Thread: Lessons of a weekend of free health care

Lessons of a weekend of free health care

Posted 34m ago
By Adam Geller, Associated Press

MAYNARDVILLE, Tenn. — The two-hour drive is done, but Hannah and Jack Hurst leave the Honda's engine running.

Hannah's prayers have brought them here. Now there's little to do but turn up the car's heat, get some sleep and wait for morning — and a set of glass and metal doors to open.

Still, Hannah doesn't complain. The 26-year-old mother of three has waited "pretty much as long as I can remember" to escape the pain throbbing through her jaws. Jack lost his road construction job a year ago and health insurance is out of the question. If the answer to Hannah's misery lies behind those doors, what's 10 hours more?

Out in the dark, the Hursts have plenty of company. Even before 10 p.m. on this Friday in late fall, nearly 50 cars ring the lot. By 6 a.m. Saturday, more than 400 men and women stand tightlipped and bleary-eyed under the Big Dipper.

By day's end, as long as they keep tempers in check and sleep from their eyes, they will win the privilege of care from a dentist or a doctor.

In a country convulsed over health care, the scene is alarming. But it is always the same, Stan Brock says. For 17 years, Brock has piloted a nonprofit called Remote Area Medical, offering free health care to the uninsured, the underinsured and the desperate.

Brock has seen so many crowds like the one outside Union County High School he chides himself for losing track of whether this is RAM's 578th expedition or its 587th. Yet in every crowd, there are hundreds of Hannah Hursts, each a unique testament to the nation's ragged pursuit of health care answers.

Over the next two days, RAM's volunteers will examine, extract and prescribe hundreds of solutions for individual aches and afflictions. They will, in the few moments left, attempt to convince patients they'll probably never see again of the virtues of healthier living and continuous care. They will try to answer Hannah Hurst's prayers.

Lawmakers debating reform could almost certainly learn something here in the trenches.

But the most striking lesson might also be the most daunting: To fix health care inequities, expanding insurance alone may not be enough.

Rare opportunities

"Good morning folks," Brock booms in an accent crisp with authority. "We're going to get started on time."

It is precisely 6 a.m. and Brock has just pushed open the high school's doors, questions ready.

"Who's here to see a dentist?"

More than half raise their hands. Who needs an eye doctor? Almost as many. Who needs a medical doctor? Scattered hands go up, but Brock expects that, too.

"Really, they all need to see a doctor," he says. "They just don't want to lose their place on line."

Ronnie and Debbie Erwin have driven 2.5 hours from Johnson City. Insurance from her job covers his care for spinal stenosis. But the prescriptions caused his teeth to disintegrate and infection followed. Insurance doesn't cover that.

"My doctor said you've got to do something or it's going to kill you," Ronnie says.

Melissa Hayes, a home health aide from nearby Luttrell, has waited since 11:30 p.m. with her daughters, aged 5, 7 and 10. Her oldest, Brittney Prince, can't see the board at school, but the family can't afford glasses.

Joe Mason is anxious about a broken molar, but if there's time, he's thinking about seeing a doctor, too. The idea, though, leaves him uncertain.

"How do you go in there and talk to a doctor? I probably haven't been to one in 20 years," says Mason, 31.

"I mean, what are you supposed to say to one?"

Desperate for help

"Who's got No. 1?"

The day's first patients are waved in to "triage" — the school cafeteria. Decide which need is today's priority, volunteers urge. There won't be enough time or doctors to deal with them all.

"Dental?" Go to the gym.

"General medical?" In the classrooms down the hall.

It's just 45 minutes from RAM's base in Knoxville to Maynardville, the center of a county of 19,000 set amid corduroy ridges. But the volunteers' arrival is the product of a long and convoluted journey.

It began in the Amazon. Brock, a British boarding school dropout, landed there more than 50 years ago and turned himself into a South American cowboy. He left in the 1960s to wrestle anacondas and rope giraffes on a popular U.S. television show, "Wild Kingdom."

But in 1985, settled in Knoxville, he began organizing medical relief flights back to the region. Seven years later, he got a call. The only hospital in Hancock County, Tenn., had closed and the sole dentist had moved away.

"We literally loaded a couple of 400-pound dental chairs that we borrowed into the back of a pickup and we went up there with a couple of dentists," Brock says. "It wasn't long before another county called and on and on and on and on."

Hundreds of expeditions later, Americans have become the group's main mission.

For all their planning, RAM's people never know entirely what to expect. Neither do their patients.

Although the Hursts got to Maynardville early, they lost their place in line when police cleared the parking lot because of shots from nearby woods. It turned out to be just some teenagers hunting.

By the time the couple reaches the gym, dentists clustered around 38 portable dental chairs fill the Union County Patriot's home court. Patients pack the bleachers.

Finally, Hannah Hurst is called to a chair and explains why she's come.

In pregnancy, her mother suffered from a calcium deficiency. Hannah's baby teeth decayed fast. It was even worse with her permanent teeth and disease filled her gums, swollen with abscesses. Insurance either wasn't enough or dental wasn't covered. Four years ago, Hannah saved enough to reach a dentist's chair, when her phone rang. Her aunt, hospitalized with cancer, had taken a turn for the worse. She rushed out, even though a spring breeze can trigger pain that knocks her to her knees.

Back home in Campbell County, worshippers at Sled Creek Holiness Community Church have prayed, even fasted, to help Hannah heal.

Today Hannah is ready to embrace the answer.

Please, she asks, pull them all out.

A symptom, not a solution

It's calmer in the classrooms reserved for medical doctors, but the patients' stories are at least as telling.

"I went to college. I'm a graduate. I just never thought I'd ever be here," Earleen Black says.

Until losing her job eight months ago, Black was a radiology technologist. She's embarrassed to ask for help. But bursitis has attacked her hip like a baseball bat. She's relieved when a doctor administers a shot without charge, but mystified there was almost no wait.

The truth is, many are here only because their blood pressure registered too high to undergo the dentist's drill.

Daniel Drake's blood pressure came in at an eye-popping 200/120. He chalks it up to an energy drink and leaves happy when a pill brings it down enough to get his tooth fixed. But Dr. Alan Weder, a Michigan researcher volunteering for the weekend, shakes his head.

"If that's the way he's walking around, his risk of having a heart attack or a stroke in the next five years is probably 20 to 30%," Weder says. "And that's for want of 30 cents in medicine."

Comprehensive insurance could resolve the patient cost dilemma, Weder says. But the problems go beyond that.

Weder notices many patients who say they can't afford basic prescriptions — now carried by discounters for as little as $4 a month — have cigarettes in their shirt pockets that cost more than the pills.

When Kevin D'Angelo, a dentist from upstate New York who's volunteered at more than 20 RAM expeditions, asks patients what they drink, the most common answer is Mountain Dew, often five or six cans a day. The only way to get teeth as bad as some he sees, D'Angelo says, is almost never to have brushed at all.

While some of those waiting speak glowingly of their regular physicians, others recount the difficulty of getting in to see a doctor or a dentist in rural areas where providers and openings for people without insurance are in short supply.

There's only so much a weekend's barrage of free care can solve.

RAM, says Bruce Behringer, an expert on Appalachia's public health needs at East Tennessee State University, "is a symptom of the problems in the health care system, not a solution."

Prescribed change: 'Educating people'

Hannah Hurst is back for Day 2.

Yesterday, RAM's dentists pulled 16 of her teeth. In the gym, Trey Parker, a University of Louisville dental student, welcomes her return. But before reaching for his tools, Parker honors Hannah's request, linking hands with Jack and two other volunteers.

"Lord," Parker says, "let Hannah have the strength to bear through getting all her teeth pulled; that she can hold up; that her jaw will be made whole and that she can live a happier life being a mother. In the name of Jesus Christ."

"Amen."

Today is a bit of a gift. By 9 a.m., just 260 patients have come through the door. RAM's volunteers may get to everybody. But patients still fill the bleachers and line a hallway, a case study in needs health care reform may not answer.

Take Hannah Hurst's teeth. Proposals by Congressional Democrats, while they would greatly expand traditional medical coverage, won't cover dental care, except for children.

It's no better for vision care, not covered for adults under either the House or Senate bills.

Changing the economics, though, is just the start.

"There's a culture that sort of surrounds the problem," Brock says.

All the high blood pressure readings aren't a coincidence. Heart disease, hypertension and diabetes are serious problems throughout Appalachia. That is the result of smoking, lack of exercise, unhealthy diets and obesity, as well as relationships with the health care system, Behringer says.

It can be hard reaching a doctor in thinly populated counties with few roads and mountains. Many people don't see a doctor regularly and many doctors are unable to build the continuous relationships with patients to help ensure care.

The challenges are all too real to Eddie Graham, the local school health coordinator, who lobbied RAM to come to Maynardville. He recounts trying to foster health in an area where some families send children to class sick and tell them to go see the school nurse. Kids arrive at elementary schools carrying chewing tobacco.

Making health care affordable only partly solves problems like these, he says.

"It's changing beliefs," Graham says. "It's educating people about what is health."

$138,370 bill

When the numbers are totaled, Expedition No. 587 into America's health care jungle will be recorded as followed:

Over 1.5 days, 701 patients have come through RAM's doors.

Its dentists have extracted 852 teeth and filled 234 others; 345 pairs of eyes have been tested; 87 people have been examined by a medical doctor.

If RAM was going to send out a bill, it would total $138,370.

Does that make it a solution to a crisis or a symptom? The answer may lie beyond the bottom line.

When Brittney Prince goes back to school Monday, she'll be wearing her first pair of eyeglasses.

"Momma," she says, gazing outside, "the grass is not fuzzy any more."

And when Hannah Hurst — her toothless mouth stuffed with gauze — is helped from the chair, she hugs her caregivers. At church, raising money for dentures may have to wait until spring. But, at last, her prayers have been heard.

"There is no other answer for it but God and it just makes me so much more thankful," she says. "It truly is my testimony now. You keep praying, you keep asking, and your answer will be there sooner or later."

http://www.usatoday.com/news/health/201 ... care_N.htm

The doctors and staff are all volunteers.

This is paid for by donations, not taxpayer money.

Donors Needed

Remote Area Medical depends heavily on people like you. Please make your generous contribution now so that our all-volunteer organization can continue to provide free health care services (dental, vision, medical, and veterinary) to those who are under-employed or under-insured. Over 90% of unrestricted donations go directly to service programs. Over 60% of our programs are based in poverty areas of the United States.

Remote Area Medical, Inc., and Remote Area Medical Foundation are 501(c)(3) publicly supported charities.

http://www.ramusa.org/

But somehow illegal aliens get better care at our expense. What is wrong with this picture??

Originally Posted by miguelina

But somehow illegal aliens get better care at our expense. What is wrong with this picture??

Just one day? American volunteers in third world countries may stay for up to two weeks on their volunteer projects. Why do we rate so low?

Originally Posted by miguelina

But somehow illegal aliens get better care at our expense. What is wrong with this picture??

Excellent point M! I was wondering as I read this article, how many illegal invaders stood in line for hours to attend this free health clinic. The answer was probably zero, since an illegal invader can show up at any emergency room across this country and have access to free health care at our expense. No questions asked!

Illegals are truly the only ones who have unfettered access to our health care system...at our expense!

Originally Posted by Captainron

Originally Posted by miguelina

But somehow illegal aliens get better care at our expense. What is wrong with this picture?? :twisted:

Just one day? American volunteers in third world countries may stay for up to two weeks on their volunteer projects. Why do we rate so low? 8O :?

I think this one was 2 days. I would guess that they got enough volunteers to handle this area in 2 days.

Hannah Hurst is back for Day 2.

I think the one in L.A. was 5 or 6 days.

L.A. was actually 8 days.

RAM LA Results

The following totals are from patient records in hand and, due to an unknown number of misplaced papers and lost data, are lower than actual numbers.

6,344 patients registered for 14,561 patient encounters (approximately 2.3 services per patient)

3,827 volunteers, largely non-medical support (It is believed that patient encounters could have doubled if medical professionals licensed in states other than California had been allowed to volunteer their services at this clinic.)

3,182 dental patients – 2, 274 teeth extracted and 5,438 teeth saved, 1,889 cleanings

2,266 vision care patients with 1,984 pairs of prescription eyeglasses made on site and fitted

8,775 general medical visits

Total value of care: $2,821,383

Thanks to everyone who made it possible for so many to receive so much during Remote Area Medical’s 8-day free clinic at The Forum in Inglewood, CA.

This is a great article about a very positive thing that happened and every comment so far has been negative. No mention of what a good thing it is that medical persons give their time to help the less fortunate or the people and companies who donated money and materials to make this all happen.

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Schedule - 2010

Guyana operations continue year-around. Call for details!
Other expeditions are under development and may not be listed in the current schedule.

Feb. 6-7 Knoxville, TN at the Jacob's Building in Chilhowee Park D, Vis, M

Feb 20-21 Jefferson County High School, Dandridge, TN D, Vis, M

Feb 27-28 RAM Veterinary Clinic, National Guard Armory, Newport TN:
The Big Fix: spay and neuter small animals Vet

March 6-7 Southern Virginia University
1 University Drive, Buena Vista, VA 24416 D, Vis, M, Vet

March 20-21 Heritage High School, Maryville, TN D, Vis, M

Apr 10-11
Palm Beach County, FL at Americraft Expo Center,
South Florida Fairgrounds. *FL Licensed Doctors Only* D, Vis, M

April 24-25 McDowell County, West Virginia
Mount View High School, Welch, WV
D, Vis, M, Vet

May 22-23 Lincoln Memorial University, Harrogate, TN D, Vis, M, Vet

June 19-20 Pike County Central High School, Pike County, KY D, Vis, M

June 26-27 Grainger County, TN D, Vis, M

July 9-20-11 Oklahoma City, OK at OK State Fairgrounds D, Vis, M

July 23-24-25 Wise County, VA, at the Wise County Fairground D, Vis, M

August 7-8 Whitley County, KY College of the Cumberland D, Vis, M

August 14-15 Unicoi County, TN D, Vis, M

September 17-19 Louisville, KY, at Freedom Hall D, Vis, M

September 25-26 Bradley County, TN, at Cleveland High School D, Vis, M

October 2-3 Grundy County, TN, at Riverview Elementary School D, Vis, M

October 8-9-10 Sullivan County, TN, at Bristol Motor Speedway D, Vis, M

October 23-24 Sequatchie County, TN, at the Fairgrounds in Dunlap D, Vis, M

November 13-14 Monroe County, TN, at the Yamaha Plant D, Vis, M

Dec ?? Project Connect, Knoxville, TN D, Vis, M

A=Airborne, D=Dental, M=Medical, Vet=Veterinary, Vis=Vision, W=Women's Health

All travel and setup is done the day before any expedition.

When volunteering to work on a RAM expedition to Tennessee, Kentucky, or Virginia, out-of-state medical licenses and certificates are acceptable.

Licensure exemption is required for the states of Kentucky and Virginia (please call RAM for more information.)

When volunteering for medical expeditions for trips outside the United States, a significant lead time is necessary to clear credentials with immigration. Volunteers for these trips are urged to contact RAM by phone at 865-579-1530.