practice in more lucrative places beyond rural regions like Appalachia.
"There are areas of the country, and certainly Wise County is one of them, where there just aren't [enough] physicians," says Dr. Susan Kirk, an endocrinologist and diabetes specialist with the University of Virginia Health System, which provides specialists for the Wise RAM event. "We provide indigent care at the University of Virginia, but that's six hours away."
RAM founder Stan Brock is impatient with those who suggest the people seeking help in Wise are somehow at fault and unworthy of care given poor health habits.
"The rest of the population is not exactly in the best of shape themselves," Brock asserts. "They're eating well and, therefore, they're putting on weight and, therefore, they've got heart disease and the rate of diabetes in this country is going up. But, in the case of the well-to-do and the well-insured, they can afford to take care of it."
At the end of her long day with dentists, Loretta Miller was still numb with Novocain but grateful for the care she could not otherwise afford.
"It's well worth the drive and the wait," Miller said, close to 12 hours after her number was called. "You get tired and stuff. But you think about all the trips and the money it would have cost to have all this done. I couldn't have had it done."
She then laughs about standing in line again at 5 a.m. the next day so she can get eyeglasses to "see what they've done."
RAM organizers say they spent about $250,000 providing care worth about $1.5 million. In 10 years in southwest Virginia, they say, they've treated more than 25,000 people. They have eight more expeditions planned this year, from Virginia to California.
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And I'm Madeleine Brand.
President Obama travels to southwest Virginia on Wednesday. There, he will continue stumping for his health care overhaul. If the president had visited this past weekend, he would have seen a graphic example of gaps in the health care system. In Wise, Virginia, about 2,700 uninsured and underinsured people lined up for free vision, dental and medical treatment at the county fairgrounds.
As NPR's Howard Berkes reports, some of them arrived three days early to be sure they would not be turned away.
HOWARD BERKES: The first carload pulled in Wednesday before dawn and they weren't alone for long.
Unidentified Woman: We started calling out numbers at 5:00 in the morning. If you're not here when your number is called, we have to skip over you. Are you staying the night?
BERKES: By Thursday night, hundreds of cars, vans and pick-ups were pulling into the grassy field, beyond the barns and animal stalls at the Wise County Fairgrounds in Virginia's Appalachian Mountain. Black numbers on yellow slips reserved a place in line for the opening of the gates at 5:00 Friday morning. Fifty-two-year-old Otis Reece of Gates City, Virginia brought the whole family: his wife, daughter, son-in-law and three grandchildren.
Mr. OTIS REECE: I came here because of health care - being able to get things that we can't afford to have ordinarily without an out-of-pocket. And being on a fixed income, this is just fantastic situation for us to have things done we ordinarily would put off.
BERKES: Reece had a six-figure income representing an international industrial supply firm, until an accident left him disabled. That was five years ago. He has Medicare, but it doesn't cover everything, and he cannot afford his share with the bills. So, he and his family are here for dental, vision and hearing exams and treatment. Grandson Jacob has his own agenda.
JACOB: Tomorrow, I'm going to see the doctor to get my ear and my nose fixed.
BERKES: That's a battered nose and an infected and oozing ear.
Mr. REECE: We're willing to sleep in pickup trucks or whatever we have to do to the cars and deal with the elements and except to - at least get some kind of health care.
BERKES: The care at this annual Remote Area Medical expedition, or RAM as it's called, is free, because hundreds of doctors, nurses, dentists and technicians donate their time. Instruments, lab work, X-rays, drugs, lenses, frames and supplies are also provided free. And 1,000 volunteers pitch in with logistical help. RAM expeditions have landed in India, Nepal and Guyana. But they're also necessary here, says RAM founder Stan Brock.
Mr. STAN BROCK (Founder, RAM): There's no doubt about it, there is a Third World right here in the United States. Here, in the world's richest country, you have this vast number of people, some say 47 million, 49 million, that don't have access to the system and that's why it's necessary.
(Soundbite of fairgrounds)
BERKES: It's close to 5:30 in the morning on Friday morning. It's still dark. There is an endless line of cars that we can see at the entrance to the fairgrounds here. And most of these people are probably not going to get treated today. They've already handed out close to 1,600 tickets. They're reaching capacity here, and they haven't even opened the gates yet.
(Soundbite of bullhorn)
Mr. BROCK: Thirty-seven, 38, 39.
BERKES: It's still dark when the gates open. Stan Brock uses a buzzing bullhorn to announce the numbers to a crowd of hundreds. Number 39 is Loretta Miller, who had four hours sleep sitting behind the wheel of her red minivan. And she's thrilled to be getting in. She took the time to put on makeup, tie her blond hair back in braids and dress up in a white lace tunic. Miller's RAM treatment last year was dramatic.
Ms. LORETTA MILLER: They'd done a ultrasound and told me that my gallbladder was enlarged and was ready to burst and it could kill me. So saved my life. They told me if I hadn't got help when I did, literally I could've died.
(Soundbite of fairgrounds)
Unidentified Dentist: Okay, need the suction now.
BERKES: Miller is back to get her teeth fixed. She spends more than five hours in dental chairs. An abscessed tooth had to be pulled, two others needed new fillings, this one's getting a root canal. Miller is a divorced hairdresser with two kids and no insurance. She'd been in pain for weeks. And the rest of her health was at risk, according to Terry Dickinson, who directs the Virginia Dental Association and the RAM dental effort here.
Dr. TERRY DICKINSON (Executive Director, Virginia Dental Association): The infection in the mouth certainly has been shown to have an effect on systemic diseases. So it's really critical that these folks be able to get infected teeth out and the infection treated in the mouth because it's going to help them with their overall health.
BERKES: Dentistry is the biggest demand at RAM. It's 8:15 on Friday morning and there are dozens and dozens of dental chairs set up here. It feels like a field hospital on a battlefield. There's 50 to 100 people being worked on here right now. But there are hundreds more waiting outside. And there will be hundreds more tomorrow. And there will be hundreds more on Sunday.
Dickinson expects his dentist volunteers to pull close to 4,000 teeth during their 30 hours of RAM work. Terrible teeth, obesity, smoking, high blood pressure and diabetes are common among the people seeking help here. That raises an important question: Are they at fault for their poor health?
Dr. DICKINSON: There's enough blame to go around for everybody. I think patients certainly have to have personal responsibility for what they're putting in their mouth. But we also are trying to create a better access care system. How are you going to get providers, whether it be dentists or physicians or anybody else, into these areas where economically these communities are struggling?
BERKES: Especially when dental and medical schools saddle graduates with $100,000 of debt or more. RAM founder Stan Brock has another perspective that those with good insurance buy their way out of bad habits.
Mr. BROCK: The rest of the population are not exactly in the best of shape themselves. I mean, they're eating well, and therefore they're putting on weight, and therefore they've got heart disease and the rate of diabetes in this country is going up. But in the case of the well-to-do and the well-insured, they can afford to take care of it.
BERKES: At the end of her long day with dentists, Loretta Miller is still numb with Novocaine, but grateful for the care she couldn't afford.
Ms. MILLER: It's well worth the drive and the wait. You get tired and stuff, but you think about all the trips and the money it would've cost to have all this done, I couldn't have had it done. I'm ready to go in the morning. Get me some glasses so I can see.
(Soundbite of laughter)
Ms. MILLER: See what they've done.
(Soundbite of laughter)
BERKES: It's now well past noon on Sunday. The drapes have come down from the sanitized horse stalls used for medical exams. Workers are moving optometry equipment out of the poultry building. And the dental chairs are finally empty. RAM organizers say everyone who came was seen - about 2,700 people. They spent about $250,000 for care worth about $1.5 million, and they have eight more expeditions planned this year from Virginia to Los Angeles.
Howard Berkes, NPR News, at the Wise County Fairgrounds in Virginia. Transcript provided by NPR, Copyright National Public Radio.
