Return to Healthcare Never-Never Land

A man sleeps in front of his car in the parking lot at the Wise County Fairgrounds, where people hope to receive free medical care the next day at the 16th annual Remote Area Medical (RAM), clinic in Wise, Virginia, U.S., in the early morning on Friday, July 17, 2015. Photo: Pete Marovich/Bloomberg

A man sleeps in front of his car in the parking lot at the Wise County Fairgrounds, where people hope to receive free medical care the next day at the 16th annual Remote Area Medical (RAM), clinic in Wise, Virginia, U.S., in the early morning on Friday, July 17, 2015. Photo: Pete Marovich/Bloomberg

Six years ago I made a trip to Wise County, Virginia, in rural Appalachia, to photograph Remote Area Medical (RAM) for the first time. A nonprofit volunteer medical relief corps based in Knoxville, Tennessee, RAM provides free health, dental and vision care to people in remote areas of the United States and around the world. Stan Brock, who once assisted Marlin Perkins on Mutual of Omaha’s Wild Kingdom, founded RAM in 1985.

RAM reports that, with the help of 36,675 volunteers, it has provided more than $33 million in free healthcare to more than 350,000 patients during the past 30 years. It has conducted two-thirds of this work in the United States.

In recent years, RAM has treated 2,500 to 3,000 people annually at the Wise County Fairgrounds. People who can’t afford health insurance or cover high medical bills wait all year to receive free care at the three-day clinic.

This year, on assignment for Bloomberg News, I returned to see whether demand for RAM’s services had decreased since the Affordable Care Act (ACA) was signed into law five years ago to help people obtain health insurance.

I discovered that little had changed.

I had forgotten that although Virginia Governor Terry McAuliffe had tried to push through Medicaid expansion, as outlined in the ACA, the Republican-controlled state legislature blocked his efforts.

The ACA called for expanding Medicaid to all Americans under age 65 whose family income is at or below 133 percent of the federal poverty line. But a 2012 Supreme Court ruling allowed states to forego the expansion, as Virginia chose to do, leaving many people in the so-called gap without healthcare coverage.

As a result, this year’s turnout for RAM’s Wise County clinic rivaled years past. In fact, the clinic set an opening-day record, taking in more than 1,600 patients. By noon on Saturday, the clinic saw an additional 1,000 patients.

One woman’s life may have been saved on Friday, after physicians determined she had a dangerous ectopic (tubal) pregnancy, and she was taken to an local hospital for further care.

Images and story from my last visit in 2009 can be found on American-Journal.org.

Here are some images from this year’s RAM expedition in Wise County, Virginia.

People wait for the gates to open at the Wise County Fairgrounds where they hope to receive free medical care at the 16th annual Remote Area Medical (RAM), clinic in Wise, Virginia, U.S., on Thursday, July 16, 2015. Photo: Pete Marovich/Bloomberg

People wait for the gates to open at the Wise County Fairgrounds where they hope to receive free medical care at the 16th annual Remote Area Medical (RAM), clinic in Wise, Virginia, U.S., on Thursday, July 16, 2015. Photo: Pete Marovich/Bloomberg

Tempers flare as people drive in from two different directions to the gates of the Wise County Fairgrounds. Photo: Pete Marovich/Bloomberg

Tempers flare as people drive in from two different directions to the gates of the Wise County Fairgrounds. Photo: Pete Marovich/Bloomberg

Volunteers direct traffic as people drive in from two different directions to gates of the Wise County Fairgrounds where people hope to receive free medical care at the 16th annual Remote Area Medical (RAM), clinic in Wise, Virginia. Photo: Pete Marovich/Bloomberg

Volunteers direct traffic as people drive in from two different directions to gates of the Wise County Fairgrounds where people hope to receive free medical care at the 16th annual Remote Area Medical (RAM), clinic in Wise, Virginia. Photo: Pete Marovich/Bloomberg

Tempers flare at the Wise County Fairgrounds, where people hope to receive free medical care the next day at the 16th annual Remote Area Medical (RAM), clinic in Wise, Virginia. In previous years they could receive their ticket for the next day and then leave to return in the early morning. This year they were told if they left, they would give up their ticket and order in line. Photo: Pete Marovich/Bloomberg

Tempers flare at the Wise County Fairgrounds, where people hope to receive free medical care the next day at the 16th annual Remote Area Medical (RAM), clinic in Wise, Virginia. In previous years they could receive their ticket for the next day and then leave to return in the early morning. This year they were told if they left, they would give up their ticket and order in line. Photo: Pete Marovich/Bloomberg

Proceedure changes cause concern at the Wise County Fairgrounds, where people hope to receive free medical care the next day at the 16th annual Remote Area Medical (RAM), clinic in Wise, Virginia. In previous years they could receive their ticket for the next day and then leave to return in the early morning. This year they were told if they left, they would give up their ticket and order in line. Photo: Pete Marovich/Bloomberg

Proceedure changes cause concern at the Wise County Fairgrounds, where people hope to receive free medical care the next day at the 16th annual Remote Area Medical (RAM), clinic in Wise, Virginia. In previous years they could receive their ticket for the next day and then leave to return in the early morning. This year they were told if they left, they would give up their ticket and order in line. Photo: Pete Marovich/Bloomberg

Tempers flare at the Wise County Fairgrounds, where people hope to receive free medical care the next day at the 16th annual Remote Area Medical (RAM), clinic in Wise, Virginia. In previous years they could receive their ticket for the next day and then leave to return in the early morning. This year they were told if they left, they would give up their ticket and order in line. Photo: Pete Marovich/Bloomberg

Tempers flare at the Wise County Fairgrounds, where people hope to receive free medical care the next day at the 16th annual Remote Area Medical (RAM), clinic in Wise, Virginia. In previous years they could receive their ticket for the next day and then leave to return in the early morning. This year they were told if they left, they would give up their ticket and order in line. Photo: Pete Marovich/Bloomberg

Wayne Moore, 55, of Clinchco. Virginia., waits in the parking lot at the Wise County Fairgrounds, where people hope to receive free medical care the next day at the 16th annual Remote Area Medical (RAM), clinic in Wise, Virginia. Photo: Pete Marovich/Bloomberg

Wayne Moore, 55, of Clinchco. Virginia., waits in the parking lot at the Wise County Fairgrounds, where people hope to receive free medical care the next day at the 16th annual Remote Area Medical (RAM), clinic in Wise, Virginia. Photo: Pete Marovich/Bloomberg

Wayne Moore, 55, of Clinchco. Virginia., waits in the parking lot at the Wise County Fairgrounds, where people hope to receive free medical care the next day at the 16th annual Remote Area Medical (RAM), clinic in Wise, Virginia. Photo: Pete Marovich/Bloomberg

Wayne Moore, 55, of Clinchco. Virginia., waits in the parking lot at the Wise County Fairgrounds, where people hope to receive free medical care the next day at the 16th annual Remote Area Medical (RAM), clinic in Wise, Virginia. Photo: Pete Marovich/Bloomberg

People spend the night in the parking lot at the Wise County Fairgrounds, where they hope to receive free medical care the next day at the 116th annual Remote Area Medical (RAM), clinic in Wise, Virginia.  Photo: Pete Marovich/Bloomberg

People spend the night in the parking lot at the Wise County Fairgrounds, where they hope to receive free medical care the next day at the 116th annual Remote Area Medical (RAM), clinic in Wise, Virginia. Photo: Pete Marovich/Bloomberg

People spend the night in the parking lot at the Wise County Fairgrounds, where they hope to receive free medical care the next day at the 116th annual Remote Area Medical (RAM), clinic in Wise, Virginia.  Photo: Pete Marovich/Bloomberg

People spend the night in the parking lot at the Wise County Fairgrounds, where they hope to receive free medical care the next day at the 116th annual Remote Area Medical (RAM), clinic in Wise, Virginia. Photo: Pete Marovich/Bloomberg

A man sleeps in front of his car in the parking lot at the Wise County Fairgrounds, where people hope to receive free medical care the next day at the 16th annual Remote Area Medical (RAM), clinic in Wise, Virginia, U.S., in the early morning on Friday, July 17, 2015. Photo: Pete Marovich/Bloomberg

A man sleeps in front of his car in the parking lot at the Wise County Fairgrounds, where people hope to receive free medical care the next day at the 16th annual Remote Area Medical (RAM), clinic in Wise, Virginia, U.S., in the early morning on Friday, July 17, 2015. Photo: Pete Marovich/Bloomberg

Roy Pickett, 48, of Wise, Va. spends the night in the parking lot at the Wise County Fairgrounds, where he hopes.  to receive free medical care the next day at the 16th annual Remote Area Medical (RAM), clinic in Wise, Virginia. Photo: Pete Marovich/Bloomberg

Roy Pickett, 48, of Wise, Va. spends the night in the parking lot at the Wise County Fairgrounds, where he hopes. to receive free medical care the next day at the 16th annual Remote Area Medical (RAM), clinic in Wise, Virginia. Photo: Pete Marovich/Bloomberg

People spend the night in the parking lot at the Wise County Fairgrounds, where they hope to receive free medical care the next day at the 116th annual Remote Area Medical (RAM), clinic in Wise, Virginia. Photo: Pete Marovich/Bloomberg

People spend the night in the parking lot at the Wise County Fairgrounds, where they hope to receive free medical care the next day at the 116th annual Remote Area Medical (RAM), clinic in Wise, Virginia. Photo: Pete Marovich/Bloomberg

People wait in the parking lot in the early morning at the Wise County Fairgrounds where they hope to receive free medical care at the 16th annual Remote Area Medical (RAM), clinic in Wise, Virginia. Photo: Pete Marovich/Bloomberg

People wait in the parking lot in the early morning at the Wise County Fairgrounds where they hope to receive free medical care at the 16th annual Remote Area Medical (RAM), clinic in Wise, Virginia. Photo: Pete Marovich/Bloomberg

People wait in the parking lot in the early morning at the Wise County Fairgrounds where they hope to receive free medical care at the 16th annual Remote Area Medical (RAM), clinic in Wise, Virginia. Photo: Pete Marovich/Bloomberg

People wait in the parking lot in the early morning at the Wise County Fairgrounds where they hope to receive free medical care at the 16th annual Remote Area Medical (RAM), clinic in Wise, Virginia. Photo: Pete Marovich/Bloomberg

People wait in the parking lot in the early morning at the Wise County Fairgrounds where they hope to receive free medical care at the 16th annual Remote Area Medical (RAM), clinic in Wise, Virginia. Photo: Pete Marovich/Bloomberg

People wait in the parking lot in the early morning at the Wise County Fairgrounds where they hope to receive free medical care at the 16th annual Remote Area Medical (RAM), clinic in Wise, Virginia. Photo: Pete Marovich/Bloomberg

Dorinda Brightwell hugs her daughter, Kristin Overman, 24, both from Johnson City, Virginia, as they wait to see if Overman will be given a spot to have denture work finished at the16th annual Remote Area Medical (RAM), clinic at the Wise County Fairgrounds in Wise, Virginia. Overman had work started at a previous RAM event in Bristol, Tennessee, and was told to come to Wise to see if she could get in to have the work completed. Photo: Pete Marovich/Bloomberg

Dorinda Brightwell hugs her daughter, Kristin Overman, 24, both from Johnson City, Virginia, as they wait to see if Overman will be given a spot to have denture work finished at the16th annual Remote Area Medical (RAM), clinic at the Wise County Fairgrounds in Wise, Virginia. Overman had work started at a previous RAM event in Bristol, Tennessee, and was told to come to Wise to see if she could get in to have the work completed. Photo: Pete Marovich/Bloomberg

A woman listens to volunteers at the 16th annual Remote Area Medical (RAM), clinic in Wise, Virginia. Photo: Pete Marovich/Bloomberg

A woman listens to volunteers at the 16th annual Remote Area Medical (RAM), clinic in Wise, Virginia. Photo: Pete Marovich/Bloomberg

Patients wait to see a dentist at the 16th annual Remote Area Medical (RAM), clinic in Wise, Virginia. Photo: Pete Marovich/Bloomberg

Patients wait to see a dentist at the 16th annual Remote Area Medical (RAM), clinic in Wise, Virginia. Photo: Pete Marovich/Bloomberg

A dentist walks past waiting patients at the 16th annual Remote Area Medical (RAM), clinic in Wise, Virginia, U.S., on Friday, July 17, 2015. Photo: Pete Marovich/Bloomberg

A dentist walks past waiting patients at the 16th annual Remote Area Medical (RAM), clinic in Wise, Virginia, U.S., on Friday, July 17, 2015. Photo: Pete Marovich/Bloomberg

A young woman stares upward as a dentist works on removing all of her teeth at the 16th annual Remote Area Medical (RAM), clinic in Wise, Virginia. Photo: Pete Marovich/Bloomberg

A young woman stares upward as a dentist works on removing all of her teeth at the 16th annual Remote Area Medical (RAM), clinic in Wise, Virginia. Photo: Pete Marovich/Bloomberg

A tray of pulled teeth at the 16th annual Remote Area Medical (RAM), clinic in Wise, Virginia, U.S., on Friday, July 17, 2015. Photo: Pete Marovich/Bloomberg

A tray of pulled teeth at the 16th annual Remote Area Medical (RAM), clinic in Wise, Virginia, U.S., on Friday, July 17, 2015. Photo: Pete Marovich/Bloomberg

Patients wait to see a dentist at the 16th annual Remote Area Medical (RAM), clinic in Wise, Virginia. Photo: Pete Marovich/Bloomberg

Patients wait to see a dentist at the 16th annual Remote Area Medical (RAM), clinic in Wise, Virginia. Photo: Pete Marovich/Bloomberg

People stand in line to be processed in the triage tent at the 16th annual Remote Area Medical (RAM), clinic in Wise, Virginia, U.S., on Friday, July 17, 2015. Photo: Pete Marovich/Bloomberg

People stand in line to be processed in the triage tent at the 16th annual Remote Area Medical (RAM), clinic in Wise, Virginia, U.S., on Friday, July 17, 2015. Photo: Pete Marovich/Bloomberg

A woman looks for frames she likes after seeing an optometrist  at the 16th annual Remote Area Medical (RAM), clinic in Wise, Virginia. Photo: Pete Marovich/Bloomberg

A woman looks for frames she likes after seeing an optometrist at the 16th annual Remote Area Medical (RAM), clinic in Wise, Virginia. Photo: Pete Marovich/Bloomberg

RAM Founder Stan Brock, left, gives Virginia Governor Terry McAuliffe, left, a tour at the16th annual Remote Area Medical (RAM), clinic in Wise, Virginia, U.S., on Friday, July 17, 2015. Photo: Pete Marovich/Bloomberg

RAM Founder Stan Brock, left, gives Virginia Governor Terry McAuliffe, left, a tour at the16th annual Remote Area Medical (RAM), clinic in Wise, Virginia, U.S., on Friday, July 17, 2015. Photo: Pete Marovich/Bloomberg

5 thoughts on “Return to Healthcare Never-Never Land

  1. The majority of people living in these rural areas are unemployed, and therefore the income tax credits which would pay for their healthcare under the ACA do not apply to them. Additionally, the legislatures of many red states have chosen solely on principle to refuse frural funding to expand Medicaid in their state.

  2. In your article and pics you emphasized “tempers flared” and long lines. I was in Wise for 3 days as a volunteer. What I saw was a large group of volunteers who worked very hard to provide needed care to a huge group. The people served were patient, polite , and extremely grateful.
    Please consider emphasizing the positive aspects of RAM and the Health Wagon , and what takes place every July in Wise County.

    • I agree with what you say about the “large group of volunteers who worked very hard to provide needed care to a huge group. The people served were patient, polite , and extremely grateful.” And I think the photos reflect this.

      But if I am going to be accurate in describing the event, it is important to mention the lines and the number of people waiting. If nothing else, showing and talking about the long lines, reinforces the need for this event.

      Tempers did flare. It was a huge issue when the people were given access to the fairgrounds at 6:00 pm on Thursday and they where told that the rules for picking up a ticket had been changed.

      If they picked up a ticket, which would determine their order for entry the next morning, they would have to spend the night at the fairgrounds. If they left, they would have to relinquish their number and place in line.

      This apparently was not the way it has been done in recent years and the change had not been announced ahead of time so people could prepare.

      Hundreds of people began arriving by noon on Thursday in order to get a low ticket number when they opened the gates at 6 a.m.

      Since they were unaware of the change in the rules, most did not have food or other necessities to spend the night. Many had kids that had not eaten since lunch. Some had just come from work to pick up a ticket and planned to return in the early morning. One lady was simply driving someone there to get a ticket and the driver had to be a work at 8:00 that night. And many complained that they needed their medications that were at home.

      And just to be completely clear here, while these people where in the parking lot, frustrated and complaining to the parking volunteers about their issues and concerns, there was an event going on inside the RAM compound with music and food for the volunteers. The parking volunteers were repeatedly trying to get the director of operations to come out and address the issues and clarify mixed information, but it took over an hour for him to come out.

      I came to understand that one of the reasons for the change was that people would get their ticket and then not return in the early morning or be late. Since only a certain number of tickets are given out each day, this would mean that more people could have received care. I can see how this would be frustrating to an organization who’s goal it is to give medical care to as many as possible. I am sure most of the people coming to RAM would agree as well. They just felt that they deserved the courtesy of being informed. One lady said to me, “Well, they know we don’t have a choice so they can do what they want.”

      I don’t thing anyone would deny that what Remote Area Medical and all of the volunteers do is beyond amazing. But I am not the public relations arm of the organization and as a documentary photographer it is my duty to deliver the facts.

      It would be a disservice to the people I photographed who were complaining and arguing with the director of operations as well as the parking volunteers, if I did not tell their side of the story as well.

  3. By and large there were fewer outbursts of temper and no more confusion than in any large crowd waiting for any high demand event; better than last year. Change is frustrating, particularly for those who are desperate, tired, hungry, and in pain. There are a wide variety of factors that influence individual responses to circumstances.

    The visit by the Governor was also a special circumstance beyond the control of the event organizers and they adapted as best they could. While every effort can stand improvement, the response by the organizers to an overwhelming first day turnout was more than impressive.

    And so long as the Virginia General Assembly refuses to expand Medicaid, there will be plenty of opportunities to refine processes. In the end, RAM Wise achieved its objective, much more than anyone can say about the legislators who own a measure of responsibility for all of this.

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