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Sunday, July 24, 2016


Just your average field hospital in America

by Tom Sullivan

Patients wait in line for free health care at the Wise County fairgrounds.

Dentists and assistants work with headlamps and floor lights and under a large, open-sided event tent. There are no overhead lights, so lighting is bad. Power cables, air and water hoses snake across the open ground. There is a steady hum of generators and air compressors. A line of patients line up outside a barn for medical check-in. Others sit patiently in the wooden stands of horse arena, waiting for their numbers to be called. This is a county fairgrounds in southwest Virginia. It is the second day of the 17th annual Remote Area Medical (RAM) free clinic in the town of Wise. This is coal country, and the fairgrounds has been converted into a massive MASH unit.

Dentists consult under the big tent.

"Five-fifty and below," a volunteer tells patients as they line up outside the barn. He asks to see their tickets. Over 1,300 got tickets before dawn on Friday. Eight-hundred more on Saturday. These are citizens who have fallen through the cracks of America's for-profit health care system. Obamacare has not reached them. Poor mostly. Out of work. Laid off. Left behind.

At the 2011 clinic, a pregnant woman's water broke. She didn't want to leave and lose her place in line:

An ambulance standing by eventually took her to town in time to have her child in a hospital instead of an animal stall. The child might have been the first ever born at a RAM free clinic. But not without a number, joked one of RAM’s 1,700 volunteers.

Far from Washington’s “debt crisis” abstractions is another crisis, an American reality one cannot describe in words nor experience secondhand.

Stan Brock founded Knoxville-based RAM in 1985 to parachute mobile medical teams into remote areas of third-world countries. Now over 60 percent the patients RAM serves are in rural areas of the United States. Brock himself lives where he stores his supplies, in an old schoolhouse RAM rents from the city of Knoxville for $1 a year. Brock himself is reportedly penniless.
Those old enough might remember Brock from Mutual of Omaha's "Wild Kingdom."

Although gas is cheaper, the patient parking lot looks less full that on my previous visits. License tags on cars (some filled with blankets and pillows) were from Virginia, Tennessee, Kentucky, and North Carolina. (In the past, I've see tags from as far away as Michigan.) Perhaps because with so many volunteers, Friday's efforts had processed many of those who arrived Thursday night to camp out in their cars and tents. The volunteer lot was full and overflowing to the other side of Hurricane Rd.

Wise County Virginia fairgrounds.

Inside the fairgrounds, state medical association trailers provide advanced diagnosis and treatment on site. Most of the treatment here is dental care not covered by most insurance policies (for those who have policies). There are lot of bad teeth here. A line of student volunteers clean and sterilize instruments just outside the big tent. They come from the University of Virginia, Virginia Commonwealth University, students and staff, and the Virginia Dental Association Mission of Mercy. More church and community groups then one can count are here. The Lions Club makes glasses and provides free meals. Popup tents feature Zika virus prevention, circulation and diabetes checks. There are free books and free clothes. On this weekend in July, everything here is free.

Extractions are commonplace at the Wise clinic.

From minor surgery to dentures and more.

Virginia Gov. Terry McAuliffe and Lt. Gov. Ralph Northam visited on Friday. I met Derek Kitts there yesterday. Kitts, "a self-described Blue Dog Democrat," is a 24-year army veteran running for Congress in Virginia's 9th District. I met Sen. Tim Kaine at the RAM clinic in 2013. It is an annual pilgrimage for state leaders. McAuliffe was impressed with the efforts of the volunteers:

But I am equally saddened that this clinic is necessary.

For most of the men, women and children who come here each summer, it is the only medical attention they will receive.

They wait a year for the fairground to be transformed into a field hospital.

They line up at midnight.

And the wait is worth it. Indeed, the RAM clinic saves lives every year by providing critical care for high-risk pregnancies, heart attacks and even brain tumors.

Many of the clinic’s patients have jobs, but they earn too much to qualify for our current Medicaid system and too little to qualify for low-cost health insurance on the federal marketplace.

Some are disabled. Some can’t find work.

The tragedy of the RAM clinic is that we have the ability as Virginians to provide these people with high-quality health care year round — if we will accept federal funds to expand Medicaid coverage in our Commonwealth.
Government intransigence is a roadblock for Stan Brock as well. The eighty-ish Brock has a noticeable limp and uses a golf cart to get around the fairgrounds. He would take his health fair to more states, but is based in Tennessee because its reciprocity laws for volunteer medical staff are the most lenient. Thirteen states have changed their laws, Brock says. That allows RAM to set up clinics in their states. Oklahoma works just fine, he said. He has held clinics in Oklahoma City.

Remote Aree Medical (RAM) founder Stan Brock.

RAM held a large clinic in Los Angeles after California adjusted its law, according to Brock. "Arnold signed it", he said meaning Gov. Schwarzenegger. But then someone found a way to "screw it up." Medical boards erected new hoops — acceptance criteria, fingerprints, forms, registration, etc. Only four of his volunteers were willing to jump through all the new hoops. Members of Congress on both sides of the aisle in Washington support a more uniform national set of standards for reciprocity, but then again many do not. "States rights," he says.

Brock speaks with some of his patients.

Asked whether the parking lot indicated the crowd was down this year, Brock explained the trick is not to turn anyone away and to make sure they don't have any more than about 200 left to treat on Sunday morning. So far this weekend they have not had to turn anyone away.

Brock had to pause speaking periodically because across the way at Becky's Place, a yellow and white tent from the Virginia Breast Cancer Foundation, a guy with a loudspeaker was promoting a cervical cancer informational training about to happen. Come for the drawing, he said. "A $50 gift certificate from Walmart. And couldn't we all use that?" How much medical care could you buy with it?